Socioeconomic status and tobacco consumption among adolescents: a multilevel analysis of Argentina's Global Youth Tobacco Survey

Cigarette access and purchase patterns among adolescent smokers aged 12-16 years in 140 countries/territories, Global Youth Tobacco Survey 2010-2018

Background

Few studies have examined access to cigarettes among adolescents. To address this, we aimed to examine cigarette access and purchase patterns among adolescent cigarette smokers based on the most recent data from the Global Youth Tobacco Surveys (GYTS).

Methods

We used the most recent school-based GYTS data (2010-2018) on 49 856 adolescent cigarette smokers aged 12-16 years in 140 countries/territories (hereafter "countries") to examine cigarette access and purchase patterns among adolescent smokers.

Results

Over half (51.2%) of adolescent smokers bought cigarettes from commercial vendors (ie, stores/shops/street vendors/kiosks) and one-third of smokers (32.7%) got cigarettes from private persons (ie, peers or adults). Males (vs females), older adolescents (vs younger ones), and adolescent smokers from low-income countries (vs those from middle- or high-income countries) were more likely to buy cigarettes from commercial vendors. Younger adolescents (vs older ones) and adolescent smokers from low-income countries (vs those from middle- or high-income countries) were more likely to get cigarettes from private persons. As many as 39.6% of adolescent smokers reported that they were not denied buying cigarettes from commercial vendors due to age restrictions, especially among males (vs females), among older adolescents (vs younger ones), and among adolescent smokers from upper-middle-income or high-income countries (vs those from low-income countries). Purchasing cigarettes as single sticks was more likely to occur in males (vs females), in older adolescents (vs younger ones), and in adolescent smokers from low-income countries (vs those from upper-middle-income or high-income countries), with inverse findings for purchasing cigarettes in full packs.

Conclusions

Adolescent smokers often obtained cigarettes from commercial vendors or private persons. Additionally, adolescent smokers often purchased cigarettes in packs and as individual sticks. These findings emphasize the need to strengthen measures to reduce the supply of cigarettes to minors.

Cigarette availability and affordability among Chinese youth smokers: Findings from the 2019 China Youth Tobacco Survey

INTRODUCTION

Preventing youth from tobacco use is a priority for tobacco control in China, and the government has taken many measures such as introducing tobacco control in the health education curriculum, banning smoking in school, promoting smoke-free household, and advocacy campaigns. The objective of this study was to understand the availability and affordability of cigarettes for middle school (MS) and high school (HS) students in China.

METHODS

The data were extracted from the 2019 China National Youth Tobacco Survey, which was a school-based cross-sectional survey with a nationally representative sample of 288192 MS and HS students. The survey employed a randomized multistage stratified cluster sampling design with probability proportional to size sampling method and used an anonymous self-administrated questionnaire to collect data. The availability and affordability of cigarettes were analyzed, and all parameter estimates were weighted to account for the complex sampling design.

RESULTS

In 2019, an estimated 80.5% of current smokers who were aged <18 years bought cigarettes in the past 30 days. Among them, 83.3% (83.0% of males and 85.2% of females; and 76.5% in MS and 87.6% in HS) had not been refused purchase of cigarettes because they were underage, with 84.1% in urban and 82.9% in rural areas, and 87.3% in central, 83.4% in eastern, and 80.5% in western regions of China. Among current smokers who bought cigarettes in the past 30 days, 77.3% had bought a pack of cigarettes (20 cigarettes) costing >10 RMB and at least 61.4% had more pocket money per week than the cost of a pack of cigarettes. Although 84.2% of current smokers bought cigarettes by the pack, 9.2% of current smokers reported that they bought cigarettes as sticks.

CONCLUSIONS

Although the youth smoking rate dropped down from 2014 to 2019, the proportion of youth smokers that bought cigarettes was still high in China. Due to the high amount of pocket money, the current cigarette price was not an effective price barrier to prevent youth smoking. Selling cigarettes by the stick worsens the situation. Strengthening the enforcement of the 2021 Law on the Protection of Minors, increasing tobacco taxes and prices, and forbidding the selling of cigarette sticks, might assist the progress in youth tobacco control.

Adaptation of the Young Adults' Cigarette Dependence (YACD) Scale for the development and validation of the Adolescent Cigarette Dependence Scale (ACDS)

