Why children start smoking cigarettes: predictors of onset

[Smoking in Netflix feature films and youth protection]

BACKGROUND

With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors.

AIM

To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes.

METHOD

A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people.

RESULTS

Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524).

DISCUSSION

Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

[Use of tobacco cigarettes, e-cigarettes, and shishas among children and adolescents: Results of the "Präventionsradar" from 2016 to 2023]

AIM

To measure trends in the use of various smoking products among children and adolescents from 2016 to 2023.

METHOD

The data is based on seven waves of the "Präventionsradar", a school-based epidemiological study in grades 5 to 10. The primary endpoints of the study were the lifetime and monthly prevalence of the use of tobacco cigarettes, e-cigarettes, shisha and the use of at least two of these smoking products (combined use). Prevalence estimates are based on logistic regression models.

RESULTS

The analysis was based on 94,127 questionnaires. The sex ratio was balanced (49% female), mean age was 13 years (SD=1.8). In 2022/2023, the lifetime prevalence of smoking tobacco cigarettes was 18.8% (95% CI 18.1-19.5), of e-cigarettes 23.5% (95% CI 22.8-24.3), of shisha 14.0% (95% CI 13.4-14.7) and combined use 19.0% (95% CI 18.3-19.7). The monthly prevalence of smoking tobacco cigarettes was 5.9% (95% CI 5.5-6.4), of e-cigarettes 7.0% (95% CI 6.5-7.4), of shisha 3.2% (95% CI 2.8-3.5) and combined use 4.8% (95% CI 4.4-5.2). The following trends in lifetime prevalence have emerged since 2016: tobacco cigarettes (-3.0 percentage points), e-cigarettes (+1.8 percentage points), shisha (-9.2 percentage points), combined use (-2.7 percentage points). In the years of the COVID-19 pandemic, youth smoking decreased and rose again post-COVID with the exception of shisha.

DISCUSSION

The use of smoking products in adolescence occurs frequently. Over the observational period, a trend reversal towards e-cigarettes as the most popular product among children and young people is most likely. In addition, the combined use of several smoking products has become a common pattern of consumption. Consistent preventive measures are required in order to achieve the goal of a smoke-free society in 2040.

Smoking in Popular Streaming Shows and Youth Protection in Germany

Aim was to investigate the amount of smoking in popular streaming series in Germany with a focus on the comparison between series recommended for adults versus youth. The sample was drawn from the 35 highest user-rated streaming series, that released 1794 new episodes between January 1, 2017 and December 31, 2020. One-third of the episodes (N = 598) were randomly selected and analyzed for smoking content. The age ratings of these episodes ranged from 6 to 18 years, with categories of "6", "12", "16" and "18" years. Ten of the 35 shows (28.6%) were completely smoke-free, 25 shows (71.4%) had at least one episode with smoking. Of all analyzed episodes, 25.1% contained smoking (range = 1 to 36 smoking scenes; median = 4). There was a statistically significant association between episode age rating and the presence of smoking (χ2[3] = 9.1; p = 0.028; Spearman's rho = 0.11): The proportion of episodes with smoking was 0% for episodes with age ratings below 12 years, 20.4% for age ratings "12", 28.3% for age ratings "16", and 32.4% for age ratings "18". This association differed between streaming services, but all services had smoking in episodes rated for youth. Smoking is common in popular streaming series. None of the streaming services meet the recommendations of the WHO Framework Convention on Tobacco Control to reliably restrict young people's access to media content that depicts smoking.

Regional socioeconomic deprivation in Germany and nicotine use among children and adolescents

To assess the association of regional socioeconomic deprivation and nicotine use, survey data from 17,877 pupils aged 9-17 years were analysed. Lifetime use of combustible, e-cigarettes, and both products were the outcome variables. The German Index of Socioeconomic Deprivation was the exposure variable. Logistic regression models controlling for age, gender, school type, and sensation seeking were used to examine associations between regional socioeconomic deprivation and nicotine use. Ever use of combustible cigarettes was 17.8%, of e-cigarettes 19.6%, and of both products 13.4%. Compared to the most affluent area, the adjusted odds ratio of combustible cigarette use in the most deprived area was 2.24 (95% CI: 1.67-3.00), of e-cigarette use 1.56 (95% CI: 1.20-2.03), and of poly use 1.91 (95% CI: 1.36-2.69). Nicotine use among young people across ages and especially in socioeconomic-deprived areas was widespread. Nicotine control measures are urgently needed to reduce smoking and vaping in German adolescents.

[Use of tobacco cigarettes, e-cigarettes, and shishas among children and adolescents: Results of the 'Präventionsradar' from 2016 to 2023]

AIM

To measure trends in the use of various smoking products among children and adolescents from 2016 to 2023.

METHOD

The data is based on seven waves of the "Präventionsradar", a school-based epidemiological study in grades 5 to 10. The primary endpoints of the study were the lifetime and monthly prevalence of the use of tobacco cigarettes, e-cigarettes, shisha and the use of at least two of these smoking products (combined use). Prevalence estimates are based on logistic regression models.

RESULTS

The analysis was based on 94,127 questionnaires. The sex ratio was balanced (49% female), mean age was 13 years (SD=1.8). In 2022/2023, the lifetime prevalence of smoking tobacco cigarettes was 18.8% (95% CI 18.1-19.5), of e-cigarettes 23.5% (95% CI 22.8-24.3), of shisha 14.0% (95% CI 13.4-14.7) and combined use 19.0% (95% CI 18.3-19.7). The monthly prevalence of smoking tobacco cigarettes was 5.9% (95% CI 5.5-6.4), of e-cigarettes 7.0% (95% CI 6.5-7.4), of shisha 3.2% (95% CI 2.8-3.5) and combined use 4.8% (95% CI 4.4-5.2). The following trends in lifetime prevalence have emerged since 2016: tobacco cigarettes (-3.0 percentage points), e-cigarettes (+1.8 percentage points), shisha (-9.2 percentage points), combined use (-2.7 percentage points). In the years of the COVID-19 pandemic, youth smoking decreased and rose again post-COVID with the exception of shisha.

DISCUSSION

The use of smoking products in adolescence occurs frequently. Over the observational period, a trend reversal towards e-cigarettes as the most popular product among children and young people is most likely. In addition, the combined use of several smoking products has become a common pattern of consumption. Consistent preventive measures are required in order to achieve the goal of a smoke-free society in 2040.

Parental Smoking in Childhood as a Smoking Risk Factor Throughout Middle Age

INTRODUCTION

Children of people who smoke have a well-documented higher risk of smoking initiation. However, little is known about the persistence of the association between parental smoking and children's own smoking as they age.

METHODS

This study uses data collected by the Panel Study of Income Dynamics collected between 1968 and 2017 and investigates the association between parental smoking and children's own smoking through middle age and how it may be modified by adult children's SES using regression models. The analysis was conducted between 2019 and 2021.

RESULTS

The results show an increased risk of smoking among adult children of parents who smoked. Their odds were elevated in young adulthood (OR=1.55, 95% CI=1.11, 2.14), established adulthood (OR=1.53, 95% CI = 1.08, 2.15), and middle age (OR=1.63, 95% CI=1.04, 2.55). Interaction analysis shows that this statistically significant relationship is limited to high-school graduates only. Among people who smoked in the past or who currently smoke, children of people who smoked had longer average smoking duration. Interaction analysis shows that this risk is limited to high-school graduates only. The adult children of people who smoked and have less than a high-school education, some college, and college graduates did not have a statistically significantly increased risk of smoking or longer smoking duration.

