The influence of self-esteem, parental smoking, and living in a tobacco production region on adolescent smoking behaviors

Risk factors for smoking in adolescence: evidence from a cross-sectional survey in Switzerland

BACKGROUND

Cigarette smoking during adolescence is a major public health concern with far-reaching health implications. Adolescents who smoke are at an increased risk of developing long-term health problems and are more likely to continue smoking into adulthood. Therefore, it is vital to identify and understand the risk factors that contribute to adolescent smoking - which in turn facilitate the development of targeted prevention and intervention programs.

METHODS

Data was drawn from a cross-sectional survey conducted between October and December 2021, encompassing adolescents of adolescents aged 14 to 19 residing in Switzerland (n = 2,683). Multiple logistic regression analysis was employed to explore which demographic, household, behavioural and psychographic factors are associated with current smoking status.

RESULTS

The regression results showed higher odds of smoking for female respondents (OR 1.39; p-value 0.007); older adolescents (OR 1.30; p-value < 0.001); those living in the French-speaking part of Switzerland (OR 1.39; p-value 0.021), in suburban areas (OR 1.35; p-value 0.023) and with a smoker in the same household (OR 2.41; p-value < 0.001); adolescents consuming alcohol (OR 4.10; p-value < 0.001), cannabis products (OR 6.72; p-value < 0.001) and hookah (OR 5.07; p-value < 0.001) at least once a month; respondents not engaging in sports (OR 1.90; p-value < 0.001) or music (OR 1.42; p-value 0.031) as top five leisure activities and those experiencing high stress levels at home (OR 1.74; p-value < 0.001). Adolescents with high scores in health awareness (OR 0.33; p-value < 0.001), on the relational self-esteem scale (OR 0.78; p-value 0.054) and on the general well-being scale (OR 0.52; p-value 0.022) were less likely to smoke than their counterparts with lower scores. High risk-seeking was associated with higher odds of smoking (OR 2.15; p-value < 0.001).

CONCLUSIONS

Our results suggest the importance of a comprehensive approach at both individual and institutional levels to reduce smoking rates in adolescents. More specifically, a holistic strategy that encompasses adolescents, families, schools and policymakers ranging from strengthening adolescents' self-esteem, smoking cessation support for parents, to increasing engagement in musical and physical activities, and enhancing health awareness in the school curriculum.

The effects of smoking habit change on the risk of depression-Analysis of data from the Korean National Health Insurance Service

BACKGROUND

We examined the effects of smoking habit change on the risk of depression using the National Health Insurance Service-National Health Screening Cohort database of Korea.

METHODS

This nationwide population-based cohort study included 88,931 men aged 40 years or older. The participants were divided into baseline heavy (≥20 cigarettes/day), moderate (10-19 cigarettes/day), and light (<10 cigarettes/day) smokers, quitters, and never smokers. Smokers were then categorized as continual smokers, reducers, quitters, and non-smokers based on the two-year change in smoking status between the first and second health examinations. The participants were followed from the index date to 2013 to assess depression status. Cox proportional models were used to examine the effects of smoking habit change on the risk of depression.

RESULTS

After a median 7.7 years of follow-up, 2,833 depression cases were identified. Never smokers and long-term quitters had a lower risk of depression than heavy continual smokers (hazard ratio, HR 0.817; 95% CI, confidence interval 0.689-0.967 and HR: 0.691; 95% CI: 0.559-0.853, respectively). Short-term quitters and reducers had a lower risk of depression, but it was not significant. The influence of smoking on depression was prominent among men in their 50 s (HR: 0.585; 95% CI: 0.419-0.820 in long-term quitters, HR:.0.738; 95% CI: 0.570-0.954 in never smokers).

LIMITATIONS

The information about smoking habits was based on self-reported questionnaires. This study examined only men because the smoking rate among women in Korea is very low.

CONCLUSIONS

This population-based study found that never smokers and long-term quitters have lower risk of depression. The risk of depression decreased when the amount of smoking decreased, but the difference was not statistically significant. Furthermore, more attention should be paid to middle-aged men when formulating smoking cessation policies.

Self-Perception and Relative Increases in Substance Use Problems in Early Adulthood

This study assessed self-perception as a long-term predictor of relative changes in problems related to alcohol and marijuana use in early adulthood. Self-report questionnaires were completed by a community sample of 124 individuals in the Southeastern United States who were followed longitudinally from age 19 to age 27. More problems due to substance use at age 27 were predicted by participants' negative perceptions of their social acceptance, romantic appeal, and self-worth. Predictions remained after accounting for potential confounds including gender, income, and baseline substance use problems at age 19. Social avoidance and distress in new situations at age 19 mediated the relationship between self-perception and relative changes in substance use problems, such that increases in substance use problems from age 19 to 27 were potentially explainable by the linkage of negative self-perceptions to social avoidance and distress in new situations.