Vulnerable adolescents may lose control over cigarette use within a day or two after smoking their first cigarette, as nicotine dependence (ND) symptoms may appear before actual daily smoking and usually occur at low levels of daily smoking. Moreover, smoking can cause illnesses and promote other types of substance abuse. Therefore, it was deemed essential to adapt the Young Adults' Cigarette Dependence (YACD) Scale to develop and validate the Adolescent Cigarette Dependence Scale (ACDS) in Lebanese adolescents and evaluate whether cumulative cigarette smoking is associated with nicotine dependence and symptoms of dependence. A cross-sectional study was carried out between August and September 2020, during the partial sanitary lockdown imposed by the government to limit COVID-19, coinciding with the summer holidays for most Lebanese. The total sample consisted of 564 community-dwelling adolescents aged 13 to 18. A factor analysis was performed using a varimax rotation. The Kaiser-Meyer-Olkin (KMO) measurement of sampling adequacy and Bartlett's sphericity test were appropriate. The factors retained corresponded to Eigenvalues > 1. Cronbach's alpha value represented the internal consistency of the scale. The Hooked on Nicotine Checklist (HONC) was used to screen for dependence symptoms. All items of the YACD were extracted, except for items 4 (smoking to concentrate at work) and 18 (smoking as a habit), which yielded a three-factor solution (factor 1 = smoking patterns; factor 2 = positive and negative reinforcements; factor 3 = smoking cessation) with Eigenvalues > 1 (variance explained = 56.18%; KMO = 0.784; Bartlett's sphericity test p < 0.001; α_Cronbach = 0.875). The newly generated scale was termed Adolescent Cigarette Dependence Scale (ACDS) and consisted of 19 items. Higher ACDS scores (higher cigarette dependence) were significantly associated with higher HONC scores (higher symptoms of dependence) (rho = 0.647; p < 0.001). Having deceased (B = 8.54) or divorced (B = 4.26) parents and higher cumulative cigarette smoking (B = 0.29) were significantly associated with higher ACDS scores. Higher cumulative cigarette smoking (B = 0.05) was significantly associated with higher HONC scores due to cigarettes. This study could validate a new tool to evaluate nicotine dependence among Lebanese adolescents, the Adolescent Cigarette Dependence Scale (ACDS). This version adapted from the Young Adults' Cigarette Dependence (YACD) Scale is reliable and valuable and correlates well with other scales, such as the HONC. However, further studies are necessary to improve this instrument, adding new questions useful for the diagnosis and evaluation of cigarette dependence.

Determinants of cigarette/bidi smoking among youth male in rural Mymensingh of Bangladesh: A cross-sectional study

BACKGROUND

Smoking cigarette/bidi, is a serious health threat, causes preventable premature morbidity and mortality. Higher prevalence of smoking among the youth hampers a country's development, as the youth are the main drivers of socio-economic development. An effective understanding of factors associated with youth smoking is precious to prevent youth smoking. This study aims to identify the determinants of smoking cigarette/bidi among the youth male of the rural areas of Mymensingh district in Bangladesh.

METHODS

The primary data from the project "Knowledge, awareness and practices among youth smokers in Trishal Upazila under Mymensingh district: A micro-survey study", funded by the Research and Extension Center, Jatiya Kabi Kazi Nazrul Islam University, Bangladesh was utilized in the current study. The data consists of 385 youth males aged 15-24 years who were interviewed face-to-face from the rural areas of Mymensingh district in Bangladesh. Univariate distribution, chi-square tests, and binary logistic regression model were employed to identify the factors associated with smoking cigarette/bidi among the youth male.

RESULTS

The prevalence of smoking cigarette/bidi among the youth male is 40.3% [95% CI: 35.0%-45.0%]. Age, occupation, monthly income, family's monthly income, cigarette/bidi smoking status of father, brother and close friends, and knowledge about harmfulness of smoking are revealed as the determinants of cigarette/bidi smoking. For instance, the odds of being smoker increases with the increase in age (Odds ratio [OR]: 1.33 [1.17-1.51]). Business owner is less likely (OR: 0.15 [0.03-0.68]) to smoke than the day labourer. Having smoker fathers (OR: 2.51 [1.39-4.53]), smoker brothers (OR: 2.88 [1.39-5.96]), smoker friends (OR: 9.85 [5.85-1.27]) are significantly associated with smoking cigarette/bidi.

CONCLUSION

As the first study, it provides the determinants of cigarette/bidi smoking among youth male of the rural areas of Mymensingh district in Bangladesh. Relevant authorities are suggested to consider the study's findings and recommendations to revise the existing smoking policies so that smoking among youth can be prevented for future development of the country.

Socioeconomic Status Inequalities Partially Mediate Racial and Ethnic Differences in Children's Amygdala Volume

BACKGROUND

While race/ethnicity and socioeconomic status (SES) impact brain structures such as the amygdala, less is known on whether or not family SES partially explains why amygdala volume is smaller for racial and ethnic minority groups.

PURPOSE

This study tested the mediating effects of family SES on racial and ethnic differences in right and left amygdala volume.

METHODS

We borrowed the structural Magnetic Resonance Imaging (sMRI) data of the Children Brain Cognitive Development (ABCD) study, a brain imaging investigation of childhood brain development in the US. The total sample was 8977, 9-10-year-old children. The independent variables were race and ethnicity. The primary outcomes were right and left amygdala volume. Age, sex, household size, and marital status were the covariates. Multiple SES indicators such as family income, subjective family SES, parental employment, parental education, and neighborhood income were the mediators. To analyze the data, we used regression models without and with our mediators. Sobel test was used to test if these mediational paths are statistically significant.

