Smoking-specific cognitions and smoking behaviour among adolescents with asthma

Association between high school students' cigarette smoking, asthma and related beliefs: a population-based study

BACKGROUND

Smoking has a detrimental effect on the symptoms and severity of asthma, a common chronic disease among adolescents. The purpose of this study was to examine the association between asthma and smoking among high school students and assess provider-patient communication with asthmatic adolescents regarding smoking and adolescents' beliefs about the harms of smoking.

METHODS

In fall 2014, data from high school students, ages 14-18 years, completing the 2009-2010 Virginia Youth Tobacco Survey (N = 1796) were used in descriptive analyses and multivariable logistic regression models adjusting for model-specific confounders as appropriate.

RESULTS

Overall, an estimated 19 % of high school students in Virginia smoked and 16 % had asthma. Odds of smoking did not differ by asthma status; however, asthmatics had 1.5 times higher odds of being asked if they smoke (95 % CI 1.06-2.13) and being advised not to smoke by a health professional (95 % CI 1.10-2.14) compared to non-asthmatics. Asthmatics who believed second-hand smoke or smoking 1-5 cigarettes/day was not harmful had respectively 4.2 and 2.8 times higher odds of smoking than those who thought each was harmful. Further, asthmatics who thought smoking 1-2 years is safe had 3.4 times higher odds of smoking than those who did not (95 % CI 1.57-10.1).

CONCLUSIONS

While asthmatic adolescents are just as likely to smoke as non-asthmatics, less healthy beliefs about the risks of smoking increase the odds of smoking among asthmatics. Thus, targeted asthma-specific smoking prevention and education to change attitudes and beliefs could be an effective tool for adolescents.

The link between asthma and smoking explained by depressive feelings and self-efficacy

OBJECTIVE

Adolescents with asthma consistently smoke at higher or similar rates as non-asthmatic peers, although smoking might involve more health risks. This study examined possible mechanisms (i.e. depressive feelings and self-efficacy to refrain from smoking) explaining the association between asthma and smoking initiation.

METHODS

An indirect path from asthma to self-efficacy through depressive feelings was examined in two independent samples. Sample 1 consisted of 4531 adolescents (mean age 12.8) and sample 2 consisted of 1289 children (late childhood, mean age 10.1). Data were gathered from maternal and self-report. In the adolescent sample, whether the relationship between depressive feelings at baseline and smoking initiation two years post-baseline runs via self-efficacy was also examined.

RESULTS

Higher amounts of depressive feelings decreased adolescents' self-efficacy to refrain from smoking, which subsequently increased the risk to initiate smoking. A diagnosis of asthma was also associated with higher levels of depressive feelings which in turn decreased self-efficacy. A marginal significant indirect effect was found in the childhood sample.

CONCLUSION

Smoking prevention efforts should start as early as mid to late childhood. The results indicate that focus should be placed on preventing depressive feelings with the aim of increasing children's self-efficacy to refrain from smoking. This is especially important for children and adolescents with asthma.

Effects of nicotine dependence and depressive symptoms on smoking cessation: a longitudinal study among adolescents

INTRODUCTION

Nicotine dependence has been shown to hamper successful smoking cessation in adolescents. Nicotine dependence and depression are highly comorbid, but the relation between depression and smoking cessation is not yet fully understood. Therefore, the present study examines both the longitudinal reciprocal relation between nicotine dependence and depressive symptoms, and the longitudinal effect of these factors on successful smoking cessation and number of quit attempts.

METHODS

A 2-wave longitudinal study was conducted among 535 adolescents aged 13-18. Written self-report questionnaires were administered in a classroom setting. Two models were tested, examining the mutual relation between nicotine dependence and depressive symptoms, as well as the predictive value of these factors on smoking cessation (n = 535), and number of quit attempts (n = 473) 1 year later.

RESULTS

Adolescents with more depressive symptoms have significantly higher levels of nicotine dependence 1 year later. Higher levels of nicotine dependence negatively predicted subsequent successful smoking cessation, whereas depressive symptoms did not. In contrast, depressive symptoms predicted a higher number of unsuccessful quit attempts in the following year, whereas nicotine dependence did not.

