Social influences and self-efficacy as predictors of youth smoking initiation and cessation: a 3-year longitudinal study of vocational high school students in Taiwan

Mechanism of community quitters' psychological traits on their smoking cessation effects: Based on a study of community intervention

INTRODUCTION

We study the relationship between psychological traits of smokers and their smoking cessation effects, and provide more scientific evidence for smoking cessation intervention.

METHODS

The study was conducted as a nested case-control study. Smokers who participated in the community smoking cessation intervention projects in Beijing in 2018-2020, were selected as the research participants and divided into two groups: a successful smoking cessation and unsuccessful smoking cessation group, according to their smoking cessation effects at 6 months. Psychological traits of quitters including smoking abstinence self-efficacy, willingness to quit smoking, and trait coping style, were compared between the two groups, and a structural equation model was established for confirmatory factor analysis to analyze their mechanisms.

RESULTS

There were differences in smoking cessation results between the successful smoking cessation group and the unsuccessful smoking cessation group in terms of smoking abstinence self-efficacy and willingness to quit smoking. Willingness to quit smoking (OR=1.06; 95% CI: 1.008-1.118) is a risk factor, while smoking abstinence self-efficacy in habit/addiction situations (OR=0.77; 95% CI: 0.657-0.912) is a protective factor. The results of the structural equation model showed that smoking abstinence self-efficacy (β=0.199, p=0.002) and trait coping style (β= -0.166, p=0.042) could influence smoking cessation effects. The structural equation model was well fitted, which showed that smoking abstinence self-efficacy (β=0.199, p=0.002) and trait coping style (β= -0.166, p=0.042) might have influenced the effect of smoking cessation among smokers.

CONCLUSIONS

Willingness to quit smoking has a positive impact on the smoking cessation effect, while smoking abstinence self-efficacy in habit/addiction situations and negative trait coping style have a negative impact. Smoking abstinence self-efficacy and trait coping styles can significantly affect smoking cessation outcomes.

Prevalence and predictors of smoking cessation among smokers receiving smoking cessation intervention in primary care in Qatar: a 6-month follow-up study

Objective

To estimate the rate and predictors of smoking cessation in smokers attending smoking cessation clinics in primary care settings in Qatar.

Methods

A cross-sectional study was conducted among 759 smokers who had attended any of the 10 smoking cessation clinics in primary health care centers from January 2019 to June 2020. The sociodemographic, clinical, and smoking-related variables were assessed. Tailored behavioral and pharmacotherapy were delivered, and patients were interviewed at 6 months to estimate the 30-day point prevalence abstinence. To identify independent factors associated with smoking cessation, a multivariable logistic regression analysis was performed.

Results

The mean age of participants was 40.6 (±11.3), majority being married, Arab and employed, and having a tertiary education. Almost half of the smokers (48.7%) received varenicline alone, 42.6% received NRT, and 31.8% received a combination of both. The selection of drug therapy was based on preferences, experiences, and history of previously encountered adverse effects. The overall 30-day quit rate at 6 months follow-up was 32.4%. About three-quarters (72.5%) of participants had at least one quit attempt and 12.5% had 3 or more attempts. Later age at smoking initiation, lower cigarette consumption at baseline, lower CO concentration at baseline, use of smoking cessation pharmacotherapy, having made fewer quit attempts and non-exposure to secondhand smoke among friends were identified as significant predictors of successful quitting at 6 months.

Conclusion

The 30-day quit rate at 6 months follow-up (32.4%) is comparable to the worldwide figure. However, further efforts should be made to plan cost-effective tobacco dependence treatment taking into account predictors and at-risk groups.

Factors influencing adolescent experimental and current smoking behaviors based on social cognitive theory: A cross-sectional study in Xiamen

Introduction

China has the largest youth population in the world. To better implement the Smoke-free School Initiative, this study aims to examine the protective and risk factors for different smoking behaviors (never smoked, experimental smoking, and current smoking) among school adolescents based on social cognitive theory.

Methods

This research was a secondary analysis of a cross-sectional survey of middle schools in Huli District of Xiamen, China. The final sample consisted of 1937 participants with an average age of 15.41 (SD = 1.64). Descriptive statistics were used to summarize the sociodemographic characteristics of the sample. Multivariate multinomial logistic regression analysis was performed using four models.

Results

Of the respondents, 1685 (86.99%) were never smokers, 210 (10.84%) were experimental smokers, and 42 (2.17%) were current smokers. Social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies were associated with adolescents' smoking behaviors. The number of smoking family members, classmates smoking, the perception that smoking is cool and attractive, and attitudes toward control tobacco policies were the predictors of current smoking behavior (p < 0.05). In contrast, friends smoking and individual and social relationship motivation were associated with only experimental smoking (p < 0.05).

Discussion

The relationship of social norms, positive outcome expectations, anti-smoking self-efficacy, and attitudes toward control tobacco policies varied across smoking behaviors. Family, school, society and the government need to cooperate in prevention and intervention programs for adolescent smoking. The relationships between these factors and adolescents' different smoking behaviors needs to be further verified.

Using intervention mapping for hookah smoking cessation: a quasi-experimental evaluation

Background

The present study aimed to evaluate the results of a theory-based and systematic intervention on Hookah Tobacco Smoking (HTS) cessation in women local to Bandar Abbas, Iran.