CONCLUSIONS

The findings highlight the durability of early life influences, especially for people with low SES.

[Smoking in Netflix feature films and youth protection]

BACKGROUND

With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors.

AIM

To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes.

METHOD

A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people.

RESULTS

Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524).

DISCUSSION

Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

Modelling Determinants of Deaths Attributable to External Causes Among Adults in India

The study aimed at finding the risk factors associated with adult mortality (15-59 years) due to external causes (accidents, suicide, poisoning, homicide, and violence). Using National Family Health Survey data-4 consisting of 1,756,867 sample, we applied a Robust Poisson Regression Model to determine the potential risk factors. Findings suggest that the highest proportion of deaths due to external causes was in the age group 20-24 years. The prevalence of these deaths was higher among older adults (age 50 years and above). The risk was more among males (Incident Rate Ratio (IRR) for females is: 0.29, p < 0.001), rural residents (IRR: 1.16, p < 0.001), exposed to mass-media (IRR: 1.08, p < 0.05), residing in female-headed households, in households having a member with higher education. This risk decreased for large families (IRR: 0.89, p < .001). A need to strengthen awareness and mentorship programs for young-adults and middle-aged people to control such avoidable deaths is recommended.

The potential of DNA methylation as a biomarker for obesity and smoking

DNA methylation is an epigenetic modification that has consistently been shown to be linked with a variety of human traits and diseases. Because DNA methylation is dynamic and potentially reversible in nature and can reflect environmental exposures and predict the onset of diseases, it has piqued interest as a potential disease biomarker. DNA methylation patterns are more stable than transcriptomic or proteomic patterns, and they are relatively easy to measure to track exposure to different environments and risk factors. Importantly, technologies for DNA methylation quantification have become increasingly cost effective-accelerating new research in the field-and have enabled the development of novel DNA methylation biomarkers. Quite a few DNA methylation-based predictors for a number of traits and diseases already exist. Such predictors show potential for being more accurate than self-reported or measured phenotypes (such as smoking behavior and body mass index) and may even hold potential for applications in clinics. In this review, we will first discuss the advantages and challenges of DNA methylation biomarkers in general. We will then review the current state and future potential of DNA methylation biomarkers in two human traits that show rather consistent alterations in methylome-obesity and smoking. Lastly, we will briefly speculate about the future prospects of DNA methylation biomarkers, and possible ways to achieve them.

Social determinants of smoking among school adolescents in Beijing, China

INTRODUCTION

Understanding the social determinants that influence adolescent smoking behavior has a meaningful impact on adolescent health. Few studies have simultaneously analyzed the impact of teacher smoking and peer smoking on adolescent smoking. Therefore, the present study aims to investigate the impact of teacher smoking, peer smoking, and other social factors, on adolescent smoking.

METHODS

The participants were drawn from schools in Beijing, China, in 2011, 2013, and 2015, using a multi-stage random group sampling method. The number of schools selected for each year was 160. The study participants were 57240 adolescents aged 8-19 years. The generalized linear model with a binomial distribution and logarithmic link function was used to estimate the influence of social determinants on adolescent smoking behavior.

RESULTS

The results show that both teacher smoking and peer smoking were significantly associated with adolescent smoking. Compared to adolescents whose teachers did not smoke, the prevalence ratio (PR) was 1.28 for adolescents with one teacher who smoked and 1.34 for adolescents with two or more teachers who smoked (95% CI: 1.16-1.41/1.23-1.46, p<0.001/0.001, respectively). Compared to adolescents whose peers did not smoke, the prevalence ratio (PR) was 3.73 for adolescents with one peer who smoked and 8.52 for adolescents with two or more peers who smoked (95% CI: 3.20-4.35/7.48-9.69, p<0.001/0.001, respectively).

CONCLUSIONS

Teacher smoking and peer smoking are significant social determinants of adolescent smoking. Prevention programs should concurrently target peer groups, school settings, and individual students.

Association Between Graphic Health Warning Labels on Cigarette Packs and Smoking Cessation Attempts in Korean Adolescent Smokers: A Cross-Sectional Study

Graphic health warning labels on cigarette packs inform smokers about the health risks associated with tobacco smoking. Adolescents are generally the main targets to influence by graphic health warning labels. This study investigated the association between graphic health warning labels on cigarette packs and attempts to quit smoking in South Korean adolescents. This cross-sectional study used data from the 2017 to 2019 Korea Youth Risk Behavior Web-based Survey, using multiple logistic regression for the analysis. The study population comprised 11,142 adolescents aged 12–18 years. The outcome variable was attempts to quit smoking among adolescent smokers who had seen graphic health warning labels. Attempts to quit smoking were higher among adolescent smokers who had seen graphic health warning labels compared to those who had not {boys, odds ratio (OR) = 1.72 [95% confidence interval (CI), 1.48–2.00]; girls, OR = 1.74 (95% CI, 1.33–2.28)}. The correlation was greater for adolescents who thought about the harm of smoking [boys, OR = 1.86 (95% CI, 1.60–2.16); girls, OR = 1.85 (95% CI, 1.41–2.43)] and the willingness to quit [boys, OR = 2.03 (95% CI, 1.74–2.36); girls, OR = 2.04 (95% CI, 1.55–2.68)] after seeing graphic health warning labels. Our findings indicate that graphic health warning labels on cigarette packs have the potential to lower smoking intentions of adolescents. We suggest that the use of graphic health warning labels is an effective policy-related intervention to reduce smoking in South Korean adolescents.

Factors associated with the onset of smoking and alcohol consumption: A cross-sectional study among Lebanese adolescents in schools

OBJECTIVES

This study aimed to evaluate factors and profiles associated with the earlier onset of cigarette/waterpipe smoking and alcohol consumption among Lebanese adolescents in schools.

METHODS

A total of 4000 adolescents (mean age = 15.31 ± 2.01 years) participated in this cross-sectional study. The standardized questionnaire was taken from the Health Behavior in School Children (HBSC) study in different countries (France, Belgium, and the USA) and adjusted to the Lebanese population. K-means clustering analysis was conducted to classify participants into three clusters according to their patterns (surrounded by smokers, surrounded by drinkers, and ease of talking to family members and friends) and Cox regression analyzes were conducted.

RESULTS

Participants were divided into three clusters. Cluster 1 (16.75% of participants) included adolescents with the lowest ease of talking to a family member or friend, with the latter smoking and drinking a lot (worst cluster). Cluster 2 (54.95%) included adolescents with moderate ease of talking to a family member and more to friends, surrounded by low-to-moderate smoking and alcohol consumption, particularly for a best friend (positive influence cluster). Finally, cluster 3 (28.30%) included adolescents with low ease of talking to friends, moderate ease of talking to a family member, and low-to-moderate smoking and alcohol consumption (low influence cluster). The results of the Cox regressions (taking the age at onset of smoking cigarettes and waterpipes as the dependent variables) showed that older age at onset of cigarette and waterpipe smoking was significantly associated with female participants and those belonging to clusters 2 and 3 compared to cluster 1. Moreover, a younger age at first alcohol use and getting drunk was significantly associated with living outside Beirut, whereas female gender and belonging to clusters 2 or 3 compared to cluster 1 were significantly associated with older age at first alcohol use and getting drunk.

