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Agbonlahor O, Mattingly DT, Rai J, Hart JL, McLeish AC, Walker KL. Differences in health care provider screening for tobacco use among youth in the United States: The National Youth Tobacco Survey, 2021. Prev Med 2023; 175:107718. [PMID: 37793477 PMCID: PMC10681140 DOI: 10.1016/j.ypmed.2023.107718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Health care providers (HCP) are encouraged to screen youth for tobacco product use as a key step in preventing such use and associated health outcomes. However, recent data examining differences in HCP tobacco screening by sociodemographic characteristics and tobacco use is scant. METHODS Data from the 2021 National Youth Tobacco Survey (N = 14,685) were analyzed. Three types of HCP screening were examined: no screening, any e-cigarette use (e-cigarette only, e-cigarette and other tobacco), and non-e-cigarette tobacco product use. Differences by HCP screening were examined using multinomial logistic regression adjusted for age, sex, gender identity, sexual orientation, race/ethnicity, and tobacco use (non-current, sole, dual/poly). RESULTS Among the sample, 42.8% were screened for any tobacco use, with 30.6% screened for any e-cigarette use and 12.2% for non-e-cigarette tobacco product use only. Youth who were older (vs. younger) (OR = 5.98, 95% CI: 4.78-7.49) and gay/lesbian (vs. heterosexual) (OR = 1.47, 95% CI: 1.02-2.12) were more likely to be screened for e-cigarette use. Youth who were non-Hispanic Black (vs. non-Hispanic White) were less likely to be screened for e-cigarette use (OR = 0.53, 95% CI: 0.42-0.67) and more likely to be screened for non-e-cigarette tobacco use (OR = 1.34, 95% CI: 1.10-1.63). Current sole tobacco use (vs. non-current use) and dual/poly tobacco use (vs. non-current use) increased the likelihood for HCP screening for e-cigarette use. CONCLUSIONS The majority of U.S. youth continue to not be screened for tobacco use by their HCP. Evidence of disparities in tobacco use screening suggest the need for policies and training that promote equity in screening.
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Affiliation(s)
- Osayande Agbonlahor
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Delvon T Mattingly
- Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY, USA; Center for Health Equity Transformation, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Jayesh Rai
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Joy L Hart
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA.
| | - Alison C McLeish
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA; Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Kandi L Walker
- Department of Communication, College of Arts and Sciences, University of Louisville, Louisville, KY, USA; Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA; American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
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Zyambo C, Olowski P, Mulenga D, Liamba F, Syapiila P, Siziya S. School tobacco-related curriculum and behavioral factors
associated with cigarette smoking among school-going
adolescents in Zambia: Results from the 2011 GYTS study. Tob Induc Dis 2022; 20:42. [PMID: 35592593 PMCID: PMC9069453 DOI: 10.18332/tid/146960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/16/2021] [Accepted: 02/25/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Tobacco smoking is a global public health concern. It has been projected that children and young people who are alive today in developing countries will bear the most burden of tobacco-related morbidity and mortality in the near future. This study investigated the school tobacco-related curriculum and behavioral factors associated with cigarette smoking among school-going adolescents. METHODS We accessed secondary data in a public domain collected using a cross-sectional study design. Altogether, 3377 seventh to ninth grade students were selected by stratified two-stage cluster sampling. Data were collected using a Global Youth Tobacco Survey (GYTS) Core Questionnaire. Multivariate logistic regression models were used to determine associations of school tobacco-related curriculum and behavioral factors with current cigarette smoking status. Adjusted odds ratios and their 95% confidence intervals are reported. RESULTS Of the 2611students included in the analysis, 6.8% (7.8% of males and 5.8% of females) reported smoking cigarettes. Slightly over half of the students were taught in schools about the effects of smoking (53.6%) and the dangers of smoking (64.1%). Adolescents who had friends who smoked were more likely to smoke compared to those who did not have friends who smoked. Adolescents whose parents smoked were more likely to smoke compared to those who did not have parents who smoked. Adolescents who were not taught at school about the dangers of smoking, or were not sure about it, were more likely to smoke compared to those who were taught (AOR=1.94; 95% CI: 1.28–2.94). CONCLUSIONS Schools play an important role in shaping smoking behavior among school-going adolescents. Based on our findings, school programs aimed at reducing cigarette smoking among school-going adolescents may achieve greater impact by implementing anti-smoking interventions that involve parents and peers in smoking prevention activities, and have a robust tobacco school curriculum.