Methods

In the present quasi-experimental research, we used an intervention mapping approach to develop, implement, and evaluate an education and training course as our intervention. Applying the results of a systematic review and two prior local qualitative studies, we identified six HTS determinants and set goals for the intervention. We selected 212 eligible women through systematic stratified random sampling and enrolled them in control and intervention groups. The course was presented to the intervention group in 17 sessions for four months. The educational material was developed to address the goals of the intervention, improve HTS determinants, and change the HTS behavior. We used a questionnaire to collect data on participants’ characteristics, HTS behavior, and detailed determinants of HTS in the control and intervention groups at the beginning of the study, at the end of the intervention, and at three- and six- months follow-up. All work done in the study was guided by ethical considerations.

Results

The results showed no significant difference between women enrolled in control and intervention groups regarding participants’ characteristics and HTS behavior. At baseline, there were no differences between groups for six determinants of HTS (knowledge, attitude, social norms, self-efficacy, habit, and intention). At the end of the intervention and at three and six months follow-up, the women in the intervention group had significantly better results in all six domains, compared with those in the control group. The rate of HTS abstinence at the end of the intervention and at the three- and six-month follow-ups was 61.3%, 48.5%, and 45.5% for the intervention and 16%, 14.4%, and 10% for the control groups, respectively.

Conclusions

HTS is a complicated behavior, and its cessation is hard. However, Intervention Mapping (IM) can be a powerful integrative, purposeful, theory-based, and participation-based method to reduce or cease HTS. This method should be tested in other settings.

Trial registration: IRCT20190126042494N1, Registered 3.3.2019. https://en.irct.ir/trial/37129

Supplementary Information

The online version contains supplementary material available at 10.1186/s13722-022-00287-5.

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

BACKGROUND

Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. As a result, smoking rates have remained disproportionately higher in some settings while decreasing in others. This study explored the socio-environmental and psychosocial risk factors for smoking susceptibility in a high-income and upper-middle income setting.

METHODS

Cross-sectional data were obtained from 1,573 male and female adolescents aged 11-15 years who completed self-administered questionnaires in schools in Northern Ireland and Bogotá, Colombia. Using logistic regression analysis, we examined how socio-environmental and psychosocial predictors of smoking susceptibility compared across the two countries.

RESULTS

In Northern Ireland, reduced odds of smoking susceptibility were significantly associated with less family smoking (OR: 0.64, 95% CI: 0.41-1.00); having access to information about smoking in school (OR: 0.75, 95% CI: 0.59-0.96); negative attitudes towards smoking (OR: 0.35, 95% CI: 0.23-0.51); higher levels of openness (OR: 0.59, 95% CI: 0.50-0.69); and higher levels of self-reported wellbeing (OR: 0.57, 95% CI: 0.44-0.74). Increased odds of smoking susceptibility were associated with reporting less smoking of a mother (OR: 1.37, 95% CI: 1.06-1.76); higher levels of extraversion (OR: 1.40, 95% CI: 1.04-1.90); and receiving pocket money (OR: 1.20, 95% CI: 1.06-1.37). In Bogotá, reduced odds of smoking susceptibility were significantly associated with reporting less smoking among friends (OR: 0.86, 95% CI: 0.76-0.98); higher levels of self-efficacy (OR: 0.58, 95% CI: 0.40-0.83); greater perceived behavioural control to quit smoking (OR: 0.71, 95% CI: 0.56-0.90); and lower levels of truancy (OR: 0.69, 95% CI: 0.52-0.92). In Bogotá, no factors were associated with increased odds of smoking susceptibility in the final model.

CONCLUSIONS

The findings illustrate that there were differences in predictors of adolescent smoking susceptibility across the two settings. By using a comparative approach we demonstrate that smoking interventions and policies must be sensitive to the cultural and normative context within which they are implemented.

Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies

BACKGROUND AND AIMS

Social norms towards smoking are a key concept in tobacco control policy and research. However, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation).

METHODS

Systematic review searching four databases (MEDLINE, EMBASE, PsycInfo, CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes) and meta-regression comparing effect sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24 years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation.

RESULTS

Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parental and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent or inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (n = 27 767). Smoking initiation was predicted by the following descriptive norms: smoking among parents [Odds Ratio (OR) = 1.88, 95% Confidence Interval (CI) = 1.56-2.28], close friends (OR = 2.53, 95% CI = 1.99-3.23), siblings (OR = 2.44, 95% CI = 1.93-3.08), family/household (OR = 1.55, 95% CI = 1.36-1.76) and adults (OR = 1.34, 95% CI = 1.02-1.75), but not peers (OR = 1.14, 95% CI = 0.92-1.42). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR = 1.74, 95% CI = 1.27-2.38) and the public (OR = 4.57, 95% CI = 3.21-6.49), but not close friends/peers (OR = 2.36, 95% CI = 0.86-6.53) or people important to the individual (OR = 1.24, 95% CI = 0.98-1.58).

CONCLUSIONS

In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.

Protective Factors Against Vaping and Other Tobacco Use

BACKGROUND AND OBJECTIVES

Vaping has gained popularity among adolescents despite negative health consequences. Few studies have focused on factors that may protect against vaping. We sought to determine if future orientation, parental monitoring, school connectedness, and social support are associated with decreased risk of vaping and other forms of tobacco use.

METHODS

Data were obtained via anonymous school-based health behavior surveys among ninth- through 12th-graders in Pittsburgh, PA (n = 2487). Protective factors were assessed through validated Likert scale instruments. The primary outcome was recent (past 30-day) vaping. Additional outcomes included other forms of tobacco use and intention to quit tobacco products. Poisson regression models examined associations between protective factors and vaping and tobacco use outcomes.