CONCLUSION

This study identified risk factors (ease of talking as well as smoking and alcohol-drinking status of parents, siblings, and friends) and profiles related to early alcohol and cigarette/waterpipe use. These risk factors and profiles could help implement prevention campaigns to reduce substance use and improve adolescent health.

Maternal working hours and smoking and drinking in adolescent children: based on the Korean National Health and Nutrition Examination Survey VI and VII

Background

Adolescent smoking and drinking are influenced by parental supervision. This study aimed to investigate the gap in adolescent smoking and drinking experience rates and age at initiation according to maternal working hours.

Methods

Data from 1,580 adolescents aged 12–18 years and 1,172 working mothers of double-parent or single-mother households were selected from the Korean National Health and Nutrition Examination Survey (KNHANES) VI & VII data. Figures on adolescents' smoking and drinking rates and their ages at imitation were used. Maternal working hours were divided into < 40 hours, 40–52 hours, and > 52 hours to analyze whether smoking and drinking experience rates and age at initiation differ according to maternal working hours and by the child's sex. Maternal age, education level, household income, occupation, shift work, current smoking status, monthly drinking frequency and child's obesity, stress recognition and depressive mood were adjusted for in the statistical analyses.

Results

The odds for adolescents' smoking behavior were significantly higher with increasing maternal working hours in boys but not in girls. The odds for adolescents' drinking behavior were not significantly higher in both boys and girls. Regardless of the child's sex, there were no significant differences in the age of smoking and drinking initiation according to maternal working hours.

Conclusions

Adolescents of mothers who work long hours are at a higher risk of being exposed to smoking. Thus, our society needs to share the burden of raising children, which is concentrated on women, and employers and governments should support policies that can help prevent long working hours.

Perceived risk of harm from monthly cannabis use among US adolescents: National Survey on drug Use and Health, 2017

There has been a steady increase in cannabis use among US adolescents over the past decade. Perceptions of risk, specifically the belief that cannabis use is not harmful, may contribute to this increased use. The purpose of this study was to evaluate parental, school, and peer influence as protective factors in perceiving there is risk of harm from monthly cannabis use. Using the 2017 National Survey on Drug Use and Health (NSDUH), the study outcome was self-reported perceived risk of harm from monthly cannabis use amongst adolescents between ages 12 and 17. The exposures were parental monitoring and support, perception of school importance, extracurricular activity participation, peer attitudes towards cannabis use, and perception of peer cannabis use. Of 12,024 eligible adolescents, about 80% reported perceived risk of harm from monthly cannabis use. Multiple logistic regression models suggest the perception of risk of harm from monthly cannabis use was significantly associated with perception of peers using cannabis, perception of peers' disapproval of cannabis use, perception of school importance, and participation in extracurricular activities. Adolescents who perceived that monthly cannabis use was risky had high parental monitoring, low perception of peer use, high perception of peers' disapproval of cannabis use, high perception of school importance, and participated more in extracurricular activities. These findings suggest substance use prevention programs targeting adolescent attitudes and beliefs would benefit from leveraging peer influence, promoting extracurricular activities, and enhancing schoolwork to be more meaningful.

The Cigarette Smoking Initiation and Continuation in Adolescents Undergoing a Long-Term Behavioral Intervention

INTRODUCTION

Targeting adolescents' smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern Mediterranean region, on smoking initiation, continuation, and risk of current smoking in Iranian adolescents.

METHODS

The current analyses were conducted on 945 nonsmoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using a two-step cluster analysis, families were classified as high and low risk, based on parental risk factors of adolescents' smoking. Participants who failed to complete all the follow-ups (n = 99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation, and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status.

RESULTS

Mean age of adolescents was 15.08 ± 1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (hazard ratio = 0.71, 95% confidence interval: 0.51-0.99; p = .044) compared with control group. At the end of the fourth follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups.

CONCLUSIONS

Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long term.

IMPLICATIONS

Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families.

Assessing Differences in the Implementation of Smoke-Free Contracts-A Cross-Sectional Analysis from the School Randomized Controlled Trial X:IT

OBJECTIVE

The X:IT study is a school-based smoking preventive intervention that has previously been evaluated in a large randomized controlled trial (RCT) with good effects. However, the actual effect for participating students depends on the individual implementation. The aim of this study was to examine the implementation of smoke-free contract, which is one of the three main intervention components. Specifically, we examined whether it was implemented equally across family occupational social class (OSC), separately for boys and girls, the joint effect of OSC and gender, and the participants' own reasons for not signing a contract.

RESULTS

Overall, the smoke-free contract was well implemented; 81.8% of pupils (total N = 2.015) signed a contract (girls 85.1, boys 78.6%). We found a social gradient among girls; more than 90% were in OSC group I vs. 75% in group VI. Among boys, however, we found no difference across OSC. Boys in all the OSC groups had about half the odds (i.e., medium OSC boys: OR = 0.48 (95% CI: 0.32-0.72) of having a smoke-free contract compared to girls from a high OSC.

CONCLUSION

future interventions should include initiatives to involve families from all OSC groups and allow for different preferences among boys and girls.

Racial Disparities in School Lunch Program Participation and Cigarette Use: Evidence from Arizona Youth Survey Data

Background: Cigarette and other tobacco product use among youth has become a serious public health issue in the United States. Thus, it is important to understand the social and contextural factors of cigarette use, especially for the young population. This study explores the relationship between participation in the National School Lunch Program (NSLP) and youth cigarettes use. Further, this study examines how this relationship differs across racial/ethnic groups. Methods: The 2016 Arizona Youth Survey (n = 34,373) data and multivariate logistic regressions were used to examine the association between NSLP participation (free and reduced-cost) and youth cigarette use, both lifetime and past 30-day smoking behaviors. In addition, subgroup analyses were conducted to test the racial disparities in NSLP participation and cigarette use. Results: Results showed that free lunch participation was associated with significantly higher odds of youth cigarette use, both lifetime (OR = 1.25; p < .001) and in the past 30-days (OR = 1.14; p < .05). However, reduced-cost lunch participation was associated with significantly higher odds only for lifetime cigarette use (OR = 1.20; p < .01). Subgroup analyses revealed differences across the six racial/ethnic groups. White and Latinx youth showed a significant relationship between NSLP participation and lifetime cigarette smoking, whereas only Latinx youth showed a significant relationship between NSLP participation and past 30-day smoking. Implications: The findings suggest that intervention approaches to smoking cessation and prevention should be tailored to different racial/ethnic groups to account for their differences. Given the findings that youth (especially Latinxs) who participate in free and reduced-cost lunch programs are at a higher risk of using cigarettes than youth who do not, this study suggests that health intervention programs can enhance their reach and effectiveness by building partnerships with schools with sizable NSLP programs.

Why Are National Estimates So Different? A Comparison of Youth E-Cigarette Use and Cigarette Smoking in the MTF and PATH Surveys

OBJECTIVE

We compared estimates of adolescents' nicotine product use and perceptions of harm from two national surveys: Monitoring the Future (MTF) and Population Assessment of Tobacco and Health (PATH). We explored one explanation for the different estimates for nicotine product use and adolescents' perceptions of harm.

METHOD

We used data source triangulation examining 30-day e-cigarette use and cigarette smoking, beliefs about harm, and friends' use of these products in two samples of adolescents from the 2015-2016 MTF and PATH samples.