RESULTS

Black and Latino children had smaller amygdala sizes than non-Latino White children. The effects of race and ethnicity on amygdala volume were partially mediated by SES indicators, suggesting that one of the many reasons Black and Latino children have smaller volumes of right and left amygdala is their lower SES.

CONCLUSIONS

For American children, lower family and neighborhood SES indicators partially, but not fully, explain smaller amygdala sizes of Black and Latino children compared to non- Latino White children.

Family Income Mediates the Effect of Parental Education on Adolescents' Hippocampus Activation During an N-Back Memory Task

Introduction: Hippocampus, a medial temporal lobe structure, has significant implications in memory formation and learning. Although hippocampus activity is believed to be affected by socioeconomic status (SES), limited knowledge exists on which SES indicators influence hippocampus function. Purpose: This study explored the separate and combined effects of three SES indicators, namely parental education, family income, and neighborhood income, on adolescents’ hippocampus activation during an N-Back memory task. As some of the effects of parental education may be through income, we also tested if the effect of parental education on hippocampus activation during our N-Back memory task is mediated by family or neighborhood income. Methods: The Adolescent Brain Cognitive Development (ABCD) study is a national multi-center investigation of American adolescents’ brain development. Functional magnetic resonance imaging (fMRI) data of a total sample of 3067 9–10-year-old adolescents were used. The primary outcome was left- hippocampus activation during the N-Back memory task (mean beta weight for N-Back run 1 2 back versus 0 back contrast in left hippocampus). The independent variable was parental education. Family income and neighborhood income were two possible mediators. Age, sex, and marital status were the covariates. To test mediation, we used hierarchical linear regression models first without and then with our mediators. Full mediation was defined according to Kenny. The Sobel test was used to confirm statistical mediation. Results: In the absence of family and neighborhood income in the model, higher parental educational attainment was associated with lower level of left hippocampus activation during the N-Back memory task. This effect was significant while age, sex, and marital status were controlled. The association between parental educational attainment and hippocampus activation during the N-Back memory task was no more significant when we controlled for family and neighborhood income. Instead, family income was associated with hippocampus activation during the N-Back memory task. These findings suggested that family income fully mediates the effect of parental educational attainment on left hippocampus activation during the N-Back memory task. Conclusions: The effect of parental educational attainment on adolescents’ hippocampus activation during an N-Back memory task is fully explained by family income. That means low family income is why adolescents with low-educated parents show highlighted hippocampus activation during an N-Back memory task. Given the central role of the hippocampus in learning and memory and as income is a modifiable factor by tax and economic policies, income-redistribution policies, fair taxation, and higher minimum wage may have implications for promotion of adolescent equality and social justice. There is a need to focus on family-level economic needs across all levels of neighborhood income.

Association Between Socioeconomic Status and Early Initiation of Smoking, Alcohol Drinking, and Sexual Behavior Among Korean Adolescents

We analyzed data from the Korean Youth Risk Behavior Web-based Survey (N = 68 043), a nationally representative survey, to examine the association between early initiation of smoking, alcohol drinking, and sexual activity and socioeconomic determinants among adolescents. The prevalence rates of early initiation of smoking (i.e, starting at age 12 years or younger), alcohol drinking, and sexual activity were 4.8%, 10.3%, and 1.4%, respectively. Adolescents with a low level of perceived household income, low level of father's education, and those living without family were more likely to start these risky behaviors early. Early initiation of smoking was significantly affected by affordability.

Neighborhood Poverty and Amygdala Response to Negative Face

Introduction

Considerable research has established a link between socioeconomic status (SES) and brain function. While studies have shown a link between poverty status and amygdala response to negative stimuli, a paucity of knowledge exists on whether neighborhood poverty is also independently associated with amygdala hyperactive response to negative stimuli.

Purpose

Using functional brain imaging data, this study tested the association between neighborhood SES and the amygdala's response to negative stimuli. Considering race as a sociological rather than a biological construct, we also explored racial heterogeneity in this association between non-Hispanic Black and non-Hispanic White youth.

Methods

We borrowed the functional Magnetic Resonance Imaging (fMRI) data of the Adolescent Brain Cognitive Development (ABCD) study. The sample was 2,490 nine to ten year old non-Hispanic Black and non-Hispanic White adolescents. The independent variable was neighborhood income which was treated as a continuous measure. The primary outcomes were the right and left amygdala response to negative face during an N-Back task. Age, sex, race, marital status, and family SES were the covariates. To analyze the data, we used linear regression models.

Results

Low neighborhood income was independently associated with a higher level of amygdala response to negative face. Similar results were seen for the right and left amygdala. These effects were significant net of race, age, sex, marital status, and family SES. An association between low neighborhood SES and higher left but not right amygdala response to negative face could be observed for non-Hispanic Black youth. No association between neighborhood SES and left or right amygdala response to negative face could be observed for non-Hispanic White youth.