CONCLUSIONS

The findings suggest that adolescents tend to smoke cigarettes in order to diminish their depressive feelings, which might provide some support for the self-medication theory. Smoking cessation programs aiming at adolescents should not only focus on symptoms of nicotine dependence but should also pay attention to depressive feelings, since these feelings are related to a higher number of unsuccessful quit attempts.

Smoking-specific communication and children's smoking onset: an extension of the theory of planned behaviour

The aim of this study was to test whether maternal smoking-specific communication and parental smoking related to smoking cognitions (i.e. attitude, self-efficacy and social norm) derived from the Theory of Planned Behaviour in association with smoking onset during preadolescence. A total of 1478 pairs of mothers and children participated (mean age: 10.11; standard deviation = 0.78). Structural equation models in Mplus were used to examine whether smoking-specific communication influences children's smoking cognitions, which in turn, affect smoking onset. A positive association was found between pro-smoking attitudes and smoking onset. Smoking-specific communication and parental smoking were related to smoking cognitions. Specifically, frequency of communication was negatively associated with pro-smoking attitudes, social norms of mother and best friend. Quality of communication related negatively to pro-smoking attitudes and positively to self-efficacy and norms of friends. Parental smoking was positively associated with pro-smoking attitudes and norms of mother and (best) friends. Additionally, more frequent communication and higher levels of parental smoking were associated with higher smoking onset. In conclusion, smoking-specific communication and parental smoking were associated with smoking cognitions and smoking onset. Already during preadolescence, parents contribute to shaping the smoking cognitions of their children, which may be predictive of smoking later in life.

Cigarette Smoking and Alcohol Use among Adolescents and Young Adults with Asthma

Asthma is one of the most common, serious chronic diseases in pediatric and young adult populations. Health-risk behaviors, including cigarette smoking and alcohol use, may exacerbate chronic diseases and complicate their management. The aim of this study was to longitudinally analyze rates of cigarette smoking and alcohol use in adolescents and young adults who have asthma and those who do not have asthma. A secondary analysis of data from the National Longitudinal Study of Adolescent Health was undertaken. Individuals with asthma were found to exhibit increasing rates of cigarette smoking and alcohol use as they aged. When an adolescent with a chronic health issue begins health-risk-taking behaviors, behavior change interventions must be planned. Pediatric nurses, practitioners, and clinicians are uniquely positioned to assess for health-risk behaviors in youth with asthma and to intervene with plans of care that are tailored for the needs of this vulnerable population.

Asthma and cigarette smoking: a review of the empirical literature

The purpose of this review paper is to present and evaluate the empirical literature on the association between asthma and cigarette smoking. The authors conducted a literature search utilizing electronic search engines (i.e., PsycINFO and MEDLINE) to examine databases using the following key word algorithms: smoking OR nicotine OR tobacco AND asthma. Only articles that focused on active tobacco smoking and analyzed groups with asthma patients only were examined in the present review. Overall, empirical evidence suggests that (1) smoking is more prevalent among individuals with asthma than those without; (2) smoking is a risk candidate for the development of asthma; (3) smoking is associated with decreased asthma control and increased risk of mortality and asthma attacks and exacerbations; (4) smokers with and without asthma may have different risk factors for smoking onset as well as different smoking motives and outcome expectancies; and (5) smoking cessation is associated with improvements in lung functioning and asthma symptoms. Future work in this domain of study will lead to clinically relevant health care advances as well as the development of theoretically driven, methodologically diverse lines of research exploring asthma-smoking comorbidity issues.

Depressive mood and smoking onset: A comparison of adolescents with and without asthma

This prospective population-based study aimed to compare associations between depressive feelings and smoking behaviour of adolescents with and without asthma. Data were collected from a two-wave 22-24 months prospective study among 5938 adolescents who completed self-report questionnaires. Logistic regression analyses showed that depressive feelings and smoking were related both cross-sectionally and longitudinally. Smoking behaviour was similar for adolescents with and without asthma, as well as its correlation with depressive feelings. However, participants with asthma were more likely to report depressive feelings than those without asthma, implying an indirect relationship between asthma and smoking behaviour. Implications for prevention are addressed.

A prospective study of perception in adolescent smoking

PURPOSE

This prospective study examined how environmental smoking affects the perception of lifetime smoking prevalence and thereby the likelihood of subsequent regular smoking.