RESULTS

Differences were found, with MTF reporting higher prevalence rates in both past-30-day e-cigarette use (12.4% vs. 6.7%) and cigarette smoking (8.6% vs. 5.1%) when compared with PATH. Differences were significant at the .001 alpha level. MTF respondents were less likely than PATH respondents to view both e-cigarettes (17.7% vs. 48.6%) and cigarettes (75.6% vs. 82.4%) as harmful. The unadjusted odds ratio (OR) shows that PATH respondents had significantly lower odds of indicating either e-cigarette (OR = 0.509, 95% confidence interval [CI] [0.400, 0.648]) or cigarette smoking (OR = 0.571, 95% CI [0.433, 0.753]) when compared with MTF respondents. However, these differences in e-cigarette use (adjusted odds ratio [AOR] = 0.849, 95% CI [0.630, 1.144]) and cigarette smoking (AOR = 0.829, 95% CI = [0.578, 1.189]) were mediated when additional predictors were included in the model (i.e., friends use, risk of harm).

CONCLUSIONS

Substantial differences were found between national surveys estimating population rates of e-cigarette use and cigarette smoking. Data source triangulation allowed for new explanations for several of the disparate nicotine use estimates between MTF and PATH.

School policies and smoking intention in a Swiss sample of adolescents

The majority of today's adult smokers took up the habit during adolescence. The school community and the rules it imposes are important factors that can influence adolescents' smoking intention and behaviour. Research on the effect of school tobacco policies on adolescents' smoking concludes with mixed results. Our study aims to look at the influence of these policies on the intention to smoke and to know if this relation is mediated by individual and environmental factors. The study includes information on social norms, attitude towards smoking and smoking intention from 4515 students of 32 Ticino middle schools and on the tobacco policy implemented in this school. Linear regression indicates a marginal impact of school policy on intention to smoke. Schools that strongly enforce tobacco policy obtain an increase in their students' intention to smoke, while schools that implement assistance programmes to overcome tobacco use decrease intention to smoke. Mediation models show that the influence of some of tobacco policy dimensions on the intention to smoke is mediated by personal attitudes towards smoking, beliefs about health consequences of smoking and perceived peers smoking. Increasing visibility of tobacco policies and having tobacco prevention programmes have stronger positive effects on smoking intention than other policy dimensions, but only through the mediation of individual and environmental factors.

The First Cigarette Smoking Experience and Future Smoking Behaviors Among Adolescents with Different Parental Risk: a Longitudinal Analysis in an Urban Iranian Population

BACKGROUND

Longitudinal research among Iranian adolescent smoking is limited. The current study aimed to investigate (1) the first smoking experience (FSE) and future smoking behaviors of adolescents with different parental risk factors and (2) the association between age of the FSE and future smoking behaviors over a 12-year follow-up.

METHOD

Based on Tehran Lipid and Glucose Study (TLGS) database, 1487 adolescents (12-18 years) with complete baseline parental data were recruited. Using two-step cluster analysis, families were classified as either high or low risk; these were based on parental risk factors including age, education, employment, and smoking status. Participants were examined four times in 12 years and their data were used for survival analysis. After exclusion of 24 cases who were smokers at baseline, Cox proportional hazard modeling was used to evaluate the effect of parental clusters on the FSE in 1463 nonsmoking adolescents who completed all prospective follow-ups. Logistic regression analysis was used to examine the effect of the age of FSE on future smoking behaviors.

RESULTS

The mean age of adolescents was 14.63 ± 2.07 years at baseline. Adolescents in the high-risk cluster group were 49% more likely to try smoking for their first time, and 55% more likely to smoke in the future. Compared with girls, boys had 83% higher chance of trying their first cigarette. Moreover, 1-year delay in the FSE resulted in 25% reduction in the probability of smoking in the future.

CONCLUSION

The findings show that compared with adolescents living in low-risk families, teenagers living in high-risk families are at greater risk of smoking at an earlier age; therefore, this group could benefit from gender- and culture specific preventive interventions.

Prevalence, patterns and sociocultural factors associated with use of tobacco-based dentifrices (Gul) in India

BACKGROUND

India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4%). Gul is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of Gul and its social determinants among adults in the capital city of India, Delhi.

METHODS

The cross-sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for Gul users to assess practice and pattern of use.

RESULTS

The overall prevalence of Gul users was found to be 4.9% with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7%) and unskilled workers (45.2%). 74.9% started using Gul to treat dental pain with 93.47% of them reporting pain relief.

CONCLUSION

Gul usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of Gul usage.

The theory of planned behavior as a behavior change model for tobacco control strategies among adolescents in Botswana

Background

Behavioral intentions (motivational factors), attitudes, subjective norm (social pressures), and perceived behavioral control promote or discourage smoking behavior among adolescents.

Objective

To assess students’ behavioral intentions, attitudes, subjective norms and perceived behavioral control on smoking using the Theory of Planned Behavior. The prevalence of smoking among the adolescents is also calculated.

Methods

In this cross-sectional study, structured self-administered questionnaires were used to collect data from adolescents in primary and secondary schools. Data on demographics, behavioral intentions, attitudes, subjective norms, and perceived behavioral control towards smoking were collected. Pearson product moment correlations and logistic regression models were used to determine factors associated with current smoking.

Results

A total sample of 2554 (mean age = 15; Range = 12–18 years) students participated in the study. Twenty-nine percent (n = 728) of the students had tried smoking at least once. Smoking was predicted by attitudes, subjective norms, perceived behavioral control and intention.There was a strong association between having a parent or guardian, caregiver or close friend who smoked (p < 0.001) and being a smoker. The majority of students (57%) conveyed that adults talked to them about the harmful effects of cigarette smoking and 50% had discussed smoking concerns with their friends. Students who had positive attitudes towards smoking like “smoking makes you confident” were more likely to be current smokers (OR: 1.63, 95% CI: 1.03–2.59). The feeling or conviction that they could refuse a cigarette if offered was an impediment from smoking (OR: 0.18, 95% CI: 0.13–0.26).

Conclusions

Attitudes, subjective norms, and perceived behavioral control contributed significantly to the students' smoking. Right attitudes must be cultivated and behavioral control must be strengthened for early effective interventions to curtail smoking among adolescents.

Electronic Cigarette and Cigarette Social Environments and Ever Use of Each Product: A Prospective Study of Young Adults in Southern California

BACKGROUND

A supportive youth cigarette social environment, for example, friends' approval of use, leads to cigarette use initiation, and cigarette users develop a more supportive social environment. Whether there is a bidirectional relationship of electronic cigarette (e-cigarette) social environment with e-cigarette use has not been studied.

METHODS

Prospective data were collected from 1441 Children's Health Study participants in 2014 (median age = 17.3 years) and at follow-up 1.5 years later. Associations were examined of (1) supportive e-cigarette social environment with subsequent e-cigarette use initiation and (2) baseline e-cigarette use with supportive e-cigarette social environment at follow-up (among those with a nonsupportive baseline social environment).

