Smoking of parents and best friend--independent and combined effects on adolescent smoking and intention to initiate and quit smoking

Individual-, social- and policy- factors associated with smoking cessation among adult male cigarette smokers in Hanoi, Vietnam: a longitudinal study

BACKGROUND

Nearly one-in-two Vietnamese men smoke cigarettes placing them among the highest tobacco consumers in the world. Despite the need for smoking cessation to curb the burden of tobacco-related diseases in Vietnam, this rate remains at less than 30%. Therefore, this study examines individual-, social- and policy factors associated with smoking cessation among adult male smokers in Vietnam.

METHODS

We established a longitudinal International Tobacco Control study of male smokers in Hanoi, Vietnam, in September 2018. This paper analyses 1525 men who participated in baseline and one-year follow-up. We applied a weighted multivariable logistic regression to examine the association between smoking cessation and individual-, social- and policy predictors.

RESULTS

At follow-up, 14.8% of participants had quit smoking for at least 30 consecutive days during the last year. Among the persistent smokers, 56.6% expressed intention to quit smoking. Factors associated with smoking cessation included a lower number of cigarettes smoked per day (aOR = 0.96, 95% CI: 0.94, 0.99) and having several attempts to quit smoking (aOR = 2.16, 95% CI 1.13, 4.12). Intention to quit smoking was associated with multiple quit attempts, a chronic condition diagnosis, more tobacco-related knowledge, greater self-efficacy, and more worries about their future health. The perceived impact of smoke-free policy and health warning labels were positively associated with intention to quit at any stage.

CONCLUSIONS

Interventions aimed at increasing smoking cessation should focus on all aspects of individual, social, and policy factors. Persistent smokers are more motivated to quit if they have made multiple quit attempts, more self-efficacy of quitting and worried about their future health, indicating that increasing smokers' beliefs and knowledge may be important for behavioural change. Health warning labels and tobacco taxation policies should be maintained and promoted as they are perceived to be particularly useful for persistent smokers' intention to quit.

Prevalence, frequency, intensity, and location of cigarette use among adolescents in China from 2013-14 to 2019: Findings from two repeated cross-sectional studies

BACKGROUND

The burden of disease caused by tobacco use is a grave public health concern in China. Preventing smoking initiation among adolescents will lower the prevalence of adult tobacco use later. Surveillance of tobacco use among adolescents helps set priorities in developing tobacco control policies. We aim to ascertain the prevalence and differences of cigarette use across sex, grade, and region among middle and high school students in 2019 and associated changes from 2013-14 to 2019 among middle school students.

METHODS

Using a multistage stratified cluster-randomized sampling design with national and provincial representativeness, we conducted two school-based cross-sectional surveys in 2013-14 and in 2019. A total of 155 117 middle school students in grades 7-9 in 2013-14 and 288 192 middle and high school students in grades 7-12 in 2019 were interviewed. Self-reported experimental and current (past 30-day) cigarette use among middle school and high school students; frequent use (≥20 days in the past 30 days) and intensity (>20 cigarettes per day) of smoking among current cigarette users; and location of smoking among current cigarette users were investigated. All estimates were weighted based on the complex sampling design.

FINDINGS

The 2013-14 survey (overall response rate: 98.1%) included 155 117 middle school students (47.1% girl). The 2019 survey (overall response rate: 98.7%) included 147 270 middle school students (46.5% girl), 106 432 academic high school students (50.8% girl) and 34 490 vocational high school students (43.8% girl). In 2019, the prevalence rate of experimental and current cigarette use was 12.9% and 3.9% for middle school students, 21.6% and 5.6% for academic high school students, and 30.3% and 14.7% for vocational high school students, respectively, with large sex and regional differences. The prevalences of smoking on 20 or more days and daily cigarette use in the past 30 days were higher in vocational high school (5.9%, 4.1%) than in academic high school (1.8%, 1.2%) and middle school (0.7%, 0.5%), and higher among boys than girls. The proportions of current cigarette users smoking more than 20 cigarettes per day in the past 30 days for girls were higher than for boys in academic high school. Students usually smoke at school and at home. Boys were more likely to use cigarettes in an internet cafe, while girls often smoked at social venues. From 2013-14 to 2019, the prevalences of experimental and current cigarette use declined by 5.0% and 2.0% (percentage points), respectively, among middle school students but increased by 1.4% and 0.5% (percentage points) among rural girls. Among current cigarette users in middle school students, the proportions of heavy cigarette use (>20 cigarettes per day) have increased by 1.8 percentage points, mainly among boys, by 2.2% (percentage points).

INTERPRETATION

From 2013-14 to 2019, the prevalences of experimental and current cigarette use among middle school students decreased overall but increased among rural girls, while the intensity of cigarette use rose among boys. Cigarette use among Chinese adolescents differs across sex and regions, with higher rates among boys, in rural areas, and in the Western region (low socioeconomic status). Smoking is much more prevalent in vocational high schools than the other settings. Effective targeted tobacco control interventions among adolescents are urgently needed in China.

FUNDING

Dr. Zhuo Chen is supported by National Natural Science Foundation (Grant#: 72174098) through the University of Nottingham Ningbo China.

Effect of relative income price on smoking initiation among adolescents in Ghana: evidence from pseudo-longitudinal data

OBJECTIVE

Many smokers initiate smoking during adolescence. Making tobacco products less affordable is one of the best ways to control tobacco use. Studies on the effect of relative income price (RIP (ie, affordability)) of cigarettes on smoking initiation are scarce in low-income and middle-income countries, especially in Sub-Saharan Africa where data are limited. The goal of this study is to examine the effect of cigarette RIP on adolescent smoking initiation in Ghana.

SETTING

The study uses a pseudo-longitudinal data set constructed from the Global Youth Tobacco Surveys (GYTS (2000-2009 and 2017)) and RIP for the most sold cigarette brand in Ghana.

PARTICIPANTS

The GYTS is a national survey on adolescents.