Smoking prevention in children and adolescents: A systematic review of individualized interventions

OBJECTIVE

This study systematically reviewed the literature to determine what type of cognitive-behavioral based interventions administered outside of formal school settings effectively prevent smoking initiation among children and adolescents.

METHODS

Applying the PRISMA guidelines we searched MEDLINE, PsycINFO, CINHAL, Pub Med, SCOPUS, and Sport Discus. Article review, data extraction, and assessment of risk of bias were conducted by two independent reviewers.

RESULTS

We included 16 studies administered in various settings: seven in health care; four informally during and outside of school hours; three in the home; and two in extra-curricular settings. Positive preventive effects in smoking behavior ranging from 3-months to 4-years were observed in eight studies. Social environmental influences (e.g., parental smoking, friends) are salient contributing factors.

CONCLUSIONS

Effective approaches involved interventions conducted in health care settings as well as those employing interpersonal communication and support strategies (e.g., via peer leaders, parent support, physicians).

PRACTICE IMPLICATIONS

Primary health care settings may be optimal for implementing cigarette smoking prevention interventions for children and adolescents. Providing tailored education and facilitating interpersonal discussions between health care providers and families about the risks of smoking/strategies to avoid uptake, as well as capitalizing on technology-based modalities may reduce rates among children and adolescents.

Causal Effect of Self-esteem on Cigarette Smoking Stages in Adolescents: Coarsened Exact Matching in a Longitudinal Study

Objectives

Identification of the causal impact of self-esteem on smoking stages faces seemingly insurmountable problems in observational data, where self-esteem is not manipulable by the researcher and cannot be assigned randomly. The aim of this study was to find out if weaker self-esteem in adolescence is a risk factor of cigarette smoking in a longitudinal study in Iran.

Methods

In this longitudinal study, 4,853 students (14–18 years) completed a self-administered multiple-choice anonym questionnaire. The students were evaluated twice, 12 months apart. Students were matched based on coarsened exact matching on pretreatment variables, including age, gender, smoking stages at the first wave of study, socioeconomic status, general risk-taking behavior, having a smoker in the family, having a smoker friend, attitude toward smoking, and self-injury, to ensure statistically equivalent comparison groups. Self-esteem was measured using the Rosenberg 10-item questionnaire and were classified using a latent class analysis. After matching, the effect of self-esteem was evaluated using a multinomial logistic model.

Results

In the causal fitted model, for adolescents with weaker self-esteem relative to those with stronger self-esteem, the relative risk for experimenters and regular smokers relative to nonsmokers would be expected to increase by a factor of 2.2 (1.9–2.6) and 2.0 (1.5–2.6), respectively.

Conclusion

Using a causal approach, our study indicates that low self-esteem is consistently associated with progression in cigarette smoking stages.

Body weight has no impact on self-esteem of minority children living in inner city, low-income neighborhoods: a cross-sectional study

BACKGROUND

The relationship between body weight and self-esteem among underserved minority children is not well documented.

METHODS

We measured the self-esteem profile using the Self-Perception Profile for Children among 910 minority children at 17 Houston community centers.

RESULTS

Weight status had no effect on any of the self-esteem scores among the minority children (P ≥ 0.21). Black children had higher scholastic competence than Hispanic children (P = 0.05). Social acceptance was not affected by age, gender, and race/ethnicity (P ≥ 0.13). Significant age x gender (P = 0.006) and race x gender (P = 0.005) interactions were detected on athletic competence. The younger boys had higher athletic competence than the younger and older girls (P ≤ 0.01). The older boys had higher athletic competence than the older girls (P = 0.008) but their scores were not different from those of the younger girls (P = 0.07). Within each race/ethnicity group, boys had higher athletic competence than girls (P ≤ 0.03). Black boys had higher athletic competence than Hispanic girls (P = 0.007) but their scores were not different from those of the Hispanic boys (P = 0.08). Age and gender had no effect on physical appearance but black children had higher scores than Hispanic children (P = 0.05). Behavioral conduct was not affected by age, gender, or race/ethnicity (P ≥ 0.11). There was an age x gender interaction on global self-worth (P = 0.02) with boys having similar scores regardless of ages (P = 0.40) or ethnicity (P = 0.98). However, boys from both age groups had higher global self-worth than the older girls (P ≤ 0.04) but their scores were not different from those of the younger girls (P ≥ 0.07).