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Affiliation(s)
- Cosmas Zyambo
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Pawel Olowski
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
| | - David Mulenga
- Department of Clinical Sciences, Copperbelt University School of Medicine, Ndola, Zambia
| | - Franklin Liamba
- Department of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Paul Syapiila
- Department of Clinical Sciences, Copperbelt University School of Medicine, Ndola, Zambia
| | - Seter Siziya
- Department of Clinical Sciences, Copperbelt University School of Medicine, Ndola, Zambia
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Wiens DP. Robust designs for dose–response studies: Model and labelling robustness. Comput Stat Data Anal 2021. [DOI: 10.1016/j.csda.2021.107189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Laviolette SR. Molecular and neuronal mechanisms underlying the effects of adolescent nicotine exposure on anxiety and mood disorders. Neuropharmacology 2020; 184:108411. [PMID: 33245960 DOI: 10.1016/j.neuropharm.2020.108411] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/16/2020] [Accepted: 11/21/2020] [Indexed: 12/28/2022]
Abstract
Tobacco addiction is highly co-morbid with a variety of mental health conditions, including schizophrenia, mood and anxiety disorders. Nicotine, the primary psychoactive compound in tobacco-related products is known to functionally modulate brain circuits that are disturbed in these disorders. Nicotine can potently regulate the transmission of various neurochemicals, including dopamine (DA), γ-amino-butyric acid (GABA) and glutamate, within various mesocorticolimbic structures, such as the ventral tegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex (PFC), all of which show pathologies in these disorders. Many neuropsychiatric diseases have etiological origins during neurodevelopment, typically occurring during vulnerable periods of adolescent or pre-natal brain development. During these neurodevelopmental periods, exposure to extrinsic drug insults can induce enduring and long-term pathophysiological sequelae that ultimately increase the risk of developing chronic mental health disorders in later life. These vulnerability factors are of growing concern given rising rates of adolescent nicotine exposure via traditional tobacco use and the increasing use of alternative nicotine delivery formats such as vaping and e-cigarettes. A large body of clinical and pre-clinical evidence points to an important role for adolescent exposure to nicotine and increased vulnerability to developing mood and anxiety disorders in later life. This review will examine current clinical and pre-clinical evidence that pinpoints specific mechanisms within the mesocorticolimbic circuitry and molecular biomarkers linked to the association between adolescent nicotine exposure and increased risk of developing mood and anxiety-related disorders. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.
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Affiliation(s)
- Steven R Laviolette
- Addiction Research Group, Dept. of Anatomy & Cell Biology, Dept. of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, N6A 3K7, ON, Canada.
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Abstract
OBJECTIVE To study the prevalence of tobacco use among teenagers, to evaluate a tobacco prevention programme and to study factors related to participation in the prevention programme. DESIGN AND SETTING Population-based prospective cohort study. METHOD Within the Obstructive Lung disease in Northern Sweden (OLIN) studies, a cohort study about asthma in schoolchildren started in 2006. All children aged 7-8 years in three municipalities were invited to a questionnaire survey and 2585 (96%) participated. The cohort was followed up at age 11-12 years (n=2612, 95% of invited) and 14-15 years (n=2345, 88% of invited). In 2010, some of the children in the OLIN cohort (n=447) were invited to a local tobacco prevention programme and 224 (50%) chose to participate. RESULTS At the age of 14-15 years, the prevalence of daily smoking was 3.5%. Factors related to smoking were female sex, having a smoking mother, participation in sports and lower parental socioeconomic status (SES). The prevalence of using snus was 3.3% and risk factors were male sex, having a smoking mother, having a snus-using father and non-participation in the prevention programme. In the prevention programme, the prevalence of tobacco use was significantly lower among the participants compared with the controls in the cohort. Factors related to non-participation were male sex, having a smoking mother, lower parental SES and participation in sports. CONCLUSIONS The prevalence of tobacco use was lower among the participants in the tobacco prevention programme compared with the non-participants as well as with the controls in the cohort. However, the observed benefit of the intervention may be overestimated as participation was biased by selection.
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Affiliation(s)
- Linnéa Hedman
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
| | | | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division for Occupational and Environmental Medicine, The OLIN Unit, Umeå University, Umeå, Sweden
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Joffer J, Burell G, Bergström E, Stenlund H, Sjörs L, Jerdén L. Predictors of smoking among Swedish adolescents. BMC Public Health 2014; 14:1296. [PMID: 25518992 PMCID: PMC4300986 DOI: 10.1186/1471-2458-14-1296] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Smoking most often starts in adolescence, implying that understanding of predicting factors for smoking initiation during this time period is essential for successful smoking prevention. The aim of this study was to examine predicting factors in early adolescence for smoking in late adolescence. Methods Longitudinal cohort study, involving 649 Swedish adolescents from lower secondary school (12–13 years old) to upper secondary school (17–18 years old). Tobacco habits, behavioural, intra- and interpersonal factors and socio-demographic variables were assessed through questionnaires. Descriptive statistics, univariable and multivariable logistic regression were used to identify predicting factors. Results Smoking prevalence increased from 3.3% among 12–13 year olds to 25.1% among 17–18 year olds. Possible predictors of smoking were: female sex, lower parental education, poorer family mood, poorer self-rated health, poorer self-esteem, less negative attitude towards smoking, binge drinking, snus use and smoking. In a multivariable logistic regression analysis, female sex (OR 1.64, CI 1.08-2.49), medium and low self-esteem (medium: OR 1.57, CI 1.03-2.38, low: 2.79, CI 1.46-5.33), less negative attitude towards smoking (OR 2.81, CI 1.70-4.66) and ever using snus (OR 3.43, CI 1.78-6.62) remained significant independent predicting factors. Conclusions The study stresses the importance of strengthening adolescents’ self-esteem, promoting anti-smoking attitudes in early adolescence, as well as avoidance of early initiation of snus. Such measures should be joint efforts involving parents, schools, youth associations, and legislating authorities.