PRIMARY AND SECONDARY OUTCOME

Effect of RIP on adolescent smoking initiation in Ghana.

RESULTS

Using the GYTS 2000-2009 data, we find that the probability of smoking initiation falls significantly in response to a higher RIP, with an elasticity of -0.372 (95% CI -0.701 to -0.042) for the unmatched sample and -0.490 (95% CI -0.818 to -0.161) for the matched sample. The RIP elasticity for women ((-0.888) (95% CI -1.384 to -0.392) and (-0.928) (95% CI -1.434 to -0.422)) is statistically significant at 1% in both the unmatched and the matched samples, respectively, while the RIP elasticity for men is statistically insignificant in the 2000-2009 surveys. Analysis of the 2017 GYTS shows a similar outcome: a negative relationship between RIP and smoking initiation, and the results are statistically significant for both men and women, and for both matched and unmatched samples.

CONCLUSION

The affordability (RIP) of cigarettes is negatively related to the probability of smoking initiation among adolescents in Ghana. Raising tobacco taxes in line with income growth would make cigarettes less affordable and dissuade adolescents from initiating smoking.

Cigarette Prices and Smoking Experimentation in Sierra Leone: An Exploratory Study

This study examines the effect of cigarette prices on the likelihood of experimental smoking among adolescents in Sierra Leone. The study links data from the 2017 Global Youth Tobacco Survey (GYTS) to price data covering 2008–2017 obtained from the World Health Organization (WHO). After employing duration analysis techniques, we find that increases in cigarette prices are associated with a lower probability of smoking experimentation, with an estimated price elasticity of −1.63 (CI: −.24 to −3.02). Other factors affecting an adolescent’s decision to experiment with smoking are parental and friends’ smoking status, gender, exposure to tobacco advertising, and income. We conclude that higher prices, through excise taxation, are important tools for controlling smoking uptake among the youth of Sierra Leone.

Antecedents and Consequences of Smoking Cessation Intention in the Context of the Global COVID-19 Infodemic

A growing body of scientific studies has been published to inform responses to the ongoing coronavirus pandemic, and some have claimed that cigarette smoking has a beneficial or mixed effect on the prevention and treatment of COVID-19. The presentation of such findings, unfortunately, has created an infodemic. This study integrated the theory of planned behavior and the health belief model and incorporated findings on addiction from the medical literature to predict cessation intention and support for tobacco control measures in the context of the COVID-19 infodemic. The study found that cessation intention partially mediated the effect of perceived severity and fully mediated the effects of perceived benefits, self-efficacy, and addiction on support for control measures. In addition, a positively-valenced message of the effect of smoking on the prevention and treatment of COVID-19 vs. a mixedly-valenced message was significant in predicting cessation intention, and the positively-valenced message of smoking indirectly predicted support for tobacco control measures. Perceived susceptibility, barriers, and subjective norms, however, exerted neither direct nor indirect effects on the two outcome variables.

Do the socioeconomic context and the European geographical area modify parental influences on smoking experimentation among adolescents?

Adolescent smoking is a major public health problem. While the socioeconomic status (SES) of the neighbourhood and that of the family are known to play a role in smoking onset and progression, it is not clear whether it modifies the association between parental influences and adolescent behaviour. The purpose of this study is to investigate family correlates of adolescent smoking experimentation and to explore the modifying role of socioeconomic context and European geographical area in a sample of European adolescents. This is a secondary analysis of the baseline survey of the European Drug Addiction Prevention (EU-Dap) trial which took place in seven European countries and involved 7079 students. School SES was used as indicator of socioeconomic context. European countries were aggregated in two geographical areas: North-Central and South. The associations between parental, family factors, and adolescents smoking experimentation were analysed through multilevel mixed-effect logistic regression models, stratified by school SES and European geographical area. Parental smoking, permissiveness towards tobacco, family conflicts, problematic relationships, low connectedness, and low parental control were significantly associated with adolescent smoking experimentation. Paternal smoking was a stronger correlate of adolescent smoking in low SES schools, while maternal smoking in high SES schools. Parental permissiveness was a stronger correlate in low SES schools. Family conflicts and low parental control were correlates only in low SES schools. The associations did not substantially differ between European geographical areas, with the exception of parental smoking that was a stronger correlate in the North, and parental control that was a correlate only in the South of Europe. To reduce inequalities in tobacco-related outcomes, prevention efforts in low socioeconomic contexts appear to be a public health priority. Parental smoking, permissiveness, family relationships, and connectedness should be addressed in preventive programs.

The Migration Intentions of Young Egyptians

This study examines the migration intentions of young people in Egypt before and after the 2011 revolution, driven by three sets of factors: (1) individual demographic and socioeconomic characteristics, (2) household characteristics, and (3) community characteristics and political and civic participation. Logistic regression models are applied to study the determinants of intentions to live, study, or work abroad among young Egyptians (defined as individuals aged 18 to 29), using data from the Survey of Young People in Egypt (SYPE) conducted in 2009 (N = 8488) and in 2014 (N = 5885). The surveys are nationally representative, covering all governorates in Egypt. The analysis indicates that respondents’ age, gender, marital status, and employment status play a significant role in shaping migration intentions. After the 2011 revolution, the effects are dependent upon economic and institutional conditions. The employment status affects the migration intention of young people in 2009; but the effects become insignificant in 2014. Moreover, respondents who have participated in political and voluntary activities are more likely to express migration intentions. Pollution levels in the community are also positively correlated with the intention to migrate. The results indicate that those who expressed migration intentions are a selective group in terms of demographic and socioeconomic characteristics. Our findings have policy relevance because knowledge and understanding of migration intentions and their determinants can be used to assess and develop scenarios about future migration.