RESULTS

Mean age was 15.7 years, 1446 (58.1%) respondents were female, and 671 youth (27.0%) reported recent vaping. Positive future orientation and high parental monitoring were associated with significantly lower prevalence of recent vaping (adjusted prevalence ratio: 0.84 [95% confidence interval: 0.73-0.97] and adjusted prevalence ratio: 0.73 [95% confidence interval: 0.62-0.85], respectively). There were no significant relationships between social support or school connectedness and vaping. All 4 protective factors were inversely associated with other forms of tobacco use. No factors were significantly associated with intent to quit tobacco products.

CONCLUSIONS

Findings reveal significant inverse associations between future orientation, parental monitoring, and vaping but no relationship between protective factors and intent to quit tobacco products. Developing interventions to foster protective factors in youth and their parental supports may inform primary prevention efforts to reduce vaping and other tobacco use.

Effect of Additional Motivational Interviewing on Smoking Abstinence for 1-Year among Korean Adolescents: Results from A Comparative Retrospective Study in Quitline

The aim of this study was to evaluate the effect of additional motivational enhancement through telephone-based counseling on short- and long-term smoking abstinence among Korean adolescents.

METHODS

A comparative retrospective study was conducted based on the longitudinal follow up in Quitline from 2010 to 2017. A total of 533 and 178 adolescent smokers voluntarily participated in the 1-year quitting counseling only (group A, who were ready to quit) and the additional 4-week motivational interviewing before 1-year quitting counseling (group B, who were ambivalent about quitting), respectively. The outcomes were self-reported continuous abstinence at 30-day, 6-month, and 1-year follow up. Logistic regression was applied to estimate the effect of potential factors, including motivational enhancement, on cessation outcome.

RESULTS

At baseline, adolescents in group B had a lower motivation to quit than those in group A (p < 0.001). The successful quit rates at 30-day, 6-month, and 1-year follow up were 37.2%, 12.8%, and 11.4% in group A and 33.7%, 15.2%, and 11.2% in group B, respectively. After adjusting factors as appropriate, successful quit rates in group B were not significantly different from the rates in group A. Higher self-efficacy increased the successful quit rate at 30-day, 6-month, and 1-year follow up, similar in subgroup analysis by gender. Never-drinking showed significant association with 30-day successful quit in the whole population and among boys. The lower number of smoking triggers was associated with an increased 30-day successful quit rate among boys only.

CONCLUSIONS

Counseling for motivational enhancement could be a promising approach for better quitting outcomes. Improving self-efficacy and eliminating smoking triggers should be continuously strengthened during the quitting process.

Predictors of long-term smoking cessation among smokers enrolled in a university smoking cessation program: A longitudinal study

Many lifelong smokers establish smoking habits during young adulthood. A university can be an effective setting for early smoking cessation. We evaluated long-term predictors of smoking cessation among smokers in a university setting.We longitudinally followed a cohort of smokers enrolled in a university smoking cessation program in Seoul, South Korea. Sociodemographic factors, smoking-related variables, and changes in smoking habits were assessed during 6-week visit sessions and follow-up telephone interviews conducted 1 year or more later.A total of 205 participants were followed up (mean follow-up duration: 27.1 months). Cessation rates were 47.3% at the end of the visit sessions and 28.8% at follow-up. The long-term persistent smoking rate was significantly higher among individuals with peers who smoked (odds ratio [OR] = 8.64; 95% confidence interval [CI] = 1.75, 42.80), with family members who smoked (OR = 3.28; 95% CI = 1.20, 9.00), and who smoked 10 to 19 cigarettes/day (OR = 4.83; 95% CI = 1.49, 15.69). Conversely, persistent smoking was less likely among those who attended the program regularly (OR = 0.84 per visit; 95% CI = 0.72, 0.99) and attempted quitting more frequently (OR = 0.93 per attempt; 95% CI = 0.87, 0.99). Use of smoking cessation medications (varenicline or bupropion) was not significantly associated with long-term quitting (OR = 0.71; 95% CI = 0.26, 1.93).Peer influences were the strongest predictors of failure in long-term cessation among smokers who attempted to quit. Similarly, the existence of smokers in the family was negatively associated with successful quitting. Regular attendance at a smoking cessation program and a high number of attempts to quit were positively associated with successful quitting. Targeting peer and family smoking groups together rather than targeting individual smokers alone, implementing active cessation programs encouraging regular attendance, and providing comprehensive antismoking environments might be effective strategies in a university setting.

Social norms towards smoking and vaping and associations with product use among youth in England, Canada, and the US

BACKGROUND

This study assesses differences in social norms towards smoking and vaping among youth across countries (England, Canada, US) and smoking and vaping status.

METHODS

Data are from the 2017 ITC Youth Tobacco and Vaping Survey, among youth age 16-19 in England (N = 3444), Canada (N = 3327), and US (N = 3509). Prevalence of friend smoking, friend vaping, peer approval of smoking, and peer approval of vaping were estimated. Adjusted logistic regression models were estimated for each norm to assess associations with country, smoking status, and vaping status, adjusting for sociodemographics, alcohol use, and marijuana use.

RESULTS

47% and 52% reported friend smoking and vaping respectively. Perceived peer approval of vaping (44%) was almost double that of smoking (23%). Compared with England, fewer Canadian and US youth reported friend smoking (Canada: AOR = 0.71 [95% CI = 0.62-0.82]; US: AOR = 0.54 [0.47-0.62]) and peer approval of smoking (Canada: AOR = 0.74 [0.63-0.87]; US: AOR = 0.78 [0.67-0.91]), yet more reported peer approval of vaping (Canada: AOR = 1.23 [1.08-1.41]; US: AOR = 1.30 [1.14-1.48]). More Canadian than English youth reported friend vaping (AOR = 1.17 [1.02-1.36]). Friend smoking, peer approval of smoking, and friend vaping were more common among smokers and vapers (all p < .02). Peer approval of vaping was more common among vapers but less common among smokers (all p < .044).