Conclusions

For American youth, particularly non-Hispanic Black youth, living in a poor neighborhood predicts the left amygdala reaction to negative face. This result suggested that Black youth who live in poor neighborhoods are at a high risk of poor emotion regulation. This finding has implications for policy making to reduce inequalities in undesired behavioral and emotional outcomes. Policy solutions to health inequalities should address inequalities in neighborhood SES.

Prefrontal Cortex Response to Threat: Race by Age Variation in 9-10 Year Old Children

BACKGROUND

Considerable research has suggested that race and age are two major determinants of brain development, including but not limited to development of the prefrontal cortex (PFC). Minorities' Diminished Returns (MDRs), however, suggests that race (as a proxy of racism) may interact with various determinants of human and brain development. Minimal knowledge, however, exists on whether age and race also interact on shaping PFC response to threat among American children.

PURPOSE

Using data from a task-based functional brain imaging study and considering race as a sociological rather than a biological construct, we investigated combined effects of race and age on prefrontal cortical (PFC) response to threat. We explored racial heterogeneities in the association between age and PFC response to threat by comparing Black and White children.

METHODS

This study used the task-based functional Magnetic Resonance Imaging (fMRI) data from the Adolescents Brain Cognitive Development (ABCD) study, a national, landmark, multi-center brain imaging investigation of 9-10 years old children in the US. The primary outcomes were mean beta weights of n-back runs measuring PFC response to threating versus neutral face contrast in the following regions of interest (ROIs): left hemisphere-lateral orbito-frontal, left hemisphere -superior-frontal, right hemisphere -caudal middle frontal, and right hemisphere -superior frontal cortex. The independent variable was age. Covariates were sex, ethnicity, family socioeconomic status, and neighborhood socioeconomic status. Race was the focal moderator. To analyze the data, we used linear regression models without and with interactions and SES as covariates.

RESULTS

We included 5,066 9-10 years old children. Age and race did not show direct effects on PFC response to threatening relative to neutral faces. While ethnicity, sex, and socioeconomic status were controlled, age and race showed a systematic interaction on PFC response to threatening relative to neutral faces.

CONCLUSIONS

For American children, race and age do not have direct effects but multiplicative effects on PFC response to threat. The results may be reflective of social inequalities in how Black and White children are socialized and developed. The results are important given the role of the PFC in regulating the limbic system response to threat. Coordinated work of the limbic system and PFC is a core element of children's behavioral and emotional development. Future research is needed on how social stratification and racism shape emotion processing and regulation of American children in response to threat.

Determination of factors influencing tobacco consumption in Turkey using categorical data analyses1

The aim of this study is to specify factors influencing tobacco consumption in Turkey, which belongs to developing countries group, and to determine the extent of their influence. Factors related to the sociodemographic, economic, personal, environmental, and healthy life indicators influencing tobacco consumption in Turkey were determined using logistic and probit regression analyses. According to the results of the study, age, gender, education, marital status, fruit consumption, exposure to tobacco smoke at home, and frequent of alcohol consumption are the most influential variables effecting tobacco consumption. More effective results in policies aimed at preventing tobacco consumption can be accomplished by giving priority to individuals more inclined to tobacco consumption. People in 25-44 age group, men, graduates of high school and its equivalents, divorced/widowed individuals, individuals exposed to tobacco smoke, and alcohol users are individuals who tend to use tobacco.

Parent Education and Substance Use among Latin-American Early Adolescents

Objective

To examine the relationship between parent education, at individual- and school-level, and substance use behaviors (smoking, alcohol drinking, binge drinking, and illicit drug use) among young adolescents from Argentina and Mexico.

Methods

A cross-sectional, school-based survey of middle-school early adolescents from Mexico (N=10,123) and Argentina (N=3,172) queried substance use.

Results

After adjusting for age, sex and individual-level parent education, students from Mexican schools with lower parent education had higher likelihood of current smoking and drug use than those from schools with higher parent education. In Argentina, lower parent education at school-level was positively associated with all outcomes.

Conclusion

Disadvantageous contextual school characteristics contributes to substance use among early adolescents in Mexico and Argentina.

Predictive validity of the tobacco marketing receptivity index among non-smoking youth

INTRODUCTION

In a previous cross-sectional study of early adolescents, we developed a marketing receptivity index (MRI) that integrates point-of-sale (PoS) marketing exposures, brand recall, and ownership of branded merchandise. The MRI had independent, positive associations with smoking susceptibility among never smokers and with current smoking behavior. The current longitudinal study assessed the MRI's predictive validity among adolescents who have never smoked cigarettes METHODS: Data come from a longitudinal, school-based survey of 33 secondary schools in Argentina. Students who had never smoked at baseline were followed up approximately 17months later (n=1700). Questions assessed: PoS marketing exposure by querying frequency of going to stores where tobacco is commonly sold; cued recall of brand names for 3 cigarette packages from dominant brands but with the brand name removed; and ownership of branded merchandise. A four-level MRI was derived: 1.low PoS marketing exposure only; 2. high PoS exposure or recall of 1 brand; 3. recall of 2 or more brands; and 4. ownership of branded merchandise. Logistic regression models regressed smoking initiation by follow up survey on the MRI, each of its components, and students' willingness to try a brand, adjusting for sociodemographics, social network smoking, and sensation seeking.