CONCLUSIONS

For the first time, we documented that being normal weight did not necessarily guarantee positive self-esteem among minority children. Their self-esteem scores were similar to those found among children who were diagnosed with obesity and obesity-related co-morbidities and lower than those reported among normal-weight white children. Therefore, activities to promote self-esteem are important when working with underserved minority children in order to promote a healthy lifestyle.

Self-esteem and quality of life in adolescents with extreme obesity in Saudi Arabia: the effect of weight loss after laparoscopic sleeve gastrectomy

OBJECTIVES

To evaluate the self-esteem and quality of life in adolescents with extreme obesity before and one year after laparoscopic sleeve gastrectomy as obesity is a major challenging medical problem, not only in adults but also in children and adolescents in Saudi Arabia.

METHODS

In a prospective cohort study, 32 adolescents (aged 13-17 years) with extreme obesity (Group 1) presenting for laparoscopic sleeve gastrectomy (LSG) were compared with 32 matched, healthy, nonobese adolescents (aged 14-17 years) (Group 2) with regards to self-esteem and quality of life. Assessment was done using the Rosenberg Self-Esteem Scale and Pediatric Quality of Life Inventory version 4.0 (self- and parent report), respectively. Body mass index (BMI) Z scores were calculated for both groups.

RESULTS

We found significantly poor self-esteem and impairment in all domains of quality of life (self- and parent report) in Group 1 compared with Group 2 (P<.001). Self esteem and quality of life (self- and parent reports) significantly improved 1 year after LSG (P<.001), and the weight loss induced by LSG, reflected by a decrease in BMI Z scores, was a significant predictor for the improvement in self-esteem (R2=0.28 and P=.003) and quality of life (R(2)=0.67 and P<.001).

CONCLUSION

LSG was found to be a safe and effective operation in adolescents with extreme obesity: LSG leads to weight loss, with subsequent improvement in self-esteem and quality of life.

A longitudinal analysis of teenage drinking patterns

This paper examines the multinomial recurrent outcome 'teenage drinking' within a statistical modeling paradigm. The proposed statistical modeling relates drinking to a set of explanatory variables, which include subjective as well as objective measures. In order to assess the degree to which explanatory variables influence smoking, an adequate statistical model must handle the possibility that substantial variation between respondents will be due to omitted variables, multicollinearity and past behavior. To address these issues, longitudinal data using appropriate statistical modeling are essential. In this paper we demonstrate the application of appropriate longitudinal modeling using data from the Yorkshire (UK) Health Related Behavior Questionnaire. The results suggest there may be substantial heterogeneity due to omitted variables in the data and complex inter-relationships between observed explanatory variables. For example, social cultures of drinking and parental involvement appear to influence heavy drinking and drug use.

Betel nut chewing behavior among adolescents in eastern Taiwan: a cluster analysis

The prevalence of betel nut chewing among junior high school students is highest in the eastern region of Taiwan (Lin, 1990). Although there is some research on the prevalence rate, little effort has been paid to developing a classification of betel nut chewing behavior applicable to adolescents. Eight-hundred and forty-three students, including 435 males (51.6%) and 408 females (48.4%), 552 non-aborigines (65.5%) and 291 aborigines (34.5%), completed a questionnaire concerning betel nut chewing behavior, beliefs (perceptions) toward betel nut chewing, self-esteem, and locus of control. Using a cluster analysis, this study identified 3 sub-types ofbetel nut chewing behaviors. They were identified as "Self-regulation oriented" (Internally controlled-oriented), "Indigenously oriented" (Taiwan culture-oriented), and "Symbolically oriented" (Externally controlled-oriented). The validity of clusters was explored in terms of gender and ethnicity. This study describes the implications for reducing betel nut chewing behaviors among adolescents.

Nicotine dependence and self-esteem in adolescents with mental disorders

Recent studies in adolescents have found a weak association between lower self-esteem and smoking. However, this association has not been investigated in a psychiatric setting. In 223 inpatient adolescents [140 girls (16.5 years) and 83 boys (16.4 years)], self-esteem was measured with Coopersmith's self-esteem inventory (SEI), and smoking dependence with the Fagerström Test for Nicotine Dependence (FTND). DSM-IV categories included major depression (n=35), anxiety disorders (n=35), psychotic disorders (n=31), eating disorders (n=9), and conduct disorders (n=113). There were 101 smokers and 122 nonsmokers. Self-esteem scores were lower in smokers than in nonsmokers (p=0.039). Self-esteem scores were very significantly lower in smokers showing moderate or high nicotine dependence (i.e., FTND score>or=4) when compared with nonsmokers (p=0.002). Smoking with moderate or high nicotine dependence was associated with lower self-esteem in both girls and boys, whereas smoking with no or low nicotine dependence was associated with lower self-esteem only in girls. Smoking was associated with lower self-esteem in all diagnostic categories, except in eating disorders. Interventions targeted on self-esteem might be used to prevent smoking in adolescents with mental disorders.