CONCLUSIONS

Youth had more positive vaping than smoking norms. English youth reported the most pro-smoking but least pro-vaping norms in adjusted models; this was unexpected given country differences in regulatory environments. Norms towards both products were associated with use, with some evidence of cross-product associations between norms and behaviours.

Alternative Tobacco Products Use among Late Adolescents in Kelantan, Malaysia

BACKGROUND

The rising prevalence of alternative tobacco and nicotine products (ATNPs) use among adolescents is a global concern that has been attributed to the reemergence of preexisting alternative tobacco products and emergence of new ones in the market. This study examined ATNP use among late adolescents. The association between ATNP use and reasons for using them was explored.

METHODS

This cross-sectional study conducted in 2016 involving 388 late adolescents from six government colleges in Kelantan, Malaysia, aged 18 to 19 years. They were requested to answer self-directed questionnaires with items on sociodemographic information and types of ATNP used. Other variables obtained include the environmental influence and reasons for using the products. Regression analyses between the dependent and independent variables were conducted using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The prevalence of ATNP use among late adolescents was 14.4%. The male sex, cigarette smoking status, and peer use were significantly associated with ATNP use. Several reasons for use were not significantly associated with ATNP use: perception of ATNP being less harmful and less addictive compared with cigarettes, curiosity, less expensive than cigarettes, to aid smoking cessation, and pleasurable flavors and taste.

CONCLUSION

The prevalence of ATNP use among late adolescents studying in government colleges in Kelantan is significant. There is higher perception on ATNP being less harmful and addictive than the conventional cigarette among the users compared with non-users. Significant associations are seen for the male sex, peer use, and concurrent cigarette smoking.

Offers of Cigarettes and E-Cigarettes Among High School Students: A Population Study from California

Receiving offers of cigarettes or e-cigarettes can contribute to the progression from intention to actual use. However, there is a lack of data about the prevalence or characteristics of youth being offered cigarettes or e-cigarettes. A random sample of 91 high schools in the state of California (with 40,137 students) participated in the 2015–16 California Student Tobacco Survey. Offers of cigarettes and e-cigarettes in the last 30 days were assessed. Separate multilevel logistical regression models identified student characteristics associated with being offered cigarettes and e-cigarettes. On average, 11.1% and 16.1% of all students reported being offered cigarettes and e-cigarettes in the last 30 days, respectively. Among those who received offers of cigarettes, 45.5% were never smokers. Among those who received offers of e-cigarettes, 29.6% were never vapers. Male students were more likely to report being offered an e-cigarette than female students (Adjusted Odds Ratio (AOR) 1.13), as were students with friends that used e-cigarettes (AOR 5.14–23.31) and those with high sensation seeking tendencies (AOR 1.33). Similar characteristics were associated with offers of cigarettes. Including measures of offers of cigarettes and e-cigarettes in surveillance systems could help identify those at risk of future cigarette and e-cigarette use.

Harm perceptions of electronic cigarettes and nicotine: A nationally representative cross-sectional survey of young people in Great Britain

BACKGROUND

E-cigarettes often contain nicotine without the most harmful constituents of tobacco smoke.

AIMS

This study aims to assess prevalence and correlates of accurately perceiving e-cigarettes as less harmful than cigarettes and that none or a small amount of the harm from smoking comes from nicotine.

METHODS

Cross-sectional survey of 2,103 11-18-year-olds in Great Britain in 2016. Prevalence of e-cigarette and nicotine harm perceptions were calculated. Logistic regressions assessed associations between accurate e-cigarette and nicotine harm perceptions and smoking, e-cigarette use, gender, age, region, social grade, family smoking, family e-cigarette use, smoking friends, public approval of smoking, and public approval of e-cigarettes. Associations between accurate e-cigarette and nicotine harm perceptions were also assessed.

RESULTS

Most (63.4%) accurate e-cigarette harm perceptions were higher among those aged 16+ (OR = 1.89 [95%CI = 1.45-2.47]), 14-15 (OR = 1.29 [1.00-1.65]), who tried/used an e-cigarette sometimes (OR = 1.51 [1.03-2.21]), with family e-cigarette use (OR = 2.11 [1.46-3.04]), who perceived public disapproval of smoking (OR = 2.11 [1.18-3.77]) and approval of e-cigarettes (OR = 2.44 [1.73-3.45]), and with accurate nicotine harm perceptions (OR = 2.05 [1.28-3.28]). Accurate nicotine harm perceptions were higher among those aged 16+ (OR = 2.60 [1.62-4.16]), from North England (OR = 1.87 [1.02-3.43]) and Wales/Scotland (OR = 2.61 [1.35-5.03]) vs. London, with family smoking (OR = 1.59 [1.05-2.42]), and with accurate e-cigarette harm perceptions (OR = 2.12 [1.32-3.41]).

CONCLUSIONS

Many young people have inaccurate harm perceptions of e-cigarettes and nicotine. Accurate e-cigarette and nicotine harm perceptions were associated with one another. E-cigarette use was associated with accurate e-cigarette but not nicotine harm perceptions; smoking was not associated with either.

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

Predictors of tobacco abstinence in outpatient smokers with schizophrenia or bipolar disorder treated with varenicline and cognitive behavioral smoking cessation therapy

BACKGROUND

The estimated mortality gap between those with and without serious mental illness (SMI) is increasing, now estimated at 28years, which is largely due to smoking-related diseases.

AIMS

We sought to identify predictors of 14-day continuous abstinence in stable outpatient smokers with SMI.