RESULTS

The MRI had an independent positive association with smoking initiation. When analyzed separately, each MRI component was associated with outcomes except branded merchandise ownership.

CONCLUSIONS

The MRI and its components were associated with smoking initiation, except for branded merchandise ownership, which may better predict smoking progression than initiation. The MRI appears valid and useful for future studies.

Adolescent injuries in Argentina, Bolivia, Chile, and Uruguay: Results from the 2012-2013 Global School-based Student Health Survey (GSHS)

OBJECTIVES

The goals of this study were to identify the proportion of early adolescents in southern South America who were injured in the past year, to identify risk behaviours and other exposures associated with injuries, and to evaluate the most common types and causes of injury in this population.

METHODS

We used complex samples analysis to examine cross-sectional data from more than 35,000 students from all four countries in South America that participated in the Global School-based Student Health Survey (GSHS) in 2012-2013.

RESULTS

The proportion of students reporting at least one injury in the past year that required medical treatment or caused at least one full day of missed school or usual activities was 27.1% in Argentina, 29.5% in Uruguay, 30.9% in Chile, and 36.8% in Bolivia. Significantly more boys than girls reported injuries. Injured students were more likely than non-injured students to report anxiety-induced insomnia, being physically attacked, being in a physical fight, and being lonely in the past year, and they were also more likely to report being bullied, using tobacco, drinking alcohol, and missing school in the past month. For both boys and girls, the most common type of injury reported was a broken bone or dislocated joint and the most common injury cause was the student falling. However, most students were not able to provide a specific answer to either question.

CONCLUSION

The GSHS has been conducted in 100 low- and middle-income countries and territories around the world, and new waves of data collection are currently being planned and implemented. The utility of the injury data from the GSHS would be improved if the injury type and cause response items were updated to better capture information about self-harm, sports injuries, and other statistics that will provide a stronger foundation for evidence-based injury prevention interventions in adolescent populations.

Current Cigarette Smoking, Access, and Purchases from Retail Outlets Among Students Aged 13-15 Years - Global Youth Tobacco Survey, 45 Countries, 2013 and 2014

Tobacco use is a leading preventable cause of morbidity and mortality, with nearly 6 million deaths caused by tobacco use worldwide every year (1). Cigarette smoking is the most common form of tobacco use in most countries, and the majority of adult smokers initiate smoking before age 18 years (2,3). Limiting access to cigarettes among youths is an effective strategy to curb the tobacco epidemic by preventing smoking initiation and reducing the number of new smokers (3,4). CDC used the Global Youth Tobacco Survey (GYTS) data from 45 countries to examine the prevalence of current cigarette smoking, purchase of cigarettes from retail outlets, and type of cigarette purchases made among school students aged 13-15 years. The results are presented by the six World Health Organization (WHO) regions: African Region (AFR); Eastern Mediterranean Region (EMR); European Region (EUR); Region of the Americas (AMR); South-East Asian Region (SEAR); and Western Pacific Region (WPR). Across all 45 countries, the median overall current cigarette smoking prevalence among students aged 13-15 years was 6.8% (range = 1.7% [Kazakhstan]-28.9% [Timor-Leste]); the median prevalence among boys was 9.7% (2.0% [Kazakhstan]-53.5% [Timor-Leste]), and among girls was 3.5% (0.0% [Bangladesh]-26.3% [Italy]). The proportion of current cigarette smokers aged 13-15 years who reported purchasing cigarettes from a retail outlet such as a store, street vendor, or kiosk during the past 30 days ranged from 14.9% [Latvia] to 95.1% [Montenegro], and in approximately half the countries, exceeded 50%. In the majority of countries assessed in AFR and SEAR, approximately 40% of cigarette smokers aged 13-15 years reported purchasing individual cigarettes. Approximately half of smokers in all but one country assessed in EUR reported purchasing cigarettes in packs. These findings could be used by countries to inform tobacco control strategies in the retail environment to reduce and prevent marketing and sales of tobacco products to youths (5).

Influence of school-related factors on smoking among Chilean adolescents: a cross-sectional multilevel study

BACKGROUND

Adolescent tobacco smoking is a major health concern in Chile. Schools may be able to influence adolescent behaviour regarding smoking; however, this topic has received limited research attention in Latin-American countries. Moreover, the prevalence of cigarette smoking varies between schools, and some of this variability may be explained by school factors. This article examines the inter-school variability in student smoking in a large sample of Chilean schools and identifies the school- and student-level characteristics associated with cigarette smoking.

METHODS

This cross-sectional study used self-reported student-level data from 45,273 students from 1462 schools and official data from these schools provided by the Chilean Ministry of Education (2007). Student smoking behaviour was used as an outcome, and individual-level and school-level features were used as explanatory variables. Logistic multilevel modelling was used to analyse the data.