RESULTS

Participants with three to four friends using e-cigarettes at baseline (vs. no friends) had an odds ratio (OR) of 4.08 of subsequent initiation (95% confidence interval [CI] = 1.96 to 8.49); those with best friends who would have a very friendly (vs. unfriendly) reaction to e-cigarette use had an OR of 2.54 of initiation (95% CI = 1.57 to 4.10); and those with someone in the home using e-cigarettes had an OR of 1.94 of initiation (95% CI = 1.19 to 3.15). Participants who had ever used e-cigarettes at baseline developed a supportive social environment at follow-up (OR of 2.06 of having any friends who used e-cigarettes [95% CI = 1.29 to 3.30] and OR of 2.33 of having friends who were friendly toward use [95% CI = 1.32 to 4.11]). Similar bidirectional associations were observed between ever cigarette use and a supportive cigarette social environment.

CONCLUSIONS

The bidirectional relationship between a supportive e-cigarette social environment and ever use of e-cigarettes was similar to that previously observed between cigarette social environment and cigarette use.

IMPLICATIONS

Disrupting the social acceptability of youth e-cigarette use merits consideration as a strategy for preventing initiation of e-cigarette use, just as the social denormalization of cigarette use has proven to be effective in preventing cigarette initiation.

The future state of patient engagement? Personal health information use, attitudes towards health, and health behavior

The past decade has given rise to interest in the effects of health care information on personal well-being. However, investigations to-date typically centered on mass communication programs in health rather than on individuals’ psychosocial characteristics, agency, and behaviors associated with their engagement with this information. Considering this gap, we examined whether the availability of personal health information is associated with health prevention behaviors in the United States. Using multivariable path analysis and data from the 2017 Health Information National Trends Survey, we investigate whether the use of personal health information is associated with positive, preventative health behaviors (healthy eating, tobacco smoking, and exercise), and if this relationship is mediated by patient confidence in their ability to care for themselves and by their self-perceived health status. Findings indicate that the use of health information, at low levels, is important for improving patient attitudes regarding their health status and confidence in caring for themselves. Perceived health-status and patient confidence, in turn, are associated with preventative health behaviors. Notably, too much information does not necessarily result in positive health behaviors among patients. Organizations may wish to critically assess how much information they make readily available to the populations they serve.

Intergenerational Transfer of Tobacco Use Behaviour from Parent to Child: A Case Control Study

Background:

Parental influence may be a strong modifiable risk factor in the initiation of Tobacco habits among young adults. Parenting style may modify the risk of initiation of Tobacco use.

Objective:

To examine the intergenerational transfer of Tobacco habits amongst the urban and tribal populations in Kerala.

Methodology:

A hospital based unmatched case control study was undertaken in urban and tribal health centres in Kerala, India. 239 cases (19-30 years of age using any form of Tobacco, 64.10% males) and 256 controls (35.90% males) were enrolled. Parental Tobacco exposure ascertainment was done by conducting in depth interviews using a validated structured questionnaire, parent bonding instrument and life grid technique. Multiple logistic regressions were performed.

Results:

The odds of a case initiating the habit of Tobacco use was nearly four times more when the parent was a Tobacco user [adjusted OR 4.26 (95% CI 2.39 – 7.58)] as opposed to controls. Among other covariates examined, low parental bonding with subject (especially father- warmth/care) was a strong risk factor for Tobacco usage [OR 2.17 (95% 1.11 – 4.23)]. The cases had nearly four times the probability of Tobacco uptake compared to controls if the mothers had no formal schooling [adjusted OR of 3.93 (95% CI, 2.12 – 7.26)].

Conclusion:

Parental use of Tobacco influences the uptake of Tobacco habits in their children, with the father’s parenting (low paternal warmth) being a strong risk factor.

The importance of social environment in preventing smoking: an analysis of the Dead Cool intervention

Background

An adolescent’s perceptions of their family’s and friends’ smoking attitudes and behaviour can influence their own uptake of smoking. There are two broad sources of such social influence: observing the behaviour directly, and assimilating attitudes.

Methods

We analysed data collected for the evaluation of Dead Cool, a school based smoking prevention intervention in Northern Ireland (n=480 in 20 clusters). The main analysis fits three nested logistic regression models predicting pre-intervention susceptibility to taking up smoking, as reflected in responses to three attitudinal questions. Model 1 includes only personal characteristics as explanatory factors. Model 2 adds the behaviour of friends and family that would provide an opportunity for social influence through observational learning. Model 3 adds the susceptibility of friends.

Results

Each additional group of variables improved the model fit (with reduced AIC and BIC). However, in the final model, only three variables were found to be statistically significant (p<0.05) in predicting susceptibility to smoking initiation: rebelliousness (OR [1.1,1.3]) from the personal characteristics group; and, in the observational learning group, being friends with a smoker (OR [1.0,2.9]) and frequency of being in the same room or car with someone smoking (OR [2.0,9.0] for most frequent). Adding the two measures of diffusion of susceptibility through the friendship network improved the model fit, but neither was found to be statistically significant.

Conclusions

The analysis provides additional evidence to support policies that could reduce children’s exposure to smoking behaviour, and potential subsequent smoking initiation. No conclusions could be drawn about the diffusion of smoking attitudes through the school friendship networks of children.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7485-7) contains supplementary material, which is available to authorized users.

Exploiting the "video game craze": A case study of the tobacco industry's use of video games as a marketing tool

BACKGROUND

Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry's role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry's interest in and use of video games to market their products to youth and young adults.

METHODS

We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games.

RESULTS

Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through.

CONCLUSIONS

Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments.

Socioeconomic factors associated with tobacco smoking among adult males in Sri Lanka

Background

Tobacco smoking is considered as a major public health issue worldwide. Reduction of tobacco usage has been one of the main government policies in Sri Lanka and the price of cigarettes has been raised several times in the last few years. The purpose of this study was to evaluate the socioeconomic factors associated with tobacco smoking among adult males in Sri Lanka.

Methods

A study was conducted in Gampaha district in Sri Lanka recruiting 365 tobacco smoking people and their spouses. Data regarding tobacco smoking were obtained using an interviewer administrated questionnaire.

Results

Frequency of tobacco smoking was negatively associated with the improvement of educational levels. Employment, monthly income, influence of friends, smoking frequency before price increment, weekly expenditure for smoking, low educational level and the age of first smoking exposure was significantly associated with tobacco smoking among smokers. According to the spouses, smoking frequency before price increment, weekly expenditure of the husbands of smoking and influence of friends, number on smoking friends, spouse’s employment and husband’s monthly income were factors associated with tobacco smoking of their husbands. In addition, smoking at home, at work places and at friend’s houses was significant with the frequency of daily smoking.

Conclusions

Increasing the price of tobacco products has no significant impact on smoking behaviors in Sri Lanka. The need for essential strategies to educate and motivate the smokers to stop smoking is required. Primary care health workers might play a major role in motivating smokers to quit smoking.

Social Norms and Smoking Risk in iTaukei Fijian Adolescent Women

OBJECTIVE

To investigate the association of a variety of social smoking exposures with cigarette smoking among iTaukei adolescent women in Fiji.

METHODS

Self-report data were collected in a representative sample of school-going iTaukei adolescent women (n=523). We fitted logistic regression models of current cigarette smoking with school, peer, media, and other social exposures to smoking as predictors.

RESULTS

Current cigarette smoking was associated with exposure to close friend, peer, and routine social smoking as well as higher prevalence of school peer smoking, but not parent tobacco use and media smoking exposures-in our fully adjusted model.

CONCLUSIONS

Peer and school-based smoking exposures may increase cigarette smoking risk in school-going iTaukei adolescent women and may be strategic interventional targets to augment existing preventive approaches.