Teenage smoking: a longitudinal analysis

This paper examines the binary recurrent outcome "teenage smoking" within a statistical modelling paradigm. The proposed statistical modelling relates smoking to a set of explanatory variables, which include subjective as well as objective measures. In order to assess the degree to which explanatory variables influence smoking, an adequate statistical model must handle the possibility that substantial variation between respondents will be due to omitted variables, multicollinearity and past behaviour. An earlier paper, using a secondary cross-sectional data source, concluded that an investigation of smoking needs to be based on longitudinal data using appropriate statistical modelling. The same data source provided observations on young adults over a period of 2 years. For comparison purposes, the same cross-sectional model was fitted to the longitudinal data. The results suggest there may be substantial heterogeneity due to omitted variables in the data and complex inter-relationships between observed explanatory variables leading to underestimation. Longitudinal data provide additional flexibility to control for omitted variables and are necessary to investigate dynamic social processes such as smoking. The results from our analysis suggest that the effects of variables reported in the literature on teenage smoking may be overestimated. For example, the role of peer pressure may not be as clear as it has been made out to be.

The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth campaign

BACKGROUND

Adolescents who live in tobacco producing regions may not respond favourably to anti-industry ads.

OBJECTIVE

To examine whether state level involvement in tobacco production appears to limit the effectiveness of anti-industry ads to prevent tobacco use among adolescents in the USA.

DESIGN

Time trend analyses were done using repeated cross sectional data from six waves of the Legacy Media Tracking Survey, which were collected between 1999 and 2003.

SETTING AND PARTICIPANTS

28,307 adolescents, ages 12-17 years, were classified as living in: tobacco producing states (TPS) (n = 1929); non-tobacco producing states (non-TPS) with low tobacco control funding comparable to TPS (n = 5323); non-TPS with relatively high funding (n = 15,076); and non-TPS with established anti-industry ad campaigns (n = 5979).

MAIN OUTCOME MEASURES

Reactions to anti-industry ads; strength of anti-industry attitudes/beliefs; changes in anti-industry attitudes/beliefs over time.

RESULTS

Ad reactions did not differ by state type. Multivariate adjusted time trend analyses indicated significant, comparable increases in anti-industry attitudes/beliefs since the onset of the truth campaign, in both TPS and non-TPS. Mediation analyses indicated that these increases were due, in part, to campaign exposure.

CONCLUSIONS

Adolescents who live in tobacco producing regions appear to be as responsive to anti-industry ads as their counterparts in non-tobacco producing regions. This study provides further evidence for the effectiveness of such ads.

"Not lighting up": a case study of a woman who quit smoking

PURPOSE/OBJECTIVES

To review the prevalence, incidence, and risks of smoking by American women; to outline services, treatments, and educational options for smoking prevention and cessation; and to present the conceptual link between the epidemiologic and research literature and experiences of one individual in the target population--an adult female former smoker with a 30-year habit who began smoking during her teenage years.

DATA SOURCES

Published literature, expert opinion, and an interview with a former smoker--a female healthcare professional who had a 30-year habit.

DATA SYNTHESIS

Literature was reviewed and the content was evaluated for relevance, accuracy, and timeliness. The relevant content was augmented with the author's practical experience and applied to the case study to make recommendations.

CONCLUSIONS

Oncology nurses may use a number of strategies to assist people to never start or to stop using tobacco products. The most effective strategy begins with collaboration between healthcare professionals and patients and a combination of instruction, counseling, and emotional support. Oncology nurses can participate in grassroots efforts to educate the public about addiction related to tobacco use, provide counseling for patients who smoke, and become actively involved in legislative solutions to the problem of tobacco use.

IMPLICATIONS FOR NURSING

Oncology nurses may intervene to affect positive behavioral change and participate in grassroots efforts to educate the public. Substantial resources are available to professionals and patients who wish to quit smoking or prevent tobacco use by friends and relatives. Nurses should take every opportunity to support smoking cessation and tobacco use prevention.