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Affiliation(s)
- Junia Joffer
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE-901 87 Umeå, Sweden.
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Edvardsson I, Geisler D, Lendahls L. Experiences of Being Non-Smoking among Adolescents in a Smoking Context. Health (London) 2014. [DOI: 10.4236/health.2014.611140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Edvardsson I, Troein M, Ejlertsson G, Lendahls L. Snus user identity and addiction: a Swedish focus group study on adolescents. BMC Public Health 2012; 12:975. [PMID: 23148521 PMCID: PMC3515430 DOI: 10.1186/1471-2458-12-975] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 11/07/2012] [Indexed: 11/10/2022] Open
Abstract
Background The teenage years are the years when adolescents seek their identity, and part of this involves experimenting with tobacco. The use of tobacco as such, and norms among their friends, is more important to the adolescents than the norms of parents when it comes to using tobacco or not. The aim was to explore the significance of using snus for adolescents, and attitudes to snus, as well as the reasons why they began using snus and what maintained and facilitated the use of snus. Methods Adolescents who use snus were interviewed in focus groups. The material was analysed using content analysis. Results Four groups of boys and one group of girls were interviewed, a total of 27 students from the upper secondary vocational program. Three themes related to the students’ opinions on and experiences of using snus were found: Circumstances pertaining to snus debut indicate what makes them start using snus. Upholding, which focuses on the problem of becoming addicted and development of identity, and approach, where the adolescents reflect on their snus habits in relation to those around them. A number of factors were described as relevant to behaviour and norm building for the development into becoming a snus user. Attitudes and actions from adults and friends as well as – for the boys – development of an identity as a man and a craftsman influenced behaviour. Conclusions The results showed that development of identity was of major importance when adolescents start using snus. The adolescents were initially unable to interpret the early symptoms of abstinence problems, but subsequently became well aware of being addicted. Once they were stuck in addiction and in the creation of an image and identity, it was difficult to stop using snus. These factors are important when considering interventions of normative changes and tobacco prevention in schools as well as among parents.
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Affiliation(s)
- Ingrid Edvardsson
- Department of Clinical Sciences, Malmö, Family medicine, Lund University, Malmö, Sweden.
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Edvardsson I, Lendahls L, Andersson T, Ejlertsson G. The social environment is most important for not using snus or smoking among adolescents. Health (London) 2012. [DOI: 10.4236/health.2012.412184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Virtanen M, Pietikäinen M, Kivimäki M, Luopa P, Jokela J, Elovainio M, Vahtera J. Contribution of parental and school personnel smoking to health risk behaviours among Finnish adolescents. BMC Public Health 2009; 9:382. [PMID: 19818130 PMCID: PMC2767354 DOI: 10.1186/1471-2458-9-382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 10/09/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study compared parental smoking with school personnel smoking in relation to adolescents' smoking behaviours, alcohol use, and illicit drug use. METHODS A cross-sectional survey for 24,379 adolescents was linked to a survey for 1946 school employees in 136 Finnish schools in 2004-2005. Surveys included smoking prevalence reported by school staff, adolescents' reports of school staff and parental smoking, adolescents' own smoking behaviours, alcohol use, and illicit drug use. Multilevel analyses were adjusted for individual and school-level confounding factors. RESULTS Parental smoking was associated with all health risk behaviours among both sexes (risk range 1.39 to 1.95 for other outcomes; Odds Ratio OR for smoking cessation 0.64, 95% Confidence Interval CI: 0.57, 0.72 among boys, 0.72; 0.64, 0.81 among girls). Among boys, high vs. low smoking prevalence among school personnel was associated with higher probability of smoking (OR 1.19; 95% CI 1.01,1.41), higher frequency of smoking during school time (Cumulative Odds Ratio COR 1.81; 95% CI 1.32, 2.48), frequent alcohol use (OR 1.23; 95% CI 1.01, 1.50), illicit drug use (OR 1.40; 95% CI 1.16, 1.69), and higher odds of reporting adults smoking at school (COR 1.51; 95% CI 1.09, 2.09). Among girls, high smoking prevalence among school personnel was related to higher odds of smoking (OR 1.18; 95% CI 1.02, 1.37) and lower odds of smoking cessation (OR 0.84; 95% CI 0.72, 0.99). CONCLUSION Parental smoking and school personnel smoking are both associated with adolescents' health risk behaviours but the association of parental smoking seems to be stronger.
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