Reports of perceived racial discrimination among African American children predict negative affect and smoking behavior in adulthood: A sensitive period hypothesis

We examined the prospective relations between a cultural risk factor, perceived racial discrimination (PRD), and subsequent negative affect and health behavior (smoking) in a panel of 889 African American children (part of the Family and Community Health Study). Cultural moderators (protective factors) of these relations were also examined. PRD was assessed six times from ages 10.5 (Wave 1) to 24.5 (Wave 6), and negative affect (anger and depressive symptoms) was assessed at Wave 2 (age 12.5) and Wave 6 (age 24.5). Results indicated that Wave 1 PRD predicted Wave 6 smoking, controlling for multiple factors related to smoking and/or PRD, including smoking at age 15.5. Structural equation models indicated that these relations between Wave 1 PRD and smoking were mediated by both early and later negative affect. The models also indicated that Wave 1 PRD had a direct impact on Wave 6 anger (assessed 14 years later), controlling for the effects of PRD on early affect. Cultural socialization was associated with lower rates of adolescent smoking, and it buffered the relation between PRD and Wave 6 anger. The impact of early PRD experiences along with suggestions for culturally informed interventions and preventive interventions that might buffer against early PRD effects are discussed.

Adolescent tolerance for deviance, cigarette smoking trajectories, and premature mortality: A longitudinal study

Cigarette smoking is a well-established cause of excess morbidity and mortality in the United States and globally. The current study builds on the existing literature by examining how smoking trajectories might be a mechanism through which adolescent tolerance for deviance predicts premature all-cause and tobacco-specific mortality. Participants were from a cohort-sequential study conducted in the Midwestern United States of the natural history of cigarette smoking from adolescence through midlife that collected nine waves of data from 1980 to 2011. For the current study, we selected participants who were measured at least once at age 18 or older and who did not die before age 24 (n = 7575). Participants' tolerance for deviance was assessed in adolescence, smoking trajectory group was based on self-reported smoking status during the first six waves of data collection, and cause of death for deceased participants (n = 222) was obtained from the National Death Index. Mediation analyses using the joint significance test were conducted separately for all-cause mortality and tobacco-specific mortality. Adolescent tolerance for deviance significantly predicted smoking trajectory group over and above the influence of covariates. Adolescents with higher tolerance for deviance were more likely to belong to any smoking trajectory group compared to abstainers, and membership in a smoking trajectory group characterized by early onset and heavy, persistent smoking was related to premature all-cause and tobacco-specific mortality. Finally, smoking trajectory group was a significant mediator of the relation between adolescent tolerance for deviance and all-cause mortality.

Risk factors associated with early smoking onset in two large birth cohorts

We use prospective data from the ongoing British Cohort Study (BCS) and Millennium Cohort Study (MCS) to: 1) document changes in the prevalence of childhood smoking onset; 2) assess whether broad historic shifts in key risk factors, such as maternal education, parental smoking, and peer childhood smoking, explain observed cohort changes in childhood smoking; and 3) evaluate whether inequalities in onset have narrowed or widened during this period. The children in these two studies were born 31 years apart (i.e., BCS in 1970; MCS in 2001), and were followed from infancy through early adolescence (n = 23,506 children). Our outcome variable is child self-reports of smoking (ages 10, 11). Early life risk factors were assessed via parent reports in infancy and age 5. Findings reveal that the odds of childhood smoking were over 12 times greater among children born in 1970 versus 2001. The decline in childhood smoking by cohort was partly explained by increases in maternal education, decreases in mothers' and fathers' smoking, and declines in the number of children whose friends smoked. Results also show that childhood smoking is now more linked to early life disadvantages, as MCS children were especially likely to smoke if their mother had low education or used cigarettes, or if the child had a friend who smoked. Although the prevalence of child and adult smoking has dropped dramatically in the past three decades, policy efforts should focus on the increased social inequality resulting from the concentration of early life cigarette use among disadvantaged children.

[School-based tobacco prevention: the "Be Smart - Don't Start" program]

The competition for smoke-free classes, the "Be Smart - Don't Start" program has been implemented in Germany since 1997. Using contract management techniques, school classes participating in the competition commit themselves to abstain from smoking for six months. Classes report on a regular basis whether they have stayed smoke-free or not. After the end of the competition period, successful classes participate in a prize draw. The competition aimes to influence social norms.Over the past 20 years, the competition has become a major school-based intervention to prevent smoking in Germany. Several studies addressed process and outcome evaluation, cost-benefit efficacy and iatrogenic effects. Following the evidence so far, the intervention is feasible for implementation in school routines, evokes positive feedback in teachers and students, and reveals a positive cost-benefit ratio. Findings from controlled studies imply that negative side-effects are unlikely to occur and that participation in the competition affects the progression of smoking positively at least in the short term.

Preventing tobacco in vocational high schools: study protocol for a randomized controlled trial of P2P, a peer to peer and theory planned behavior-based program

BACKGROUND

In France, the issue of youth smoking remains a major challenge for public health. School failure, socio-economic and socio-cultural backgrounds influence the initiation and maintenance of smoking behavior in adolescents. Vocational students are at particularly high risk of using psychoactive substances, including tobacco. One of the most important factors is the environment, whether family, friends or peers. Therefore, peer education has a positive potential to change smoking behavior of adolescents. It has also been demonstrated that the Theory of Planned Behavior (TPB) has yielded the best prediction of intentions and behavior, in several health domains, including on tobacco. However, it is usually confined to the measurement of processes by which interventions change behavior, rather than to the development of these interventions. The objective of this paper is to describe the protocol for a randomized controlled trial of a peer intervention based on the TPB on a highly exposed young population.

METHODS/DESIGNS

This is a cluster randomized controlled trial comparing an intervention group to a control group, randomized into clusters (professional schools and classes) and stratified in three departments (Hérault, Aude and Gard) in the Languedoc-Roussillon region. The primary issue is the prevalence of daily smoking at 24 months, defined by a daily tobacco use of at least 1 cigarette, validated by CO levels in exhaled air. The primary hypothesis is that intervention will lead to decrease the daily smoking prevalence of 10% between the intervention group and the control group during a 2-year follow-up.

DISCUSSION

The results from this trial will provide evidence on the effectiveness of an innovative peer-to-peer intervention based on the TPB.

TRIAL REGISTRATION

ISRCTN: 37336035 , Retrospectively registered 11/12/2015.

School-level disadvantage and failed cessation treatment among adolescent smokers

INTRODUCTION

While understanding factors that lead to successful adolescent smoking cessation outcomes is necessary, it is also prudent to determine factors and conditions that contribute to failure to quit smoking. The present study posits that adolescents' proximal environments, such as schools, may influence cessation treatment outcomes.

METHODS

Using aggregated and geographically-referenced data from multi-year school-based cessation trials with 14-19 year olds seeking cessation in 5 States of the USA, the present study developed and applied a tobacco-specific socio-spatial model inclusive of Hierarchical Linear Modeling. Specifically, this novel approach spatially joined individual data files (n=8855) with measures of school (n=807) and county socio-economic factors. Once linked multi-level analyses explored the extent to which cessation treatment failure was explained by the interplay of individual, school and county-level factors. Treatment was deemed as failing to meet its primary goals if participants continued to smoke cigarettes, measured 3-months post baseline.