METHOD

Adult smokers with schizophrenia spectrum (n=130) or bipolar disorder (n=23) were enrolled in a 12-week course of varenicline and cognitive-behavioral therapy for smoking cessation.

RESULTS

Independent predictors of abstinence included reduction in withdrawal symptoms prior to the quit day, fewer cigarettes smoked per day at baseline, better baseline attention, remitted alcohol dependence, and lower expectation of peer support to aid quitting.

CONCLUSIONS

Interventions that consider these targets may improve smoking cessation outcomes in those with SMI.

What parents can do to keep their children from smoking: A systematic review on smoking-specific parenting strategies and smoking onset

AIM

To provide a systematic overview of longitudinal studies on different smoking-specific parenting practices (i.e., perceived parental norms and influences, smoking-specific monitoring, availability of cigarettes at home, household smoking rules, non-smoking agreements, smoking-specific communication, and parental reactions) as useful tools in the prevention of youth smoking.

METHOD

MEDLINE and PsychINFO search identified 986 studies published from 1990 to December 2016. Two independent researchers identified eligible studies. Study quality was assessed using Newcastle Ottawa Scale (NOS).

RESULTS

The systematic search resulted in 1 to 14 longitudinal studies per parenting practice. Studies scored between 4 and 9 on the NOS, indicating an overall moderate quality. The results of complete smoking house rules showed a preventive effect on smoking onset. Furthermore, availability of cigarettes, frequency and quality of communication, parental reaction (i.e., conflict engagement) and norms showed significant and non-significant effects. Significant results were in line with expectations: availability of cigarettes and frequent communication about smoking predicted smoking, whereas a high quality of communication, negative reactions or punishments and setting norms by parents showed a preventive effect. No effects were found for non-smoking agreements. The number of studies was too limited to draw conclusions about other parenting strategies. More research on (1) reliable and valid instruments, (2) other stages of smoking in addition to onset, and (3) potential moderators and mediators is warranted.

CONCLUSION

While evidence supports the effectiveness of smoking-specific parenting, further research is required.

An Evaluation of the Youth Quitline Service Young Hong Kong Smokers

PURPOSE

The psychological and social factors associated with smoking initiation and continuation are different for young and adult smokers. Before 2005, there were no population-based smoking cessation interventions targeting young smokers in Hong Kong, China. This study describes the processes and outcomes of an individualized "Youth Quitline" service for young Hong Kong Chinese smokers over a 10-year period.

METHODS

A retrospective population-based study was conducted to evaluate the effectiveness of the Quitline and identify the predictors of quitting. Telephone records were used to obtain information of each call. Young smokers of the Quitline completed a questionnaire at baseline and 6-month follow-up. Data were collected between August 2005 and August 2015.

RESULTS

Over the 10-year period, the Youth Quitline received 7,720 telephone inquiries and provided smoking cessation counseling to 1,684 young smokers. At the 6-month follow-up, 16.9% had reduced cigarette consumption by more than 50%, 33.8% had tried quitting, and 23.6% had successfully quit smoking. Logistic regression analyses indicated that 7 factors, including (1) age; (2) daily cigarette consumption; (3) level of nicotine dependence; (4) intention to quit; (5) having made at least one quit attempt; (6) level of self-efficacy; and (7) adherence to telephone counseling, significantly predicted smoking cessation at 6 months.

CONCLUSIONS

During the first 10 years of the Youth Quitline, we trained many youths to become smoking cessation peer counselors. The Youth Quitline successfully increased youths' awareness of the risks of smoking and smoking cessation services and provided individualized smoking cessation counseling services to young smokers.

Psychological and Familial Factors of Depression in Relation to Adolescent Smoking Behavior

BACKGROUND

Several common factors have been identified for smoking and depression. The The present study explores the relation of psychological and familial factors with depression, by student smoking behavior.

MATERIALS AND METHODS

A total of 5500 middle- and high-school students were selected in Isfahan province in 2010. A self-administered questionnaire collected data on background characteristics, smoking status, depression, and risk factors. Univariate analysis multiple logistic regressions were conducted to compare between depressed and nondepressed people by adolescent smoking status. Odds ratios and the corresponding 95% confidence intervals (CIs) were reported.

RESULTS

Fathers lower education attainment was accompanied adolescents higher depression prevalence. Parental smoking and sibling smoking increased the depression likelihood by 1.41 (95% CI: 1.18, 1.68) and 1.43 folds (95% CI: 1.04-1.94) for never-smokers. Positive attitude toward smoking increased the probability of depression by 1.18 among never-smokers. Never-smokers lacking refusal skill had 1.23 (1.03-1.47) higher chance of depression. A higher level of self-efficacy related to lower chance of depression. Taking risky behavior, increased the depression likelihood by 1.56 (95% CI: 1.29-1.89) in never-smokers, by 1.85 (95% CI: 1.37-2.44) in experimental smokers, and by 1.14 times (95% CI: 1.01-1.72) in current smokers. Family conflict increased depression chance by 2.25 times (95% CI: 1.89-2.66) in never-smokers, by 1.95 (95% CI: 1.46-2.61) in experimental smokers, and by 2.06 times (95% CI: 1.38-3.08) in current smokers.

CONCLUSIONS

Targeting self-efficacy level, risky behavior, and family conflict can drop the comorbidity of smoking and depression simultaneously. This may help public health practitioners and policymakers to develop common strategies in reducing adolescents smoking and depression comorbidity.

Determinants of cigarette smoking initiation in Jordanian schoolchildren: longitudinal analysis

OBJECTIVE

To identify determinants of cigarette smoking initiation, by gender, among schoolchildren in Irbid, Jordan.