Levels and factors of knowledge about the related health risks of exposure to secondhand smoke among medical students: A cross-sectional study in Jeddah, Saudi Arabia

INTRODUCTION

Secondhand smoke (SHS) appears to be an insidious public health issue in Saudi Arabia, with a high percentage of people being reportedly exposed. In an attempt to raise awareness about this issue, we explored medical students' level of knowledge about SHS risks, as well as their levels of exposure to SHS and the correlation between knowledge and exposure.

METHODS

A cross-sectional study was conducted in February 2020 at the Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. An online, modified version of a validated questionnaire was distributed among 2nd to 6th year medical students. The questionnaire mainly explored the following items: 1) exposure level to SHS; 2) impact of SHS exposure; and 3) knowledge about SHS related health risks, with calculation of a knowledge score (range: 0-8). Adequate knowledge was defined as a score ≥5 (median = 5), and associations with sociodemographic and lifestyle factors and exposure to SHS were analyzed using chi-squared and independent t-test, as appropriate.

RESULTS

Of a total 416 participants, 65.0% declared having one or more smoking persons among acquaintances, 26.4% being exposed to SHS at home, and 40.1% exposed to parental smoking during childhood. Further, 79.8% reported being regularly exposed to SHS in public places. Majority of participants reported significant discomfort (53.2%) and physical symptoms (98.3%) subsequent to SHS exposure. Among the list of 8 health risks, ear infection in children (28.1%), heart attack in children (37.5%), and cognitive deficit (47.8%) were the least frequently identified. Adequate knowledge was found among 57.5% of the participants, and was higher among females and lower among participants living with their friends, compared to their counterparts (p<0.05). No association of knowledge level was observed with the parameters of exposure to SHS and poor discomfort feeling.

CONCLUSIONS

The level of knowledge of medical students about health risks related to passive smoking is inadequate, while their exposure to SHS in public places is still substantial. This urges for the reinforcement of tobacco control strategies and highlights the great interest for medical colleges to implement effective educational interventions by improving their curricula regarding the risks of SHS and the benefits of smoking cessation.

Pattern and quitting of tobacco smoking among Egyptian university students

OBJECTIVES

University students are at high risk of practicing the smoking habit being exposed to smoking peers and easier cigarette availability.

METHODS

This study aims to explore prevalence, attitude and pattern of tobacco smoking and quitting among Beni-Suef University students. A cross-sectional study was conducted from March to May 2019. A total of 4,599 students were selected by using randomized multi-stage sampling using self-administered questionnaire for data collection.

RESULTS

The mean age of students found to be smokers was 20.8 ± 1.42 years. Males: Females' ratio was 2:1 (66 vs.34%). Prevalence of smoking was 17.4%. Students of non-medical and non-health colleges showed a significant high smoking rate (18.8 and 18.3% respectively) than students in health faculties (15.2%); p=0.017. Participants believed that they might smoke because of: peers' pressure (73.3%), stress (71.4%), imitating popular figures (61.7%) and availability of money (60.4%). Regarding smoking provinces; 86.1% did smoke in coffee-shops, 73.1% in university yards and only 16.87% used to smoke at home Regarding the attitudes of smokers and nonsmokers towards smoking; the acceptance of indoor smoking was significantly higher (85.6%) among smokers than non-smokers (6.42%); p=0.0001. Of note; 51.2% of smokers versus 86.3% of non-smokers agreed to ban smoking in public places (P=0.001). Majority of smokers (72.1%) had the desire to stop smoking while (57.8%) tried to stop smoking but failed.

CONCLUSIONS

Smoking is becoming a habit among university students and initiative of a smoke free environment should be encouraged and subject and method.

Drinking, smoking and type a polydrug behaviours: Psychosocial factors among Portuguese university students

Aim

This paper aims to describe alcohol, tobacco and type A polydrug consumption among university students.

Method

A cross-sectional study was performed. Through a convenience sampling, a total of 338 were included (51.8% male with a mean age of 20.6 years, SD = 3.4). Data was collected using a self-reported questionnaire. The questionnaire was composed by sociodemographic and substance consumption and behaviours variables. Spearman's correlation coefficients were assessed to measure the strength and direction of the association between sociodemographic and substance consumption variables. To evaluate type A polydrug consumption, multivariate logistic regression models were performed.

Results

It was observed significant correlations between tobacco consumption with cannabis and alcohol involvement, and coping, conformity, social, enhancement drinking motives. About alcohol consumption, there were observed relations with students’ social environment, and with enhancement, conformity and social drinking motives. Regarding sociodemographic factors on type A polydrug consumption it was verified that students who have parents and friends who smoke are more likely to polydrug.

Conclusion

Findings suggest that interventions focused on substance consumption may need to address descriptive and injunctive norms, drinking motives and social environment as part of the student’s consumption behaviours.

Adolescent Smoking in Hong Kong: Prevalence, Psychosocial Correlates, and Prevention

Preventing adolescent smoking is important as smoking is typically initiated by young people. This article reviews the prevalence, psychosocial correlates, and prevention of smoking in Hong Kong adolescents. The past 30-day smoking prevalence in adolescents decreased from 9.6% in 2003 to 2.5% in 2017. Tobacco advertisements, parental and best friends smoking, nonintact families, poor family relationships, lower socioeconomic status, being a new immigrant, poor knowledge of smoking-related harm, positive attitudes toward smoking, overestimation of peer smoking, and depressive symptoms were positively associated with smoking outcomes, whereas positive youth development, authoritative mother and permissive father, family functioning, school competence, and stronger tobacco industry denormalization beliefs were protective against smoking. Along with tobacco tax increase, ban on tobacco advertisements, smoke-free law and pictorial warnings, educational efforts through theater performances, social norms campaigns, and positive adolescent training programs have been conducted to prevent adolescent smoking. To achieve the ultimate goal of tobacco endgame, further tax increase, plain packaging, banning point-of-sale display of tobacco products, smoke-free area extension, and raising minimum age of purchase should be implemented. The government proposed law to ban e-cigarettes, and heated tobacco products should be passed soon to protect children and adolescents from using these products.