RESULTS

Ten per cent of the variation in cessation treatment failure was attributable to school-level variables. Adolescent smokers were more likely to experience failure to quit in: a) school districts with large percentages of the population having less than high-school education, and b) schools with a higher ratio of students to teachers. The strength of the relationship between cessation self-efficacy and treatment success was further weakened among adolescents attending schools with higher percentages of students eligible for free or reduced lunch programs.

CONCLUSIONS

Findings implicate school-level socio-economic disadvantage as a significant factor inhibiting cessation, regardless of adolescent self-efficacy to quit smoking. Understanding the interplay of proximal school environments and individual-level factors may provide insights to educators, policy makers and practitioners into the complexities that inhibit or strengthen an adolescent's smoking cessation treatment experience.

Parental transmission of smoking among middle-aged and older populations in Russia and Belarus

OBJECTIVES

The very high rates of smoking among men and the rapid changes among women in the Post-Soviet countries mean that this region offers an opportunity to understand better the intergenerational role of parental influences on smoking.

METHODS

In this study, we exploit a unique data set, the PrivMort cohort study conducted in 30 Russian and 20 Belarusian towns in 2014-2015, which collects information on behaviours of middle-aged and older individuals and their parents, including smoking. We explored the associations between smoking by parents and their offspring using multiply imputed data sets and multilevel mixed-effect Poisson regressions.

RESULTS

Adjusting for a wide array of social origin, socio-demographic, and socio-economic variables, our analysis suggests that sons of regularly smoking fathers have prevalence ratios of 1.35 [95% confidence intervals (CI) 1.21-1.50] and 1.39 (CI 1.23-1.58) of smoking, while the figures for daughters of regularly smoking mothers are 1.91 (CI 1.40-2.61) and 2.30 (CI 1.61-3.28), respectively, in Russia and Belarus.

CONCLUSIONS

Intergenerational paternal and maternal influences on smoking should be taken into account in studies seeking to monitor the rates of smoking and the impact of tobacco control programmes.

What Is More Important

The unnecessary question what a man is without his masculinity, is deeply ingrained into the socially established norms of strength, power, virility and machoism. Although the traditional male masculinity stereotype and its association with meat consumption are still undisputable for many “real” men, there is indication about a shift toward a new modern evolutionary masculinity which reflects more sustainability values. The chapter explores this based on a survey of Sydney men. It reveals the influence of new factors, such as environmental, health and animal welfare concerns, which shape the concept of the masculine. Meat-eating men will experience increasing pressure to defend their traditional masculinity. The Sydney study also explores the factors likely to influence Australian men to replace a meat-centred diet with more plant-based alternatives.

Tobacco outlet density and tobacco knowledge, beliefs, purchasing behaviours and price among adolescents in Scotland

Despite long-term falls in global adult smoking prevalence and over 50 years of tobacco control policies, adolescent smoking persists. Research suggests greater densities of tobacco retail outlets in residential neighbourhoods are associated with higher adolescent smoking rates. Policies to reduce retail outlets have therefore been identified by public health researchers as a potential 'new frontier' in tobacco control. Better understanding of the pathways linking density of tobacco retailers and smoking behaviour could support these policies. In this study we use path analysis to assess how outlet density in the home environment is related to adolescent tobacco knowledge, beliefs, retail purchases and price in Scotland. We assessed 22,049 13 and 15 year old respondents to the nationally representative cross-sectional 2010 Scottish School Adolescent Lifestyle and Substance Use Survey. Outlet density was based on Scottish Tobacco Retailers Register, 2012, data. A spatially-weighted Kernel Density Estimation measure of outlet density within 400 m of respondents' home postcode was grouped into tertiles. The analysis considered whether outlet density was associated with the number of cigarette brands adolescents could name, positive beliefs about smoking, whether smokers purchased cigarettes from shops themselves or through adult proxies and perceived cost of cigarettes. Models were stratified by adolescent smoking status. The path analyses indicated that outlet density was not associated with most outcomes, but small, significant direct effects on knowledge of cigarette brands among those who had never smoked were observed. With each increase in outlet density tertile the mean number of brands adolescents could name rose by 0.07 (mean = 1.60; SD = 1.18; range = 4). This suggests greater outlet densities may have affected adolescents' knowledge of cigarette brands but did not encourage positive attitudes to smoking, purchases from shops or lower cigarette prices. Exposure to tobacco outlets may influence adolescents' awareness of tobacco products, a potential pathway to smoking behaviour.

Pre-adolescent Receptivity to Tobacco Marketing and Its Relationship to Acquiring Friends Who Smoke and Cigarette Smoking Initiation

BACKGROUND

This study extends research on receptivity to tobacco marketing over a key developmental period for cigarette smoking experimentation.

PURPOSE

The purpose of this study was to understand the effect of receptivity to tobacco marketing and exposure to friends who smoke on smoking experimentation.

METHODS

Participants were 10 to 13 years old who had never tried cigarettes (n = 878), interviewed six times at 8-month intervals.

RESULTS

At baseline, 25% percent of the 10 and 11 years old in the sample of never smokers were receptive to tobacco marketing, while less than 5% had friends who smoked. Having a friend who smoked at study baseline and acquiring such friends for the first time during the study were the strongest predictors of smoking experimentation. Initial receptivity to tobacco marketing increased the risk of smoking experimentation independently of having friends who smoke at baseline or acquiring friends who smoke throughout the study period.

CONCLUSIONS

The high level of receptivity observed even among 10 and 11 years old and its robust relationship with cigarette smoking experimentation independent of the significant risk associated with having friends who smoke suggests that successful prevention of receptivity may require intervention at an early age.

A social norms approach to changing school children’s perceptions of tobacco usage

Purpose

Over 200,000 young people in the UK embark on a smoking career annually, thus continued effort is required to understand the types of interventions that are most effective in changing perceptions about smoking amongst teenagers. Several authors have proposed the use of social norms programmes, where correcting misconceptions of what is considered normal behaviour lead to improved behaviours. There are a limited number of studies showing the effectiveness of such programmes for changing teenagers’ perception of smoking habits, and hence this paper reports on the results from one of the largest social norms programmes that used a variety of interventions aimed at improving teenagers’ perceptions of smoking. The paper aims to discuss this issue.

Design/methodology/approach

A range of interventions were adopted for 57 programmes in year nine students, ranging from passive interventions such as posters and banners to active interventions such as student apps and enterprise days. Each programme consisted of a baseline survey followed by interventions and a repeat survey to calculate the change in perception. A clustering algorithm was also used to reveal the impact of combinations of interventions.

Findings

The study reveals three main findings: the use of social norms is an effective means of changing perceptions, the level of interventions and change in perceptions are positively correlated, and that the most effective combinations of interventions include the use of interactive feedback assemblies, enterprise days, parent and student apps and newsletters to parents.

Originality/value

The paper presents results from one of the largest social norm programmes aimed at improving young people’s perceptions and the first to use clustering methods to reveal the impact of combinations of intervention.