METHODS

Between 2008 and 2011, data were collected annually using self-reported questionnaires over 4-years in a prospective cohort of 1,781 students recruited from all 7th grade classes in 19 secondary schools, selected out of a total 60, using probability-proportionate-to-size method. Independent predictors of smoking initiation were identified among the cigarette naïve participants (N = 1,454) with mixed-effect multivariable logistic regression.

RESULTS

Participants were 12.6 years of age on average at baseline. 29.8% of the 1,454 students (37.2% of boys and 23.7% of girls) initiated cigarette smoking by 10th grade. Of those who initiated (n = 498), 47.2% of boys and 37.2% of girls initiated smoking in the 8th grade. Determinants of cigarette smoking initiation included ever smoking a waterpipe, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends who smoked. For girls, familial smoking was also predictive of cigarette initiation.

CONCLUSION

This study shows that many Jordanian youth have an intention to initiate cigarette smoking and are susceptible to cigarette smoking modeled by peers and that girls are influenced as well by familial cigarette smoking. Prevention efforts should be tailored to address culturally relevant gender norms, help strengthen adolescents' self-efficacy to refuse cigarettes, and foster strong non-smoking social norms.

The Smoking Outcome Expectation Scale and Anti-Smoking Self-Efficacy Scale for Early Adolescents: Instrument Development and Validation

Smoking-related outcome expectation and self-efficacy have been found to be associated with adolescent smoking initiation. There is, however, a lack of appropriate instruments to investigate early adolescents' smoking outcome expectations and antismoking self-efficacy. The purpose of this study was to develop and validate the Smoking Outcome Expectation Scale (SOES) and Anti-Smoking Self-Efficacy Scale (ASSES). A total of 232 fifth and sixth graders from four elementary schools in Taiwan participated in the study. Both scales had good content validity, internal consistency, and test-retest reliability. On the basis of exploratory factor analysis, the 6-item SOES with two factors accounted for 54.72% of total variance and the 15-item ASSES with three factors accounted for 56.49% of total variance. The SOES had convergent and discriminant validity and ASSES had convergent validity. The two scales could help school nurses to understand early adolescents' smoking outcome expectation and antismoking self-efficacy and to develop more appropriate antismoking curricula.

Social and Psychological Predictors of Initial Cigarette Smoking Experience: A Survey in Male College Students

Knowledge about social and psychological risk factors for initial cigarette smoking experience (ICSE) is sparse. The present study aimed to estimate the prevalence of ICSE and to examine the psychological and social factors related to ICSE. In a cross-sectional survey, 1,511 male college students were recruited using multistage sampling techniques from four universities located within the city of Ilam, Iran. Self-administered multiple-choice questionnaires were distributed to students from March to June 2013. Risk factors for ICSE were evaluated using logistic regression models. Participants were 22.3 ± 2.4 years of age. ICSE prevalence was 30.6%. In multivariable adjusted analysis, risk taking behavior (odds ratio [OR] = 1.61; 95% confidence interval [CI] = 1.11-2.33), perceived peer smoking prevalence (OR = 2.48; 95% CI = 1.03-5.97), positive thoughts about smoking (OR = 1.06; 95% CI = 1.02-1.10), high self-efficacy (OR = 0.95, 95% CI [0.93, 0.98]), presence in smokers' gathering (OR = 4.45; 95% CI = 2.88-6.81), comity of smokers (OR = 2.56; 95% CI = 1.66, 3.92), very hard access to cigarettes (OR = 2.20; 95% CI = 1.16-4.16), close friends' medium reaction toward smoking (OR = 1.38; 95% CI = 1.02-1.88), and sporting activity (OR = 0.74; 95% CI = 0.56-0.98) were significantly associated with ICSE. This study identified that a combination of psychological and social variables account for up to 78% of the probability of ICSE. The most important protective factor against ICSE was physical activity, whereas the most important risk factor for ICSE was frequent gathering in the presence of smokers.

Determinants of waterpipe smoking initiation among school children in Irbid, Jordan: a 4-year longitudinal analysis

OBJECTIVE

Guided by the Attitude-Social influence-self Efficacy (ASE) theory, this study identified predictors of waterpipe (WP) smoking initiation in a WP naïve cohort of Jordanian school children.

METHODS

A school-based cohort of all 7th grade students (N=1781) in 19 of 60 schools in Irbid, Jordan, was followed from 2008 to 2011. Generalized linear mixed modeling was used to examine predictors of WP initiation among WP-naïve students (N=1243).

RESULTS

During the 3-year study, WP initiation was documented in 39% of boys and 28% of girls. Prior cigarette smoking (boys: odds ratio 7.41; 95% confidence interval 4.05-12.92 and girls: 8.48; 4.34-16.56) and low WP refusal self-efficacy (boys: 26.67; 13.80-51.53 and girls: 11.49; 6.42-20.55) were strongly predictive of initiating WP. Boys were also more likely to initiate WP smoking if they had siblings (2.30; 1.14-4.64) or teachers (2.07; 1.12-3.84) who smoked and girls if they had friends (2.96; 1.59-5.54) who smoked.

CONCLUSION

There is a sizeable incidence of WP initiation among students of both sexes. These findings will help in designing culturally responsive prevention interventions against WP smoking. Gender-specific factors, refusal skills, and cigarette smoking need to be important components of such initiatives.

Longitudinal examination of predictors of smoking cessation in a national sample of U.S. adolescent and young adult smokers

INTRODUCTION

To better inform the development of smoking cessation programs for adolescents and young adults, a prospective study was employed to systematically examine behavioral, demographic, health, and psychosocial determinants of smoking cessation.