RESULTS

The mean prevalence of smoking in the 1462 schools was 39.9 %. The null model indicated that 8 % of the variance in smoking behaviour was explained by schools; and in the final model, controlled by individual- and school-level variables, the variance explained by schools dropped to 2.4 %. The main school-level variables explaining the school influence were school bonding, school truancy and school achievement.

CONCLUSIONS

This is the first study to examine the extent to which student smoking varies between Chilean schools and to identify some of the school factors associated with this inter-school variability. Although most variation in smoking prevalence lies between students within schools, there is sufficient between-school variation to be of interest to educators and policy makers.

Assessing tobacco marketing receptivity among youth: integrating point of sale marketing, cigarette package branding and branded merchandise

BACKGROUND

As countries prohibit tobacco marketing through traditional channels, marketing at point of sale (PoS) and through tobacco packaging is increasingly important for promoting tobacco consumption.

OBJECTIVES

Assess the validity of a novel marketing receptivity index that considers frequency of PoS exposures, tobacco brand recall and ownership of branded merchandise.

METHODS

Data come from a cross-sectional survey of 3172 secondary school students in Argentina. Questions assessed frequency of going to stores where tobacco is often sold; cued recall of brand names for 3 cigarette packages with brand name removed and ownership of branded merchandise. A four-level marketing receptivity index was derived: low PoS exposure only; high PoS exposure or recall of 1 brand; recall of 2 or more brands; and ownership of branded merchandise. Indicators of marketing receptivity and smoking involvement were regressed on the index, including in adjusted models that controlled for sociodemographics, social influences and sensation seeking.

FINDINGS

Among never-smokers, the index had independent positive associations with smoking susceptibility (ie, adjusted OR (AOR)_2v1=1.66; AOR_3v1=1.64; AOR_4v1=2.95), willingness to try a specific brand (ie, AOR_2v1=1.45; AOR_3v1=2.38; AOR_4v1=2.20) and positive smoking expectancies (ie, B_{adj 2v1}=0.09; B_{adj 3v1}=0.18; B_{adj 4v1}=0.34). A more marked dose-response independent association was found with current smoking behaviour (ie, AOR_2v1=2.47; AOR_3v1=3.16; AOR_4v1=3.62).

CONCLUSIONS

The marketing receptivity index was associated with important variation in smoking-related perceptions, intentions and behaviour among Argentine adolescents. Future research should determine the predictive validity and generalisability of this measure to other contexts, including the explanatory power gained by integrating cigarette package brand recognition tasks.

School- and family-level socioeconomic status and health behaviors: multilevel analysis of a national survey in wales, United Kingdom

BACKGROUND

Interventions to address inequalities in adolescent health behaviors often target children from less affluent families, or schools in poorer areas. Few studies have examined whether school- or family-level affluence predicts health behaviors independently, or in combination.

METHODS

This article reports secondary analysis of the Welsh Health Behavior in School-aged Children (HBSC) survey. Mixed-effects logistic regression models test associations of school and family socioeconomic status (SES) with smoking, fruit and vegetable consumption, alcohol consumption, and physical activity.

RESULTS

Higher family SES was associated with healthier behaviors, except in relation to alcohol consumption. For all behaviors except physical activity, school-level SES was independently associated with healthier behaviors. In higher SES schools, a stronger association of family SES with health behavior was observed, particularly in relation to smoking and physical activity.

CONCLUSIONS

School and family SES may exert independent and combined influences upon adolescent health behaviors. Targeting interventions toward deprived schools may fail to address substantial inequalities within more affluent schools. Targeting deprived families may fail to address behaviors of children from affluent families, attending more deprived schools. Identifying universal health improvement interventions which have greater effects among children from poorer backgrounds may be a more effective means of reducing inequalities.

Smoking in school-aged adolescents: design of a social network survey in six European countries

BACKGROUND

In Western countries, smoking accounts for a large share of socio-economic inequalities in health. As smoking initiation occurs around the age of 13, it is likely that school context and social networks at school play a role in the origin of such inequalities. So far, there has been little generic explanation of how social ties at school contribute to socio-economic inequalities in smoking. The SILNE (Smoking Inequalities - Learning from Natural Experiments) survey was designed to test the hypothesis that a combination of peer effect, homophilous social ties, and school context may explain how smoking inequalities are magnified at school - a theory known as network-induced inequality. In this paper, the survey theory and design are presented.

FINDINGS

The social network survey was carried out in 2013 in six medium-sized European cities with average incomes similar to the national average: Namur (Belgium), Tampere (Finland), Hannover (Germany), Latina (Italy), Amersfoort (The Netherlands), and Coimbra (Portugal). In each city, 6 to 8 schools were selected in a stratified sampling procedure. In each school, two grades in secondary education, corresponding to 14-16-year-olds, were selected. All adolescents in these two grades were invited to participate in the survey. Social ties were reported using the roster approach, in which each adolescent had to nominate up to 5 friends from a directory. The survey collected information from 11,015 adolescents in 50 schools, out of a total of 13,870 registered adolescents, yielding a participation rate of 79%. The SILNE survey yielded 57,094 social ties, 86.7% of which referred to friends who also participated in the survey.