Sex Differences in Multilevel Factors of Smoking Experimentation and Age of Initiation in Korean Adolescents

This study purpose was to investigate sex differences in multilevel factors associated with smoking experimentation and age of initiation among Korean adolescents. Based on the ecological model, this cross-sectional study used data from the 2016 Korea Youth Risk Behavior Web-Based Survey (N = 65,528). Among 33,803 males (51.6%) and 31,725 females (48.4%), a greater proportion of males (21.9%) than females (7.1%) engaged in smoking experimentation. Males started smoking earlier than females (males: 12.7 years, females: 12.9 years, respectively, p < .05). In both sex groups, common factors associated with smoking were age, depression, suicidal ideation, academic achievement, household economic status, and having friends smoking and a specific person to talk with about their personal concern (all p values <.05). There were significant sex differences in psychological, family, and school factors of smoking initiation and experimentation. It is necessary to develop smoking interventions considering both individual and environmental factors with sex-specific strategies.

Prevalence and determinants of smoking status among university students: Artvin Çoruh University sample

Background and aim

Smoking is still a public health concern in many countries, especially among young adults. Consequently, we determined what factors affect university students’ smoking behavior in Turkey.

Methods

This cross-sectional study was conducted between March and June 2017 using a simple random sampling method. A self-administered questionnaire was used to collect information on participants’ (N = 2,505; mean age = 20.9 ± 2.5 years; 58.9% women) sociodemographic characteristics, cigarette smoking status, and related risk factors. Univariate analysis and multivariate logistic regression analysis were performed with the Backward likelihood-ratio method.

Results

Students were completing either two- or four-year degrees (45.6% and 54.4%, respectively). Regarding familial smoking behavior, 36.1% had a father who smoked, 10.3% had a mother who smoked, and 15.0% had siblings who smoked. Among participants, 27.9% were current smokers: 46% of the men and 15.3% of the women. Mean smoking onset age was 16.34 ± 2.72 years (15.65 ± 2.67 years for men and 16.34 ± 2.72 for women (p < .05). Mean Fagerströmtest score was 4.43 ± 1.82, and women had lower test scores than did men (p < .05). After controlling for potential confounders in multivariate analyses, five factors were significantly positively associated with current smoking: being a man (odds ratio (OR): 3.43; 95% confidence interval (CI): 2.75–4.28), studying in a two-year program (OR: 1.74; 95% CI: 1.39–2.18), having at least one immediate family member who smoked (OR: 1.63; 95% CI: 1.31–2.04), having all close friends who smoked (OR: 1.81; 95% CI: 1.40–2.33), and alcohol consumption (OR: 4.39; 95% CI: 3.51–5.49).

Conclusion

There was a higher smoking rate among our study population, both compared to similar national studies and Turkey’s overall smoking rate. Underlying factors should be evaluated via qualitative studies and preventive strategies should be implemented accordingly.

Active and passive smoking impacts on asthma with quantitative and temporal relations: A Korean Community Health Survey

This study aimed to evaluate the relations of smoking with asthma and asthma-related symptoms, considering quantitative and temporal influences. The 820,710 Korean adults in the Korean Community Health Survey in 2009, 2010, 2011, and 2013 were included and classified as non-smoker, past smoker or current smoker. Total smoking years, total pack-years, and age at smoking onset were assessed. Information on wheezing, exercise wheezing, and aggravation of asthma in the past 12 months and asthma diagnosis history and current treatment was collected. Multiple logistic regression analysis with complex sampling was used. Current and former smokers showed significant positive relations with wheezing, exercise wheezing, asthma ever, current asthma, and asthma aggravation. Current smokers demonstrated higher adjusted odd ratios (AORs) for wheezing, exercise wheezing, and asthma aggravation than former smokers. Former smokers showed higher AORs than current smokers for current asthma treatment. Longer passive smoking was related to wheezing and exercise wheezing. Greater age at smoking onset and duration since cessation were negatively related to wheezing, exercise wheezing, and current asthma; total pack-years demonstrated proportional associations with these symptoms. Former, current, and passive smoking was positively correlated with wheezing and exercise wheezing. Total pack-years and early initiation were increasingly related to asthma.

Impact of Parents and Peers Smoking on Tobacco Consumption Behavior of University Students

Introduction:

In the United Arab Emirates, smoking prevalence has increased in both sexes, especially among young adults. Various factors have led to this catastrophe; examples include coverage on TV and social media, as well as market availability. One major influence is smoking by parents and peers. A lot of students may start smoking because of the behavior of their family and friends, and therefore it is necessary to quantify adverse contributions. The aim of this project was to study to what degree parents and peers smoking habits may impact on smoking behavior of students at the University of Sharjah.

Methods:

This cross-sectional observational study with a non-probability convenient type of sampling, was conducted with university students aged 18 to 23. Information was collected using a self-administered questionnaire, comprising 23 questions, developed by ourselves.

Results:

A total of 400 University of Sharjah students (50% males and 50% females) were included.Some 15.8% of the smoking students had smoking parents, and 17.1% of them had smoking peers. The respective figures were 22.2% and 21.7% for males and 10% and 7.8% for females.

Conclusions:

Peers had a stronger impact than parents and both parents and peers had greater influence on males than on females. Interestingly, almost 80% of the smoking students did not have smoking parents or peers, which leaves the question unanswered of why they started smoking in the first place. Actions at a societal level should be taken into consideration to prevent smoking and thus help create a non-smoking generation.