METHODS

Data from the 2003-2005 National Youth Smoking Cessation Survey were used. Of 2,582 smokers aged 16-24 years sampled, 1,354 provided complete baseline telephone interview data on the study variables, and their self-reported smoking status at 2-year follow-up was known (currently smoking vs. not smoking). Multivariable logistic regression analysis was employed to examine independent predictors of smoking status (outcome variable) at the 2-year follow-up period.

RESULTS

Four of 5 participants remained smokers after 2 years. Of the high nicotine dependence smokers, 90% remained smokers at follow-up; of the low nicotine dependence smokers, 77% remained smokers at follow-up. Higher nicotine dependence smokers started smoking earlier in life (13.2 vs. 14.3 years; p < .05). Similarly, those not smoking at the 2-year follow-up period started smoking later in life than those still smoking (14.5 vs. 13.7 years). Along with nicotine dependence, various psychosocial and demographic variables at baseline predicted smoking status at the 2-year follow-up period.

CONCLUSIONS

Identifiable demographic and psychosocial factors influence smoking behavior among U.S. adolescents and young adults. Even low nicotine dependence is a strong predictor of follow-up smoking behavior. This, coupled with the early smoking age of high nicotine dependence smokers, underscores the importance of early nicotine avoidance among youth.

Reliability and validity of the Greek version of the Smoking Self-Efficacy Scale for adolescents

This study examined the psychometric properties of the Greek version of the Smoking Efficacy Scale (SES) for adolescents in a sample of 536 high school students. The factorial structure of the SES was examined by means of a series of exploratory factor analyses. The structural validity, the internal consistency, the temporal stability, and the concurrent validity of the SES were assessed. Exploratory and confirmatory factor analyses revealed a clear three-factor (emotion, opportunity, and friends) structure. Furthermore, SES predicted students' smoking behavior. Overall, the multidimensionality of the SES was supported by our findings, suggesting that the Greek version of the SES appears to be a psychometrically sound instrument that can be used for the evaluation of smoking prevention and smoking cessation programs for high school students.

Effect of self-efficacy on Turkish children's perceptions of the advantages/disadvantages of smoking

OBJECTIVE

This descriptive, cross sectional study was conducted to examine the effect of levels of self-efficacy on children's perceptions of pros and cons of smoking.

METHODOLOGY

The sample was 233 fifth-grade students. Data were collected in September 2010 using the Socio-Demographic Data Collection Form, Self Efficacy Scale Child Form and Child Decision Balance Scale and analyzed via percentage calculations and t test with the SPSS 11.00 statistical package program.

RESULTS

Average age of the students participating in the research was 11.1±0.41, 49.8% (n: 116) being female and 50.2% (n:117) male. The difference between the score averages of the pros of smoking perceptions of children with a high self-efficacy level and of those with a low self efficacy level (t=2.117, p=.042) and the difference between the score averages of the cons of smoking perceptions of children with a high self-efficacy level and of those with a low self-efficacy level (t=2.206, p=.035) were found to be statistically significant.

CONCLUSIONS

Children's positive perceptions of smoking were low and negative perceptions high when their self efficacy levels were high. Conversely, children's positive perceptions of smoking were high when their self efficacy levels were low.

Youth employment, income, and smoking initiation: results from Korean panel data

PURPOSE

To estimate the effect of youth employment and income on smoking initiation, this study tests whether youth with higher incomes from either employment or allowance are more likely to smoke, and, if so, whether it is the employment effect or the income effect that affects youth smoking initiation.

METHODS

Data from the 2003-2007 Korea Youth Panel Study were used to estimate the effect of youth employment and income on smoking initiation. A fixed-effects linear probability model was estimated to control for unobserved individual heterogeneity, which may affect both youth employment/income and smoking initiation.

RESULTS

Even after controlling for unobserved individual heterogeneity, youth employment raised the probability of smoking initiation by 4.4% points, but neither employment income nor allowance was significantly associated with youth smoking initiation.

CONCLUSIONS

Youth employment is an important risk factor for smoking initiation in South Korea, suggesting that workplaces that hire youth may be an appropriate target for antismoking interventions.

Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis

This study examined the timing of smoking onset during mid- or late adolescence and the time-varying effects of refusal self-efficacy, parental and sibling smoking behavior, smoking behavior of friends and best friend, and parental smoking-specific communication. We used data from five annual waves of the 'Family and Health' project. In total, 428 adolescents and their parents participated at baseline. Only never smokers were included at baseline (n = 272). A life table and Kaplan-Meier survival curve showed that 51% of all adolescents who did not smoke at baseline did not start smoking within 4 years. The risk for smoking onset during mid- or late adolescence is rather stable (hazard ratio between 16 and 19). Discrete-time survival analyses revealed that low refusal self-efficacy, high frequency of communication, and sibling smoking were associated with smoking onset one year later. No interaction effects were found. Conclusively, the findings revealed that refusal self-efficacy is an important predictor of smoking onset during mid- or late adolescence and is independent of smoking-specific communication and smoking behavior of parents, siblings, and (best) friend(s). Findings emphasize the importance of family prevention programs focusing on self-efficacy skills.

The relative role of nicotine dependence and smoking-related cognitions in adolescents' process of smoking cessation

The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14-16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.

The changing role of self-efficacy in adolescent smoking initiation

BACKGROUND

Refusal self-efficacy is assumed to be linked to adolescent smoking. The aim of the present study was to examine the changing role of self-efficacy in adolescent smoking over time while controlling for parental, sibling, and friends' smoking.