Familial influences on adolescent smoking

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate, but somewhat overlapping, lines of research: genetic epidemiological studies and risk-factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross-sectional designs and the use of inconsistent definitions of tobacco-related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking; inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking.

Choosing to remain smoke-free: the experiences of adolescent girls

PURPOSE

To develop an understanding of the experiences of nonsmoking girls and determine how these girls avoid smoking.

METHODS

A grounded theory approach was used to direct the discovery of process(es) that nonsmoking females undertake to remain nonsmokers. Seventeen nonsmoking females between the ages of 13 and 17 years were interviewed using open-ended questions designed by the authors. The interviews were tape-recorded and then analyzed using the techniques described by Strauss and Corbin.

RESULTS

The data revealed that the process of remaining a nonsmoker is composed of three phases: making sense of smoking, rejecting smoking, and declaring oneself to be a nonsmoker. The process of remaining a nonsmoker appears to be rooted in developing self-confidence. As girls rejected smoking, self-confidence was boosted because they learned that their choice would be accepted and their strategies were effective in rejecting smoking.

CONCLUSIONS

The findings of this study offer new insights into the experiences of adolescent nonsmokers. Our assumption that there is a process that underlies remaining a nonsmoker was supported. The findings suggest that adolescents use several strategies in this process. These strategies are noteworthy because they offer those who work in the field of health promotion new insights into ways in which they might contribute to increasing the ranks of nonsmokers.

Cigarette use in adolescents: the Cardiovascular Health in Children and Youth Study

Tobacco is the leading cause of preventable death in the United States, and its use is increasing in adolescents. To determine the interventions needed to prevent the initiation of smoking, it is important to know the factors related to tobacco use by adolescents. In this study the following factors related to cigarette use were examined: age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status. Participants were 1,207 youth completing a written survey for the Cardiovascular Health in Children and Youth Study (CHIC II). Participants ranged in age from 10 to 15 years, with a mean age of 12.2 years; 64.2% were White, 24.0% Black, 5.8% Hispanic, and 6.0% other races. White and Hispanic youth and youth of other races had significantly higher rates of smoking than did Black youth. Significant risk factors for smoking were: higher grade in school, White race, and for girls only, lower self-esteem. In White youth those in the lowest socioeconomic status were most likely to be current and experimental smokers. Smoking was as common in girls as in boys at these ages. Multivariate analysis showed that neither physical activity nor parental smoking were significant predictors of smoking behaviors. These results suggest that smoking prevention programs for adolescents should specifically target White and Hispanic youth and those from families with low socioeconomic status. In addition, these interventions should include ways to increase self-esteem in girls.

Adolescent smoking cessation: how effective have we been?

Adolescent smoking, at its current rate, is considered a pediatric epidemic, with 3,000 youths less than 18 years of age becoming regular smokers each day (Johnson, O'Malley, & Bachman, 1998). The reasons adolescents begin and continue to smoke are multifactorial. There is a paucity of research describing effective adolescent smoking-cessation programs. Much of the research on adolescent tobacco use has focused on correlates and prevention of onset, rather than on intervention with active smokers. Current research indicates that 75% of adolescents who currently smoke want to quit. It is essential that nurses involved with adolescent health promotion become active in smoking-cessation efforts. This article describes the risk factors for adolescent smoking and identifies smoking-cessation strategies, with interventions specific to the adolescent population.

Association of adolescent cigar use with other high-risk behaviors

OBJECTIVES

To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use.

METHODS

A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires.

RESULTS

The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2-32.3; boys, OR: 21.3; 95% CI: 17.1-26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4. 5-12.4; boys, OR: 13.0; 95% CI: 9.8-17.4), and alcohol (girls, OR: 6. 6; 95% CI: 4.8-9.1; boys, OR: 6.8; 95% CI: 5.3-8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9-16.9; boys, OR: 34.8; 95% CI: 19.4-62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item.

CONCLUSIONS

Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Childhood obesity and self-esteem

BACKGROUND

Although childhood obesity may have detrimental consequences for childhood self-esteem, the prevalence and magnitude of this problem is controversial. In addition, the social and emotional effects of decreased self-esteem in obese children are unknown.

METHODS

A total of 1520 children, 9 to 10 years of age, born to mothers in the National Longitudinal Survey of Youth were studied. Comprehensive demographic data including race and family income were available in 97% of the cohort. Self-esteem was measured using Self-Perception Profile for Children. The 4-year follow-up Self-Perception Profile for Children scores were available in 79% of the children. Obesity was defined as a body mass index greater than the 95th percentile for age and gender. Additional data include a self-administered questionnaire at 13 to 14 years of age concerning emotional well being, smoking, and alcohol consumption. Data were stratified by race and gender. The data were weighted to reflect a nationally representative sample of children born to mothers 17 to 28 years of age.