DISCUSSION

The SILNE survey was designed to measure the association between adolescents' social ties at school, their socio-economic background, and their smoking behaviour. Two difficulties were encountered, however: legal privacy constraints made it impossible to apply the same parental consent procedure in all countries, leading to somewhat lower participation rates in two cities: Hannover and Latina. It was also difficult to match the 6 cities in terms of both age and type of education. The SILNE survey provided a comparable database for the study of smoking inequalities across European cities from a social network perspective.

The sociodemographic patterning of opposition to raising taxes on tobacco and restricting tobacco advertisements in Argentina

BACKGROUND

Argentina has enacted important tobacco control initiatives in recent years. Yet little is known about the social patterning of attitudes toward tobacco control. Research is needed to explore what predicts opposition to tobacco control initiatives such as higher taxes on tobacco and the prohibition of tobacco advertising.

STUDY DESIGN

Secondary analysis of Argentina's Global Adult Tobacco Survey (N = 6645).

METHODS

Binary logistic regression analysis examining opposition to raising tobacco taxes and banning tobacco publicity. Models were stratified by smoking status.

RESULTS

Respondents generally indicated very little opposition to either tobacco control measure, with only 15.6% of respondents opposed to increasing taxes on tobacco products and 9.6% opposed to banning tobacco advertisements. Smoking status is the most important predictor of opposition to increasing taxes (OR = 7.85, 95% CI = 6.60-9.34) and banning advertisements (OR = 1.72, 95% CI = 1.39-2.11). Opposition to these measures is most likely among young respondents (aged 15-24) and least likely among older age groups (55-64 and 65 or over), compared to the 25-34 age group. Stratified models suggest that the effect of age may be different for smokers and non-smokers. Low income is a significant predictor of opposition, but only in stratified models for smokers.

CONCLUSION

There is general support for stronger tobacco control measures in Argentina. Opposition to raising taxes on tobacco products and banning tobacco advertisement appears to be concentrated among young smokers with low and medium levels of household income.

Neighbourhood deprivation and smoking and quit behaviour among smokers in Mexico: findings from the ITC Mexico Survey

BACKGROUND

In high-income countries (HICs), higher neighbourhood socioeconomic deprivation is associated with higher levels of smoking. Few studies in low-income and middle-income countries (LMICs) have investigated the role of the neighbourhood environment on smoking behaviour.

OBJECTIVE

To determine whether neighbourhood socioeconomic deprivation is related to smoking intensity, quit attempts, quit success and smoking relapse among a cohort of smokers in Mexico from 2010 to 2012.

METHODS

Data were analysed from adult smokers and recent ex-smokers who participated in waves 4-6 of the International Tobacco Control (ITC) Mexico Survey. Data were linked to the Mexican government's composite index of neighbourhood socioeconomic deprivation, which is based on 2010 Mexican Census data. We used generalised estimating equations to determine associations between neighbourhood deprivation and individual smoking behaviours.

FINDINGS

Contrary to past findings in HICs, higher neighbourhood socioeconomic deprivation was associated with lower smoking intensity. Quit attempts showed a U-shaped pattern whereby smokers living in high/very high deprivation neighbourhoods and smokers living in very low deprivation neighbourhoods were more likely to make a quit attempt than smokers living in other neighbourhoods. We did not find significant differences in neighbourhood deprivation on relapse or successful quitting, with the possible exception of people living in medium-deprivation neighbourhoods having a higher likelihood of successful quitting than people living in very low deprivation neighbourhoods (p=0.06).

CONCLUSIONS

Neighbourhood socioeconomic environments in Mexico appear to operate in an opposing manner to those in HICs. Further research should investigate whether rapid implementation of strong tobacco control policies in LMICs, as occurred in Mexico during the follow-up period, avoids the concentration of tobacco-related disparities among socioeconomically disadvantaged groups.

Sex-stratified and age-adjusted social gradients in tobacco in Argentina and Uruguay: evidence from the Global Adult Tobacco Survey (GATS)

OBJECTIVE

To examine social gradients in tobacco use in Argentina and Uruguay, using newly available directly comparable data sets.

METHODS

Secondary analysis of Global Adult Tobacco Survey data from Argentina (N=6645) and Uruguay (N=5581). Social gradients in current tobacco use, exposure to secondhand smoke, and cessation attempt were examined with sex-stratified and age-adjusted logistic regression.

RESULTS

Among men, there is evidence of higher odds of being a current smoker among respondents with lower levels of education, but the association is only statistically significant for respondents with less than primary education in Uruguay (OR=2.15, 95% CI 1.22 to 3.77). Similarly, women with lower levels of education have higher odds of being a current smoker in Uruguay. The association between education and exposure to secondhand smoke is broadly similar for both sexes in both countries, with generally higher odds among groups with low education, though the relationship is only statistically significant among men in Uruguay (OR=1.77, 95% CI 1.08 to 2.92). In both countries, respondents with lower levels of education in general have higher odds of having attempted to quit smoking in the past year, although these associations did not attain statistical significance.