Smoking Prevalence Among Users of Primary Healthcare Units in Brazil: The Role of Religiosity

The objective of this cross-sectional study is to examine the association between religious involvement and tobacco use in a large representative sample of users of primary healthcare units of Ribeirão Preto, Southeast Brazil. Current and past smoking habits were determined among 1055 users of primary healthcare units. Participants' religiosity was measured using the DUREL questionnaire. The prevalence of smoking among men was 16.8% [95% confidence interval (CI) 12.0-22.5] and among women was 12.6% (95% CI 10.4-15.0). Among the current smokers, 40.9% were light smokers, 24.6% were moderate smokers, and 34.5% were heavy smokers. The mean number of cigarettes smoked per day was 13.5. Respondents who have a religion had a lower smoking prevalence than people who had no religion. Current smoking prevalence tended to be higher among people who do not practice their religion than people who practice their religion. Smoking status is also associated with self-reported religiosity, organizational religious activity and some aspects of intrinsic religiosity. Religiosity is an important factor in influencing the smoking behavior in Brazilian users of the public health services.

The prevalence of and factors associated with tobacco smoking behavior among long-distance drivers in Lagos, Nigeria

BACKGROUND

Factors associated with tobacco smoking are useful in designing tobacco control programs.

OBJECTIVES

To estimate the prevalence of and factors associated with tobacco smoking among long-distance drivers.

METHODS

A cross-sectional study. Stratified cluster sampling approach was used to select drivers based on if they received annual health screening (AHS) or not (non-AHS). We used a structured questionnaire to obtain information and weighted the resulting observations to derive population based estimates. Association between tobacco smoking and socio-demographic factors was explored in multivariate models.

RESULTS

A total of 414 male drivers, with a mean age of 43.6 (standard error 0.6) years were studied. Population weighted prevalence of current smoking was 18.9% (95% CI: 14.3-23.4) all drivers, 6.5% (95% CI: 2.6-10.4) of AHS drivers and 19.5 (95% CI: 14.7-24.2) of non-AHS drivers (p<0.001). In multivariate models, having close friends that smoked (OR= 6.36, 95% CI= 2.49 - 16.20) cargo driving (OR= 2.58, 95% CI= 1.29 - 5.15) and lower education levels (OR for post-secondary education vs. Primary education or less= 0.17, 95% CI= 0.04 - 0.81) were associated with current smoking.

CONCLUSION

Prevalence of tobacco smoking is higher among non-AHS compared to AHS drivers. Having close friends that smoked, cargo driving, and lower education levels were associated with current smoking.

Family members’ and best friend’s smoking influence on adolescent smoking differs between Eastern Finland and Russian Karelia

Aims: The aim of this study was to find out whether family members’ (mother, father, siblings) and best friend’s smoking is related to 9th grade pupils’ daily smoking in Eastern Finland and in the Pitkäranta district, in the Republic of Karelia, Russia, and whether these relations have changed in these two culturally very different neighbourhood countries from 1995 to 2013. Methods: Data comprised four cross-sectional studies in all schools of the Pitkäranta region and selected schools in Eastern Finland. In data analyses, structural equation modelling techniques were used. Results: Our findings showed that best friend’s smoking had the strongest influence on adolescents’ smoking in both countries and study years (p < .01). The relations among family members were highly different between Pitkäranta and Eastern Finland, particularly in 2013. Conclusions: Results suggest that health promotion in schools should take into account cultural impacts and pay special attention to pupils who have family members and friends who smoke.

The prevalence of and factors associated with tobacco smoking behavior among long-distance drivers in Lagos, Nigeria

BACKGROUND

Factors associated with tobacco smoking are useful in designing tobacco control programs.

OBJECTIVES

To estimate the prevalence of and factors associated with tobacco smoking among long-distance drivers.

METHODS

This was a cross-sectional study. Stratified cluster sampling approach was used to select drivers based on if they received annual health screening (AHS) or not (non AHS). We used a structured questionnaire to obtain information and weighted the resulting observations to derive population based estimates. Association between tobacco smoking and socio-demographic factors was explored in multivariate models.

RESULTS

414 male drivers, mean age 43.6 (standard error 0.6) years. Population weighted prevalence of current smoking was 18.9% (95% CI: 14.3-23.4) of all drivers, 6.5% (95% CI: 2.6-10.4) of AHS drivers and 19.5 (95% CI: 14.7-24.2) of non AHS drivers (p<0.001). In multivariate models, having close friends that smoked (OR= 6.36, 95% CI= 2.49 - 16.20) cargo driving (OR= 2.58, 95% CI= 1.29 - 5.15) and lower education levels (OR for post-secondary education vs. primary education or less= 0.17, 95% CI= 0.04 - 0.81) were associated with current smoking.

CONCLUSION

Prevalence of tobacco smoking is higher among non AHS compared to AHS drivers. Having close friends that smoked, cargo driving, and lower education levels were associated with current smoking.

Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents

OBJECTIVE

To understand reasons for cigarillo initiation and cigarillo manipulation methods among adolescents.

METHODS

We conducted surveys in 8 Connecticut high schools to assess reasons for trying a cigarillo and cigarillo manipulation methods. We used multivariable logistic regressions to assess associations with demographics and tobacco use status.

RESULTS

Among ever cigarillo users (N = 697, 33.6% girls, 16.7 years old [SD = 1.14], 62.1% White), top reasons for trying a cigarillo were curiosity (41.9%), appealing flavors (32.9%), because "friends use it" (25.3%), and low cost (22.4%). Overall, 40.3% of ever cigarillo users added marijuana (to create blunts) and 39.2% did not manipulate the product. Endorsement of these reasons for initiation and manipulation methods differed significantly across sex, age, SES and other tobacco use.

CONCLUSIONS

Cigarillo regulations should include restricting all appealing flavors, increasing the cost, monitoring the restriction of sales of cigarillos to minors, and decreasing the appeal of cigarillo manipulation.

Smoking related attitudes, motives, and behaviors of male secondary school students in an urban setting of China

Background

Most smokers have their first experience of cigarette use when they are teenagers (i.e. at schools). Aiming tobacco control initiatives at secondary school students offers preventive measures to eliminate or reduce tobacco use initiation by students. This study assessed smoking-related attitudes, motives and behavior as well as other factors associated with smoking among male secondary school students in an urban setting in China.