RESULTS

Scholastic and global self-esteem scores were not significantly different among 9- to 10-year-old obese and nonobese children. However, over the 4-year period, obese Hispanic females and obese white females showed significantly decreased levels of global self-esteem compared with nonobese Hispanic females and nonobese white females, respectively. Mild decreases in self-esteem also were observed in obese boys compared with nonobese boys. As a result, by 13 to 14 years of age, significantly lower levels of self-esteem were observed in obese boys, obese Hispanic girls, and obese white girls compared with their nonobese counterparts. Decreasing levels of self-esteem in obese children were associated with significantly increased rates of sadness, loneliness, and nervousness compared with obese children whose self-esteem increased or remained unchanged. In addition, obese children with decreasing levels of self-esteem over the 4-year period were more likely to smoke and drink alcohol compared with obese children whose self-esteem increased or remained unchanged.

CONCLUSIONS

Obese Hispanic and white females demonstrate significantly lower levels of self-esteem by early adolescence. In addition, obese children with decreasing levels of self-esteem demonstrate significantly higher rates of sadness, loneliness, and nervousness and are more likely to engage in high-risk behaviors such as smoking or consuming alcohol.

Smokeless tobacco use in adolescents: the Cardiovascular Health in Children (CHIC II) Study

Smokeless tobacco has seen a resurgence of popularity among adolescents despite its association with oral cancer and altered cardiovascular function. This study examined age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status as predictors of smokeless tobacco use among middle school children. Subjects included 1,211 youth (White (64%), Black (24%), Hispanic (6%), and Other (6%); age 12.2) participating in the Cardiovascular Health in Children and Youth (CHIC II) study. All data were collected by questionnaire. Factors related to ever using smokeless tobacco included older age (p < .001), being male (p < .001), lower self-esteem (p < .001), and having parents who currently (p = .02) or formerly (p = .05) smoked. Hispanics reported a higher current usage rate than other ethnic groups (p < .001). White youth in the lowest socioeconomic status were most likely to be experimental users (p = .007), while those in the high socioeconomic status were more likely to be current users (p = .006). Physical activity was not associated with smokeless tobacco use.

Relationship between self-esteem and smoking behavior among Japanese early adolescents: initial results from a three-year study

Researchers examined the relationship between self-esteem and smoking behavior among Japanese elementary and junior high school students. Students (2,090) in fourth to ninth grade from three elementary schools and two junior high schools in the Hyogo and Niigata prefectures completed an anonymous questionnaire. Self-esteem was measured using the Harter Perceived Competence Scale, the Pope Self-Esteem Scale, and the Rosenberg Self-Esteem Scale. Results indicated that never smokers had higher cognitive, family, and global self-esteem, but lower physical self-esteem than ever smokers. Grade and gender were significantly associated with self-esteem, showing a decrease of self-esteem with increases in grade and a higher level of self-esteem among boys than girls. The results suggest that effective smoking prevention programs for Japanese early adolescents should be integrated into more comprehensive health education or health promotion programs including self-esteem enhancement training.

Smoking initiation in youth: the roles of gender, race, socioeconomics, and developmental status

PURPOSE

To describe smoking initiation, and to investigate factors that predict the early initiation of smoking in schoolchildren using a longitudinal approach.

METHODS

A prospective study of smoking habits of children from the third and fourth grades through the eighth and ninth grades. The initial study population was 1970; 79.8% were white and 20.2% were African-American. Children were classified as "nonsmokers," "experimental smokers," or "current smokers" at five time points over 6 years. Multivariate regression models examined relationships of demographic and developmental factors with smoking initiation.

RESULTS

Experimental smoking increased from 4% at Grades 3-4 to 42% at Grades 8-9, and current smoking prevalence rose from 0.4% to 9% over the same period. The mean age of initiation of smoking was 12.3 years. Smoking initiation (experimental smoking) was significantly different by racial group, socioeconomic status (SES), and pubertal development. White children and those of low SES were more likely to be experimental smokers, and also started earlier than African-American children and children of high SES. Once they started, white children advanced more rapidly to become current smokers. Boys had a higher prevalence of experimental smoking than girls at all time points. Children in rural areas were more likely than urban children to start smoking after age 12 years. Children who were at a higher pubertal stage than their peers were also more likely to experiment with smoking.