CONCLUSIONS

Social gradients in tobacco use, exposure to secondhand smoke and cessation attempts are broadly similar in both countries. Efforts to evaluate the long-term effects of tobacco control efforts in these countries should monitor how policies affect national averages, and the social gradients that are embedded in aggregate data.

Association between wheeze and selected air pollution sources in an air pollution priority area in South Africa: a cross-sectional study

BACKGROUND

An association between wheeze (a symptom of asthma) and environmental tobacco smoke (ETS), types of fuel used for residential heating or cooking and the frequency of trucks passing near homes, has been reported mainly in developed countries. Little is known about the strength of such associations in developing countries. This study was conducted in residential areas situated in Ekurhuleni Metropolitan Municipality, namely Tembisa and Kempton Park, which form part of the Highveld region, a priority area in terms of air pollution in South Africa.

METHODS

From 3764 eligible school children, aged between 13 and 14 years, from 16 selected high schools in the study area, 3468 completed a modified questionnaire based on the International Study of Asthma and Allergies in Childhood (ISAAC). Data were analysed using multiple logistic regression models.

RESULTS

The results are based on data from 3424 children. In the adjusted models, exposure to ETS at school was associated with wheeze ever (OR 1.22 95% CI: 1.03 - 1.45) and current wheeze (OR 1.33 95% CI: 1.08 - 1.64). When gas was most frequently used for residential heating the likelihood of wheeze ever increased by 47% (OR 1.47 95% CI: 1.15 - 1.88). Trucks passing near homes for almost the whole day during weekdays, increased the likelihood of wheeze ever (OR 1.32 95% CI: 1.01 - 1.73), current wheeze (OR 1.61 95% CI: 1.15 - 2.24) and current severe wheeze (OR 2.22 95% CI: 1.28 - 3.77). When data were stratified according to residential area, for children living in Tembisa, ETS exposure at home was associated with current wheeze (OR 1.36 95% CI: 1.06 - 1.77); gas most frequently used for residential heating was associated with wheeze ever (OR 1.68 95% CI: 1.23 - 2.28) and current wheeze (OR 1.61 95% CI: 1.08 - 2.39); paraffin most frequently used for residential heating was associated with current severe wheeze (OR 1.85 95% CI: 1.04 - 3.28).

CONCLUSION

It was concluded that children living in one of the air pollution priority areas of South Africa, have an increased risk of wheezing due to exposure to both indoor and outdoor air pollution sources.

The prevalence and correlates of single cigarette selling among urban disadvantaged drug users in Baltimore, Maryland

BACKGROUND

Selling of single cigarettes, also known as loosies, is a public health concern. Loosies allow for those with fewer resources to buy cigarettes without having to purchase a pack. Selling of loosies may cue smoking behaviors. In the US, socioeconomically disadvantaged populations have high rates of smoking and illicit drug use and the selling of loosies appears to be linked to the urban informal economy. We examined the proportion and frequency of cigarette selling and roles in the informal economy associated with selling loosies among a sample of urban drug users.

METHODS

There were 801 participants, recruited by community outreach, assessed at baseline, who were enrolled in an HIV prevention intervention for drug users.

RESULTS

Most (89%) smoked cigarettes in the prior 30 days, of whom 92% smoked daily. Self-reported selling of cigarettes was common with 58% reporting that they had sold cigarettes within the last six months; 20.4% reported selling cigarettes a few times a week and 7.4% reported daily selling of cigarettes. In a stepwise regression model, four sources of income were associated with frequent cigarette selling: providing street security (OR=2.214, 95% CI 1.177-4.164), selling food stamps (OR=1.461, 95% CI 1.003-2.126), pawning items (OR=2.15, 95% CI 1.475-3.135), and selling drugs (OR=1.634, 95% CI 1.008-2.648).

CONCLUSION

There is a high rate of selling loosies among urban substance users. The wide availability of loosies may promote smoking. Smoking cessation programs with drug treatment and economic development programs may help to reduce economic pressures to sell loosies.

Smoking Prevalence and the Association between Smoking and Sociodemographic Factors Using the Korea National Health and Nutrition Examination Survey Data, 2008 to 2010

Using data from the Korea National Health and Nutrition Examination Survey collected from 2008 to 2010, smoking prevalence for Korean adults (n = 11,681) by gender and age group and the association between smoking and sociodemographic factors were evaluated.

Smoking prevalence was 42.3% for men and 5.6% for women. Young adult (YA) males, ie, 19 to 24 and 25 to 34 years old, were 2.45 (95% CI: 1.60, 3.73) and 5.05 (95% CI: 3.83, 6.66) times more likely to smoke compared to male adults aged 65 and above (31.6%) after controlling for sociodemographic factors. The association between smoking and marital status was different by gender.

In South Korea, the high smoking prevalence among young adults is a troubling pattern. The high smoking prevalence among widowed or divorced women is also concern.