Methods

A cross-sectional survey was conducted in urban areas of Chongqing using a structured questionnaire administered to 1297 male secondary school students. Logistic regression analysis was employed to investigate the factors that affect smoking.

Results

Of the participants (n = 1297), 27.7% were secondary and 72.3% were middle school students. Overall, 30.5% of the participants were smokers. The majority of the students procured their first cigarette from friends. The motivations of middle school students to smoke their first cigarette were curiosity (70.5%) and imitation (13.1%). The motivations of high school students for smoking their first cigarette were to satisfy their curiosity (51.8%), relief of stress and social pressures (17.1%), and imitation of smoker friends (15.9%). Respondents from poor family financial conditions were more likely to smoke than those from rich family financial conditions [odds ratio (OR) 1.59, 95% confidence intervals (CI) 1.00, 2.52]. Respondents whose fathers were smokers were more likely to smoke than those whose fathers were non-smokers (OR 1.65, 95% CI 1.25, 2.17). Respondents who had one or two smoker friends (OR 2.98, 95% CI 1.93, 4.60) and three or more smoker friends (OR 5.92, 95% CI 4.35, 8.05) were more likely to smoke than those who did not have any. Respondents who were neutral (OR 0.43, 95% CI 0.20, 0.91) and disagreed about the item “friends smoking” (OR 0.18, 95% CI 0.08, 0.39) were less likely to smoke than those who agreed with the item.

Conclusions

This study indicates that male students who have negative attitudes toward smoking, who do not have a father or friends who smoke, and are from affluent backgrounds exhibit low tendency to start smoking at a young age. This study provides some implications for tobacco control policies among male secondary school students in urban settings.

Association between Family and Friend Smoking Status and Adolescent Smoking Behavior and E-Cigarette Use in Korea

Smoking is harmful to the health of adolescents because their bodies are still growing. The aim of this study was to analyze the association between the smoking status of Korean adolescents' parents and friends and their own smoking behavior. The study assessed a nationwide sample of 72,060 middle and high students from the 10th Korea Youth Risk Behavior Web-based Survey (2014). Descriptive analysis, chi-square tests, and multiple logistic regression analysis were used to probe the association between family and friend smoking status and adolescent smoking behavior. The current cigarette smoking rates were 13.3% of boys and 4.1% of girls. The corresponding rates for electronic cigarette smoking were 4.1% and 1.5%, respectively. Higher exposure to secondhand smoke, smoking by any family member, more friends smoking, and witnessed smoking at school were associated with current smoking and electronic smoking. The smoking status of family and friends was significantly related to adolescent smoking behavior. These results should be considered in designing programs to control adolescent smoking.

Harsh Parenting, Deviant Peers, Adolescent Risky Behavior: Understanding the Meditational Effect of Attitudes and Intentions

Although research supports the influence of parents and peers on adolescent risky behavior, less is known about mechanisms proposed to explain this relation. This study examined the influence of adolescent attitudes and intentions about such behaviors. Prospective, longitudinal data came from rural youth who participated throughout adolescence (n= 451). Observed harsh parenting and relationship with deviant peers was assessed in early adolescence, attitudes and intentions were measured during middle adolescence, and risky behavior was assessed in late adolescence. Results indicated that parenting and deviant peers was related to engagement in tobacco use, alcohol use, and risky sexual behaviors. Moreover, attitudes and intentions mediated this relationship even after parent use and adolescent early involvement in these behaviors were taken into account.

Within-Family Discussion on Harmful Effects of Smoking and Intention to Initiate Smoking Among European Adolescents

OBJECTIVE

The main objective of this study was to determine the impact of discussion within family about the harmful effects of smoking on intention to initiate smoking in the long term among nonsmoking adolescents.

METHODS

Data from Global Youth Tobacco Survey for 25 European countries were used. The outcomes of interest were, therefore, the intention to initiate smoking 1 and 5 years after the survey. Discussion within family about harmful effect of smoking was the main predictor with age, sex, and smoking status of parents, friends, and classmates as covariates. The association between predictors and outcomes was assessed through multiple regression analysis.

RESULTS

A total of 118,703 nonsmoking adolescents were included. Within-family discussion significantly reduced the odds of intention to initiate smoking 1 and 5 years later. Intention to initiate smoking also was significantly associated with the smoking status of friends, classmates, and parents, except for father's smoking status, which was not associated with intention to initiate 1 year later.

CONCLUSIONS

This study demonstrated that within-family discussion about the harmful effects of smoking may contribute to reduce the intention to start smoking among adolescents in the long term. Such a discussion was associated with reduced intention to smoke even when adjusting for parent/friend and classmate smoking.

The relation of socio-ecological factors to adolescents’ health-related behaviour

Purpose

– The purpose of this paper is to identify and describe adolescents’ health-related behaviours from a socio-ecological perspective. Socio-ecological factors have been widely shown to be related to health behaviours (smoking, alcohol consumption, physical activity and diet) in adolescence and to affect health. The review integrates evidence with socio-ecological factors (social relationships, family, peers, schooling and environment).

Design/methodology/approach

– The data were collected from electronic databases and by manual search consisting of articles (n=90) published during 2002-2014. The selected articles were analysed using inductive content analysis and narrative synthesis.

Findings

– The findings suggest that there was a complex set of relations connected to adolescent health behaviours, also encompassing socio-ecological factors. The authors tentatively conclude that socio-ecological circumstances influence adolescents’ health-related behaviour, but that this review does not provide the full picture. There seemed to be certain key factors with a relation to behavioural outcomes that might increase health inequality among adolescents.

Practical implications

– School health education is an important pathway for interventions to reduce unhealthy behaviours among adolescents including those related to socio-ecological factors.

Originality/value

– Some socio-ecological factors were strongly related to health behaviours in adolescence, which may indicate an important pathway to current and future health. This paper may help schoolteachers, nurses and other school staff to understand the relationships between socio-ecological factors and health-related behaviours, which may be useful in developing health education to reduce health disparities during adolescence.