METHODS

This study used data from five annual waves of the "Family and Health" project. A total of 428 adolescents (mean age = 13.3 years; standard deviation = .48) and their parents participated at baseline. Only never smokers at baseline (n = 272) were included to measure smoking initiation. First, the effects of baseline self-efficacy, parental, sibling, and friends' smoking on adolescent smoking initiation at measurement five were examined. Second, with latent growth curves analyses, individual growth curve parameters of adolescent smoking, self-efficacy, parental, sibling, and friends' smoking were calculated. Subsequently, these growth parameters were used to predict growth of adolescent smoking.

RESULTS

Findings showed that baseline self-efficacy, parental and friends' smoking did not predict adolescent smoking at wave five, but baseline sibling smoking did. However, growth curve parameters showed that a decrease in self-efficacy, an increase in proportion of smoking friends, and an increase in sibling smoking over time were related to an increase in adolescent smoking. Initial levels of sibling and friends' smoking moderated the link between self-efficacy and adolescent smoking over time.

CONCLUSION

A decrease in self-efficacy over time, rather than baseline self-efficacy, is associated with smoking initiation in adolescence. Findings emphasize the need for more fine-grained analyses when looking at self-efficacy or other individual characteristics that might fluctuate over time.

Factors associated with Taiwanese junior high school personnel advising students to quit smoking

BACKGROUND

Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco-control efforts because they interact daily with students, are role models for students, teach about tobacco-use prevention in school curricula, and implement school tobacco-control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking.

METHODS

School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004.

RESULTS

Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use.

CONCLUSIONS

To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.

Evaluation of a peer-led smoking prevention programme for Romanian adolescents

The goal of this study was to assess the effects of a school-based smoking prevention programme that used both a video and peer-led discussion groups among Romanian junior high school students aged 13-14 years. The programme embraced the social influence approach and concentrated on enhancing self-efficacy and the acquisition of cigarette refusal skills. Twenty schools were randomly assigned to the control and experimental conditions, resulting in 55 participating classes from the seventh grade (28 in the control group and 27 in the experimental group). Pretest and 9 months follow-up data on weekly smoking initiation and psychosocial variables were collected from 1071 students. Multilevel logistic regression analyses demonstrated a significant effect of the programme on adolescents' smoking behaviour after 9 months. At post-test, weekly smoking onset was 4.5% in the experimental group versus 9.5% in the control group. Furthermore, the programme had significant effects on smoking-related beliefs. In the experimental group, this resulted in a more negative attitude towards smoking, increased social self-efficacy levels and a more negative intention towards smoking. These findings show that short-term effects of the smoking prevention programme can be realized in Romania. More studies are needed to analyse how to maintain these effects over time.

Social-cognitive and school factors in initiation of smoking among adolescents: a prospective cohort study

AIMS

The aim of the present study was to examine the association between social-cognitive factors, school factors, and smoking initiation among adolescents who had never smoked.

METHODS

The study was based on longitudinal data on Danish adolescents attending randomly selected public schools. Adolescents enrolled in grade 7 (mean age, 13 years) who had never smoked (n = 912) were followed up for 6 months after baseline. Those who had still never smoked were followed up again 18 months after baseline, in grade 8 (n = 442). Social-cognitive factors were examined with five measures: self-efficacy, social influence (norms), social influence (behavior), social influence (pressure), and attitude. We used multilevel analyses to estimate the associations between social-cognitive factors at baseline and smoking initiation as well as the random effects of school, school class, and gender group in the school class.

RESULTS

At the first follow-up, we found significant associations between attitude, father's smoking, best friend's smoking, and smoking initiation. At the second follow-up, we found a significant association with pressure to smoke from friends. Of the school factors, gender group in the school class showed an effect at both first and second follow-up.

CONCLUSION

Our results suggest that father's smoking, best friend's smoking, attitude, and pressure to smoke from friends affect smoking initiation. The results for school factors suggest an effect of classmates of the same gender, which has not previously been examined longitudinally.

Are positive changes in potential determinants associated with increased fruit and vegetable intakes among primary schoolchildren? Results of two intervention studies in the Netherlands: the Schoolgruiten Project and the Pro Children Study

Background

To investigate if positive changes or maintenance high scores on potential behavioral determinants of fruit and vegetable (F&V) intake are associated with increased or maintenance favorable levels of F&V intake frequency in the same time lapse or later in time. Data were used from two intervention studies in the Netherlands: the Schoolgruiten Project and the Pro Children Study.

Methods

A design with baseline and two follow-up measurements. 344 children of the Dutch Schoolgruiten Project and 258 children of the Pro Children Study completed questionnaires, including questions on general demographics, usual F&V intake frequency, important potential determinants of F&V intake, such as taste preferences of F&V, availability of F&V, knowledge of recommended intake levels of F&V, self-efficacy for eating F&V, and parental influences for eating F&V. Three different associations between changes in determinants of F&V intake and changes in F&V intake frequency were assessed by multilevel multinomial regression analyses.

Results

Results of one of the investigated associations indicated that in both studies behavior change (increase in F&V intake frequency) was preceded by changes in the following variables; liking of fruit, parental facilitation of vegetables, family rules for eating vegetables and availability at home of vegetables. Furthermore, changes in F&V intake frequency preceded changes in liking of F&V later in time.

Conclusion

In accordance with behavior change theories, the present study provides some evidence that behavior change was preceded by changes in certain potential determinants of F&V intake. Potential determinants of F&V intake that appear to be important to induce behavior change were liking of fruit, parental facilitation of vegetables, family rules for eating vegetables and availability at home of vegetables. Some evidence was also found that behavior changes may precede changes in presumed determinants of F&V intake, such as liking of F&V.