CONCLUSIONS

Race, SES, and pubertal stage are important predictors of initiation of smoking in schoolchildren. This study indicates a need for smoking prevention classes in elementary and middle school, especially in areas with large numbers of white and low-SES youth. Also, smoking cessation programs, as well as smoking prevention classes, would be useful for middle school and high school students.

Self-esteem and self-efficacy as predictors of success in smoking cessation

The purpose of this study was to compare psychological, biophysical, and socioeconomic variables as predictors of success in smoking cessation adherence among adults who have participated in a smoking cessation program. The purposive sample (N = 75) was selected from participants of 10 smoking cessation programs in Texas who were measured for self-esteem and self-efficacy at the beginning of their program using the Rosenberg Self-Esteem Scale and Stanton's revised Self-Efficacy for Smoking Cessation Questionnaire. Subjects self-reported their smoking/nonsmoking status and use/nonuse of the nicotine patch at the end of their program via postcards and at 3 months later through a phone interview with the researcher. Using discriminant analysis, the psychological variables correctly classified 75% of the subjects at the 3-month follow-up as smoking or nonsmoking (based on their preprogram scores of self-esteem and self-efficacy). With this sample, the biophysical and socioeconomic variables were insignificant in their ability to predict smoking cessation adherence.

Girls, pecking order and smoking

Against a background of growing concern about the failure to reduce cigarette smoking amongst young people, particularly girls, this paper attempts to unravel the complex interrelationships between smoking, peer group structure and gender. We were particularly intrigued to explore a recent hypothesis in the literature that suggests that girls who smoke, far from lacking self-esteem, are more self-confident and socially skilled than their non-smoking peers. Sociometric and qualitative analyses revealed that smoking behaviour was indeed shaped by gender, and that the psychosocial processes involved in smoking uptake may be different for boys and than for girls. Peer group structure, consistently described by young people as hierarchical, was closely related to smoking behaviour. Girls at the top of the social pecking order who projected an image of high self-esteem were identified as most likely to smoke, while only a small minority of girls fitted the stereotype of the young female smoker who has poor social skills and low self-esteem. Boys of high social status were less vulnerable, since sport and a desire to be fit to some extent protected them. Our findings raise fundamental questions about the meaning of self-esteem in relation to smoking uptake, arguing instead for an exploration of the term "self-worth". They suggest the need for health education programmes which are sensitive both to gender and to peer group structures.

The health practices of homeless women: a causal model

A theoretical model was developed and tested to explain the effects of learned helplessness, self-esteem, and depression on the health practices of homeless women. Data were collected from a sample of 122 homeless women recruited from six shelters. Structural equation analysis was used to evaluate the model. Analysis revealed a goodness-of-fit index of 98, indicating a good fit of the model with the data. Overall, the variables in the model accounted for 14% to 21% of the variance in the health practices of homeless women.

Smoking and associated factors among young Swedish females

OBJECTIVE

To analyse the smoking habits of young females and various associated factors.

DESIGN

Cross-sectional population study; questionnaire with fixed-response options.

SETTING

Upper secondary schools in the municipalities of Ludvika and Smedjebacken in central Sweden.

SUBJECTS

524 girls aged 16-19; response rate 85%.

MAIN OUTCOME MEASURES

Social smoking, daily smoking, heavy smoking.

RESULTS

The following causes of social smoking among 16-17-year-old girls were identified: a dismissive attitude to the danger of smoking, maternal smoking, and being sexually experienced. A dismissive attitude to smoking and maternal smoking were the corresponding causes among 18-19-year-olds. A practical school curriculum, lack of interest in sports, smoking by one's best friend, maternal smoking, and a desire for weight control were the causes of daily smoking among 16-17-year-olds. Smoking by one's best friend, maternal smoking, and a dismissive attitude to smoking were the corresponding causes among 18-19-year-olds.

CONCLUSIONS

The most important cause of social smoking among female 16-19-year-olds was a dismissive attitude to the dangers of smoking. The causes of daily smoking and heavy smoking were more complex, particularly among 16-17-year-olds, and included various social characteristics and habits of the respondents.

Global and multidimensional self-concept as a predictor of health practices in middle adolescents

OBJECTIVE

To describe the relationship between global and multidimensional aspects of self-concept and the health practices of adolescents.

METHODS

A total of 195 adolescents, ages 14-17, who attended two Senior high schools within rural county in a Southeastern state completed research questionnaires.