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.

Psychosocial Determinants of Intention to Use Tobacco Among Adolescents in India

Aim

The present study aims to determine the psychosocial factors associated with ‘intention to use tobacco’, because it is influenced by social norms and beliefs about smoking.

Method

A cross-sectional survey on a random sample of 665 individuals, aged 15-20 years, was conducted using a pretested questionnaire. Three logistic regression models were constructed to identify determinants of ‘intention to use tobacco’, with the total sample, with respondents under 18 years old, and with respondents 18 years old and above.

Results

Odds of intention to use tobacco were higher when friends used tobacco products, and perceived no negative effects on health. Parental use of tobacco increased the odds of intention to use tobacco, and a similar effect was observed when a celebrity was followed as a role model. Approval of occasional use of tobacco increased the odds of intention to use tobacco. Communication with parents about harmful effects of tobacco reduced the odds of intention to smoke among respondents younger than 18 years old.

Conclusion

Social factors and perception of risk significantly influenced the intention to use tobacco. Study results are useful in designing interventions for prevention of tobacco use among adolescents.

The relationship between secondhand smoke exposure, pro-tobacco social influences, and smoking susceptibility among nonsmoking Zambian adolescents

BACKGROUND

We tested the hypothesis that the extent of secondhand smoke (SHS) exposure among nonsmoking adolescents would be associated with their overall exposure to pro-tobacco social influences.

METHODS

Data were analyzed using descriptive and multivariate methods from the 2011 Zambia Global Youth Tobacco Survey.

RESULTS

The odds of SHS exposure increased with increasing exposure to pro-tobacco advertisements. About 39.5% of the gap in SHS exposure between nonsmokers with low versus high smoking susceptibility was attributable to differences in parental or peer smoking.

CONCLUSIONS

Sustained efforts are needed to denormalize tobacco use in order to reduce youth susceptibility to tobacco use.

Hong Kong Chinese adolescents' self-reported smoking and perceptions of parenting styles

BACKGROUND

Adolescent smoking has been associated with general parenting style, although potential differences between fathers and mothers were seldom investigated, especially in non-Western populations.

PURPOSE

The aim of this study is to investigate associations between Hong Kong adolescents' smoking and their perceptions of paternal and maternal parenting styles.

METHOD

In a school-based survey in 2006-2007, 33,408 adolescents (44.6 % boys; mean age 14.5 ± 1.3 years) provided information on smoking and the frequency of care and control by each parent, who was classified into one of four adolescent-reported parenting styles: authoritative (high care, high control), authoritarian (low care, high control), permissive (high care, low control), or neglectful (low care, low control). Logistic regression was used to calculate adjusted odds ratios (AORs) of current smoking (past 30 days) for parenting variables, considering potential effect modification by age, sex and parental smoking.

RESULTS

Maternal care and control were strongly and significantly associated with lower odds of adolescent current smoking. However, such association was weak for paternal care and observed only in girls. Conversely, paternal control was positively associated with current smoking, especially if the father smoked. The lowest AORs of current smoking were associated with authoritative mothers, permissive fathers and combinations of maternal and paternal parenting styles with an authoritative mother whether or not the father was authoritative.

CONCLUSION

Maternal care, control and authoritative parenting were associated with lower odds of adolescent smoking in Hong Kong. Paternal care was only weakly associated with lower odds of adolescent smoking, and paternal control was even associated with higher odds of smoking.

Use of Internet viral marketing to promote smoke-free lifestyles among Chinese adolescents

Purpose

Youth smoking is a global public health concern. Health educators are increasingly using Internet-based technologies, but the effectiveness of Internet viral marketing in promoting health remains uncertain. This prospective pilot study assessed the efficacy of an online game-based viral marketing campaign in promoting a smoke-free attitude among Chinese adolescents.

Methods

One hundred and twenty-one Hong Kong Chinese adolescents aged 10 to 24 were invited to participate in an online multiple-choice quiz game competition designed to deliver tobacco-related health information. Participants were encouraged to refer others to join. A zero-inflated negative binomial model was used to explore the factors contributing to the referral process. Latent transition analysis utilising a pre- and post-game survey was used to detect attitudinal changes toward smoking.

Results

The number of participants increased almost eightfold from 121 to 928 (34.6% current or ex-smokers) during the 22-day campaign. Participants exhibited significant attitudinal change, with 73% holding negative attitudes toward smoking after the campaign compared to 57% before it. The transition probabilities from positive to negative and neutral to negative attitudes were 0.52 and 0.48, respectively. It was also found that attempting every 20 quiz questions was associated with lower perceived smoking decision in future (OR  = 0.95, p-value <0.01).

Conclusions

Our online game-based viral marketing programme was effective in reaching a large number of smoking and non-smoking participants and changing their attitudes toward smoking. It constitutes a promising practical and cost-effective model for engaging young smokers and promulgating smoking-related health information among Chinese adolescents.

Assessing the psychometric properties of smoking-related attitudes, self-efficacy, and intention among a diverse population of middle school students

Large-scale surveys frequently assess smoking-related attitudes, self-efficacy and intention to understand differences in smoking behavior. However, a critical assumption is that measures of these determinants should be equivalent across different subgroups of a target population. The current study examined the factorial invariance of measures of smoking-related attitudes, self-efficacy, and intention with a large sample (N=13,733) of middle school students from 25 schools in Texas. We examined five levels of factorial invariance using a sequential process, in which increasingly constrained models assess the equivalence of a measure across subgroups. Strong factorial invariance provided a good fit for the model across all of the subgroups: race/ethnicity (CFI=.93), gender (CFI=.96), age (CFI=.95), and grade level (CFI=.95). Invariance results provide strong empirical support for the validity of smoking-related attitudes, self-efficacy, and intention measures across race/ethnicity, gender, age, and grade level for middle school students.