The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation

Although the influence of peers on adolescent smoking should vary depending on social dynamics, there is a lack of understanding of which elements are most crucial and how this dynamic unfolds for smoking initiation and continuation across areas of the world. The present meta-analysis included 75 studies yielding 237 effect sizes that examined associations between peers' smoking and adolescents' smoking initiation and continuation with longitudinal designs across 16 countries. Mixed-effects models with robust variance estimates were used to calculate weighted-mean Odds ratios. This work showed that having peers who smoke is associated with about twice the odds of adolescents beginning (OR ¯ = 1.96, 95% confidence interval [CI] [1.76, 2.19]) and continuing to smoke (OR ¯ = 1.78, 95% CI [1.55, 2.05]). Moderator analyses revealed that (a) smoking initiation was more positively correlated with peers' smoking when the interpersonal closeness between adolescents and their peers was higher (vs. lower); and (b) both smoking initiation and continuation were more positively correlated with peers' smoking when samples were from collectivistic (vs. individualistic) cultures. Thus, both individual as well as population level dynamics play a critical role in the strength of peer influence. Accounting for cultural variables may be especially important given effects on both initiation and continuation. Implications for theory, research, and antismoking intervention strategies are discussed. (PsycINFO Database Record

Race/Ethnicity, Smoking Status, and Self-Generated Expected Outcomes from Smoking among Adolescents

Racial/ethnic differences in adolescent smoking suggest that different factors may motivate smoking among various racial/ethnic groups. This study examined relations among race/ethnicity, self-generated smoking outcome expectancies, and smoking status. Our findings noted that current smoking was highest among Hispanics, whereas African Americans and Asians were least likely to ever smoke. African Americans were most likely to experiment but least likely to smoke currently. Five expectancies differed significantly by race/ethnicity: reduce tension, image, negative aesthetics, addiction, and cost. However, none were significant mediators or moderators. Racial/ethnic groups most susceptible to smoking initiation and with the highest rates of current smoking should be targeted for prevention and cessation. Research is needed to examine more thoroughly racial/ethnic differences in expectancies.

Nicotine enhances an auditory Event-Related Potential component which is inversely related to habituation

Nicotine is a psychoactive substance that is commonly consumed in the context of music. However, the reason why music and nicotine are co-consumed is uncertain. One possibility is that nicotine affects cognitive processes relevant to aspects of music appreciation in a beneficial way. Here we investigated this possibility using Event-Related Potentials. Participants underwent a simple decision-making task (to maintain attentional focus), responses to which were signalled by auditory stimuli. Unlike previous research looking at the effects of nicotine on auditory processing, we used complex tones that varied in pitch, a fundamental element of music. In addition, unlike most other studies, we tested non-smoking subjects to avoid withdrawal-related complications. We found that nicotine (4.0 mg, administered as gum) increased P2 amplitude in the frontal region. Since a decrease in P2 amplitude and latency is related to habituation processes, and an enhanced ability to disengage from irrelevant stimuli, our findings suggest that nicotine may cause a reduction in habituation, resulting in non-smokers being less able to adapt to repeated stimuli. A corollary of that decrease in adaptation may be that nicotine extends the temporal window during which a listener is able and willing to engage with a piece of music.

Cascades of emotional support in friendship networks and adolescent smoking

Social support from peers and parents provides a key socialization function during adolescence. We examine adolescent friendship networks using a Stochastic Actor-Based modeling approach to observe the flow of emotional support provision to peers and the effect of support from parents, while simultaneously modeling smoking behavior. We utilized one school (n = 976) from The National Longitudinal Study of Adolescent to Adult Health (AddHealth) Study. Our findings suggest that emotional support is transacted through an interdependent contextual system, comprised of both peer and parental effects, with the latter also having distal indirect effects from youths' friends' parents.

Are social inequalities in early childhood smoking initiation explained by exposure to adult smoking? Findings from the UK Millennium Cohort Study

Introduction

To assess the socio-economic gradient in early smoking initiation at age 11 years and the extent to which any inequality was explained after accounting for longitudinal exposure to adult smoking.

Methods

Analysis of the UK Millennium Cohort Study, based on 9, 609 children from ages 9 months to 11 years. The outcome was smoking initiation by age 11. Odds ratios (ORs) for smoking initiation were estimated using logistic regression, according to maternal education, whilst adjusting for baseline demographic factors. Longitudinal exposure to a regular smoker in the same room was assessed as potential mediator of the association between maternal education and early smoking, along with other socially patterned risk factors for early smoking initiation, such as parental separation and mental health.

Results

Overall 2.7% (95% CI: 2.3–3.1) of children had tried a cigarette by age eleven. Children of mothers with no qualifications were more than six times as likely to have tried a cigarette than children of mothers with degree level qualifications or higher (OR 6.0 [95%CI 3.5–10.1]), with clear social gradient. Controlling for potentially mediating variables, particularly exposure to a regular adult smoker reduced the OR smoking initiation in children of mothers with no qualifications by 63% (aOR 2.9 [95%CI 1.7 to 5.1]).

Conclusions

Smoking initiation is more common in disadvantaged children, and this is largely explained by regular exposure to an adult smoker in the same room. Reducing adult smoking in front of children may reduce inequalities in smoking initiation in children by over a half.

Identifying demographic and psychosocial factors related to the escalation of smoking behavior among Mexican American adolescents

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health. N=1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age=11.8 (SD=0.8), and 26.0% were born in Mexico. By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR=1.30; CI=1.07-1.57), male (OR=1.88, CI=1.40-2.53), having higher levels of anxiety (OR=1.03, CI=1.02-1.05), intending to smoke (OR=1.70, CI=1.18-2.46), having friends who smoke (OR=1.73, CI=1.12-2.70) and having parents' friends who smoke (OR=1.38, CI=1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR=0.91, CI=0.83-0.99) were protective against smoking escalation. Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation.

Tobacco use patterns, knowledge, attitudes towards tobacco and availability of tobacco control training among school personnel from a rural area in Poland

Background

Tobacco-free school environment as well as non-smoking teachers and school personnel provide positive role models for children and young people. In Poland, smoking should be banned in colleges, schools, educational establishments and educational care facilities. However, for the existing law to be effective, awareness of all people in school curriculum and enforcement of the law are crucial. The aim of the study was to evaluate tobacco use patterns, knowledge and attitudes towards tobacco as well as availability of tobacco control training among school personnel in a rural area in Poland. Moreover, compliance with tobacco control policies and their enforcement were assessed.

Methods

The study was carried out in Piotrkowski district between November 2014 and May 2015 in accordance with the Global School Personnel Survey (GSPS) methodology. Sixty schools participated in the survey (92% of the schools from the region) with involvement of 1044 teachers and 500 non-teaching staff (the response rate – 83.1%). The multivariate linear regression analyses were applied to study factors linked to the need for anti-tobacco training dedicated to the youth and teachers’ knowledge as well as activities to educate the students about tobacco use and its prevention.

Results

About 24% of the school personnel were current and 9% were ex-smokers. Significantly more teachers than the non-teaching staff indicated that the schools had a policy prohibiting tobacco use among students. In addition, 6% of the study participants indicated everyday violations of the tobacco control policy by the school personnel. More than 80% of the teaching personnel indicated the need for training dedicated to the youth to prevent their tobacco use. In the multivariate linear regression model, longer duration of working experience predicted higher levels of knowledge and more activities performed to teach the youth about tobacco use and its prevention. The smokers comparing to the non–smokers perceived the need for anti- tobacco training among the youth less strongly.

Conclusions

In order to make it possible for the inhabitants of Piotrkowski district to work and learn in tobacco smoke free environment there is an urgent need for taking actions aiming at increasing effectiveness of enforcing applicable tobacco control regulations in educational units. The necessity for systematic training dedicated to the youth to prevent their tobacco use, including accurate preparation of teachers, also needs to be highlighted.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-016-0110-y) contains supplementary material, which is available to authorized users.