METHODS

A longitudinal design (N = 6769) with three waves was used to test our research questions. Exposure to smoking by peers, best friends, and parents were assessed at T1. Perception of lifetime smoking prevalence was calculated at T2. Adolescent smoking was assessed at three waves.

RESULTS

Overestimation of lifetime smoking prevalence was predicted by having a predominantly smoking peer group, having a best friend who smokes, and by having at least one parent who smokes. In consistency with a false consensus effect, smokers were more susceptible to overestimate lifetime smoking prevalence than nonsmokers. Subsequently, while controlling for smoking at T2, overestimating lifetime smoking prevalence was predictive of regular smoking at T3 (in accordance with the conformity hypothesis). Specifically, overestimation of lifetime smoking appeared to mediate the effects of environmental smoking (peers, best friends, and parents) on adolescent smoking. No support was found for a moderation effect of exposure to environmental smoking on the link between misperception of lifetime smoking prevalence and regular smoking.

CONCLUSIONS

The study offers a rare and needed theoretical and empirical research examining environmental and individual predictors of regular smoking. Besides direct prevention of exposure to smoking, cognitions that are a product of exposure to smoking need to be addressed in prevention campaigns.

Do smoking attitudes predict behaviour? A longitudinal study on the bi-directional relations between adolescents' smoking attitudes and behaviours

AIMS

Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi-directional relations existed between smoking attitudes and behaviour.

DESIGN

Data were used from the three annual waves of the 'Family and Health' project.

SETTING

Participants were asked to complete questionnaires individually at their homes.

PARTICIPANTS

Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement.

MEASUREMENTS

Self-reports were used to assess adolescents' smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling.

FINDINGS

Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking.

CONCLUSIONS

The current findings imply that smoking behaviour predominantly shapes smoking-related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.

An integration of parents' and best friends' smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: a comparison between adolescents with and without asthma

OBJECTIVE

To study the impact of parents' and best friends' smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma.

METHODS

Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma.

RESULTS

Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends' smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma.

CONCLUSIONS

Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers' transition through the stages of change

AIMS

To examine the significance of the transtheoretical processes of change in predicting transition through the stages of change in adolescent smokers, as well as the relative role of nicotine dependence in predicting stage transitions.

DESIGN

In grades 9 and 10, adolescents' stage of change, the use of processes of change and nicotine dependence were assessed (T1). Stage transitions were assessed 1 year later (T2). Response rate was 73.2%.

SETTING

Twenty-five secondary schools throughout the Netherlands participated in the present study.

PARTICIPANTS

Respondents were 721 adolescents who were classified as smokers at T1 and consequently completed the paper-and-pencil questionnaire at T2.

MEASUREMENTS

Stages of change and processes of change were assessed according to the original transtheoretical measures. Nicotine dependence was measured using a newly developed multi-dimensional scale consisting of 11 items.

FINDINGS

Few associations were found between the processes of change and stage transitions. Nicotine dependence contributed significantly to the explanation of adolescents' transition from preparation to action, after adjustment for processes of change. No evidence for a moderating effect of nicotine dependence in the relation between the processes of change and stage transitions was found.

CONCLUSIONS

Processes of change do not seem significant in explaining adolescents' stage transitions. As an alternative for promoting the use of the processes of change for intervention purposes in adolescents, it might be more useful to focus on treating nicotine dependence.

A longitudinal test of the theory of planned behavior predicting smoking onset among asthmatic and non-asthmatic adolescents

Despite the particularly detrimental health risks of smoking for adolescent with asthma, several studies demonstrated higher smoking rates among asthmatic adolescents than among healthy adolescents. To gain insight into underlying mechanisms, longitudinal studies on differences in smoking predictors between asthmatic and non-asthmatic adolescents are essential. This longitudinal study with two waves with an 18 months interval tests the Theory of Planned Behavior (TPB) among 346 asthmatic adolescents and 3,733 non-asthmatic adolescents aged 12-16 years. Structural equation models were used to test the predictive value of the TPB in these two groups. The results show, consistent with the TPB, that smoking-related cognitions (attitude, perceived behavioral control, and subjective norm) predict smoking onset via intention among both asthmatic and non-asthmatic adolescents. The TPB predicted smoking onset even stronger among adolescents with asthma. These findings may contribute to the development of tailored interventions for the prevention of smoking among asthmatic adolescents.