Quantifying the effect of changes in state-level adult smoking rates on youth smoking

OBJECTIVE

Quantify the degree to which changes in state-level adult smoking prevalence subsequently influence youth smoking prevalence.

DESIGN

Analysis of data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) collected from 1995 to 2006 and the National Youth Tobacco Survey (NYTS) collected from 1999 to 2006.

SETTING AND PARTICIPANTS

Adults 25 years or older who completed the TUS-CPS and youth in middle and high school who completed the NYTS.

MAIN OUTCOME MEASURES

Current smoking among middle and high school students as a function of the change in state-level adult smoking, controlling for individual-level sociodemographic characteristics and state-level tobacco control policy variables.

RESULTS

Among middle school students, declines in state-level adult smoking rates are associated with lower odds of current smoking (P < .05), and each doubling of the decline in adult smoking rates is associated with a 6.0% decrease in youth smoking. Among high school students, declines in state-level adult smoking rates are not associated with current smoking. Higher cigarette prices were associated with lower odds of smoking among middle and high school students. Greater population coverage by smoke-free air laws and greater funding for tobacco control programs were associated with lower odds of current smoking among high school students but not middle school students. Compliance with youth access laws was not associated with middle or high school smoking.

CONCLUSION

By quantifying the effect of changes in state-level adult smoking rates on youth smoking, this study enhances the precision with which the tobacco control community can assess the return on investment for adult-focused tobacco control programs.

Can an index of smokers' emotional status predict the chances of success in attempts to quit smoking?

Smoking cessation still is a great challenge for smokers and health care professionals. Most subjects try cigarettes in adolescence under predominant environmental influences, and some psychological features are clearly associated with the establishment of continuous cigarette use. As a result, it is acceptable to assume that the risk of becoming regular smokers should be higher for subjects exhibiting imperfect psychological well-being. Since nicotine exhibits recognized psychopharmacological actions, an important reason for smoking would be the comfort of smokers' emotional afflictions. In this scenario, cigarettes might be seen as effective coping instruments for smokers. We hypothesize that a simple measure covering major emotional features of smokers might become a useful instrument for predicting the chances of success in attempts to quit smoking. The development of this new test aimed to measure the degree of smokers' emotional imbalance has the potential to predict the chances of success in response to standard therapy, as well as the need for introduction of intensive individualized psychological or psychiatric interventions. Preliminary analyses of a new test called Smokers' Emotional Index (SEI) support such a hypothesis. The SEI scores showed significant correlations with the values of the Fagerström test of nicotine dependence (FTND) for adult smokers. More numerous and better correlation coefficients were also observed between aspects of smoking history with SEI punctuations than with FTND scores. A clinical trial is proposed to test this hypothesis that could help to improve the results of current approaches to smoking cessation.

Significant others, knowledge, and belief on smoking as factors associated with tobacco use in italian adolescents

Tobacco use is dramatically increasing among youth. Growing attention has been addressed towards possible predictors of smoking in such a population. We evaluated a sample of Italian adolescents to verify whether adults and peers might influence their smoking status. Cross-sectional study was conducted in 16 schools of North Italy. Data were collected from 2001 to 2010 by means of a self-administered questionnaire on sociodemographic data and individual/social possible predictors of smoking. 2,444 students (56.7% boys; 43.3% girls; mean = 14.32 ± 1.384 years) were analysed. 607 (24.8%) were current smokers; 1,837 (75.2%) were nonsmokers. The presence of smokers in the family, seeing teachers who smoke, the influence of friends, and the feeling of inferiority were predictors of youth smoking as well as unawareness of nicotine dangerous action to health. Running the logistic multivariate analysis with all the variables listed above in the same model, the strongest predictors of smoking were as follows: being unaware that pipe/cigar is harmful to health as cigarettes; not knowing that passive smoking is harmful to the growth of children; having seen teachers smoking. The present findings help to identify the variables that might favour smoking in youth. Such variables should become the target of prevention programs.

Youth's narratives about family members smoking: parenting the parent- it's not fair!

BACKGROUND

Successful cancer prevention policies and programming for youth must be based on a solid understanding of youth's conceptualization of cancer and cancer prevention. Accordingly, a qualitative study examining youth's perspectives of cancer and its prevention was undertaken. Not surprisingly, smoking (i.e., tobacco cigarette smoking) was one of the dominant lines of discourse in the youth's narratives. This paper reports findings of how youth conceptualize smoking with attention to their perspectives on parental and family-related smoking issues and experiences.

METHODS

Seventy-five Canadian youth ranging in age from 11-19 years participated in the study. Six of the 75 youth had a history of smoking and 29 had parents with a history of smoking. Youth were involved in traditional ethnographic methods of interviewing and photovoice. Data analysis involved multiple levels of analysis congruent with ethnography.

RESULTS

Youth's perspectives of parents and other family members' cigarette smoking around them was salient as represented by the theme: It's not fair. Youth struggled to make sense of why parents would smoke around their children and perceived their smoking as an unjust act. The theme was supported by four subthemes: 1) parenting the parent about the dangers of smoking; 2) the good/bad parent; 3) distancing family relationships; and 4) the prisoner. Instead of being talked to about smoking it was more common for youth to share stories of talking to their parents about the dangers of smoking. Parents who did not smoke were seen by youth as the good parent, as opposed to the bad parent who smoked. Smoking was an agent that altered relationships with parents and other family members. Youth who lived in homes where they were exposed to cigarette smoke felt like a trapped prisoner.

CONCLUSIONS

Further research is needed to investigate youth's perceptions about parental cigarette smoking as well as possible linkages between youth exposed to second hand smoke in their home environment and emotional and lifestyle-related health difficulties. Results emphasize the relational impact of smoking when developing anti-tobacco and cancer prevention campaigns. Recognizing the potential toll that second-hand smoke can have on youth's emotional well-being, health care professionals are encouraged to give youth positive messages in coping with their parents' smoking behaviour.