RESULTS

The adolescents in this sample scored average or slightly above average for global self-concept on the Piers-Harris Self-Concept Scale. Adolescents scored lowest in the health-related behavior of time spent eating a balanced diet and highest in the area of safety. The single highest correlation between self-concept and self-care practices was between the total health practice score and global self-concept.

CONCLUSIONS

The results suggest that an individual's knowledge, feelings of worth related to status at school, and level of anxiety and stress are important predictors of health behavior.

Attitudes and perceptions toward smoking: smokers' views of themselves and other smokers

A sample of American smokers completed a questionnaire regarding their motivations for and opinions about smoking. The subjects also indicated their perceptions of how other smokers feel about the same issues. The results indicated that the subjects perceived psychological addiction as the primary reason for their own smoking. The subjects perceived differences between their own motivations and opinions and those of the other smokers'. The subjects were likely to be more critical of their own smoking. The longer the subjects had been smoking, and the more cigarettes they smoked, the more likely they were to say that smoking is psychologically and physically addictive and that quitting would be difficult.

Genetic contribution to risk of smoking initiation: comparisons across birth cohorts and across cultures

Self-report data on smoking initiation (whether the respondent admitted ever having smoked) were obtained from three large adult twin samples (Australia, N = 3,808 pairs; Virginia, N = 2,145 pairs; AARP, N = 3,620 pairs). Data were broken down into birth cohorts, and genetic models were fitted to test whether the decline, in more recent birth cohorts, in the percentage of individuals becoming smokers has led to a change in the relative contributions of genes and environment to risk of becoming a smoker. Despite a marked change in the proportion of male respondents who reported ever having smoked, we found no evidence for cohort differences in genetic and environmental effects (no Genotype x Cohort interaction). Significant differences in genetic and environmental parameters were found between sexes, and between the Australian and the two U.S. samples. In the U.S. samples, estimates of the genetic contribution to risk of becoming a smoker were 60% in men, 51% in women. In the Australian sample, heritability estimates were 33% in men, but 67% in women. Significant shared environmental effects on smoking initiation also were found, accounting for 23% of the variance in U.S. men, 28% of the variance in U.S. women, 39% of the variance in Australian men, and 15% of the variance in Australian women. In models that allowed for the environmental impact of cotwin smoking on a twin's risk of smoking initiation, estimates of the direct genetic contribution to risk of smoking initiation were comparable or higher (49-58% in U.S. women and 71% in Australian women; 58-61% in U.S. men, and 37% in Australian men).

Adolescent wellness. Facilitating compliance in social morbidities

The establishment of a well adolescent schedule needs to be developed similar to the scheduled clinical visits in pediatric care. However, providing adolescent wellness visits without appropriate financial reimbursement for time expended and without increased provider training may make "well" adolescent visits an unrealistic expectation. However, two major trends will significantly impact on the future of adolescent health care. These include a sharp increase in numbers of adolescents beginning in 1990 and the poverty within the adolescent population. These data suggest that obstacles, whether personal, financial, or educational, need to be addressed quickly in order to resolve these problems because of increasing numbers of adolescents and related morbidities through the year 2000. The increasing trend of juvenile poverty in this population has been significantly associated with a number of the new morbidities such as substance abuse, STD, pregnancy, and the latest morbidity, AIDS. Without a wellness schedule, it is likely that adolescents will continue to represent an underserved population; as a consequence, mortalities and morbidities will increase through the year 2000. The issue of adherence to prescribed medical regimens in the adolescent population is an interesting, complex, and especially challenging one when faced with the social morbidities. Although preliminary work in this area has progressed in the last 15 years, greater attention must be paid to the needs of adolescents in order to determine effective strategies that can minimize the effects of the current morbidities. It is important for the primary care physician not to become overwhelmed with the scope of problems that adolescents have or become discouraged because anticipatory guidance seems ineffective. Repeated dosages of anticipatory guidance should not be viewed as limitations or failures but rather as necessary and standard care. One should consider such interventions as similar to immunizations, in which certain vaccines result in life-long immunity. One would not eliminate the tetanus vaccine because the patient must receive periodic boosters. Similarly, as health care professionals, we should not consider interventions designed to preclude behavior or mental health problems as failures if periodic and developmentally appropriate relevant "boosters" are necessary. Anticipatory guidance is an extremely effective tool that every primary care physician has at his or her disposal to assist in the diagnosis of problematic behavior in adolescents and to preclude problems. Future research needs to focus on documenting strategies that can be utilized by physicians on a daily basis without excessive time or financial constraints.(ABSTRACT TRUNCATED AT 400 WORDS)