What works to prevent adolescent smoking? A systematic review of the National Cancer Institute's Research-Tested Intervention Programs

Developing a co-production strategy to facilitate the adoption and implementation of evidence-based colorectal cancer screening interventions for rural health systems: a pilot study

BACKGROUND

Evidence-based colorectal cancer screening (CRCS) interventions have not been broadly adopted in rural primary care settings. Co-production of implementation strategies through a bundled approach may be promising in closing this gap by helping rural healthcare practitioners select and implement the best fitting CRCS interventions to the local context. This paper describes the process and outcomes of co-development and delivery of the bundled implementation strategy to improve adoption and implementation of CRCS interventions with two rural clinics.

METHODS

We used a bundle of implementation strategies with a core focus on academic-clinical partnership development (strategy 1) and Plan-Do-Study-Act cycles (strategy 2) to identify clinical partner interests/preferences on delivery methods and content needed to facilitate intervention identification and implementation that improves CRCS. We also developed an implementation blueprint for each clinic (strategy 3) through an online blueprinting process based on adapted "Putting Public Health Evidence in Action" (PPHEA) training curriculum. Clinic physicians and staff (n = 7) were asked to evaluate the bundled approach based on overall reactions and perceptions of innovation characteristics using 5-point Likert scale. After completing the bundled approach, we collected implementation outcomes and limited intervention effectiveness of the CRCS evidence-based interventions (EBIs) developed through the process.

RESULTS

Our co-production strategy yielded a prototype online blueprinting process consisting of 8 distance-learning PPHEA modules that guide selection and implementation of EBIs tailored to CRCS. Modules were delivered to clinic participants with minor adaptations, using PDSA cycle to improve quality of module contents and formats. Overall, participants in both clinics reported positive reactions toward the bundled approach. Both clinics reported improvements in how they perceived the characteristics of the innovation (the bundled approach) to tailor selected CRCS EBIs. As a result of the bundled strategies, each clinic selected and adopted specific EBI(s) with the varying degrees of implementation and CRCS outcomes.

CONCLUSIONS

The bundle of implementation strategies used were feasible and acceptable in rural primary care practices to facilitate the use of EBIs to improve CRCS.

Core functions and forms of Bright IDEAS: A multi-methods evaluation of the adoption of an evidence-based psychosocial training program through iterative adaptation

Background

Despite efforts to widely disseminate interventions designed to increase access to quality supportive care to pediatric cancer patients and their families, many of these interventions fail to meet expectations once deployed in real-life clinical settings. This study identifies the functions and forms of Bright IDEAS: Problem-Solving Skills Training, an evidence based psychosocial intervention for caregivers of children recently diagnosed with cancer, to identify pragmatic program adaptations in its real-world clinical implementation. We compare intervention adoption before and after adaptations to the Bright IDEAS training program as part of a national training program designed to disseminate the intervention.

Methods

209 pediatric psychosocial oncology practitioners representing 134 unique institutions were trained during 10 in-person 8-hour workshops (2015-2019). Functions and forms of Bright IDEAS were identified, and adaptations made to the training agenda and curriculum based on practitioner feedback following implementation in local institutions. Mixed method evaluation included longitudinal surveys at 6- and 12-months post training; and qualitative interviews among a subgroup of practitioners (N = 47) to understand and compare perspectives on intervention adoption and barriers to implementation before and after adaptations to the Bright IDEAS training program. The RE-AIM framework was used to guide dissemination evaluation.

Results

A total of four adaptations were tailored to the identified forms of the intervention: case studies; pre-training reading materials; training videos; and letters of institutional support from primary supervisor. Pre- and post-training adaptations to the Bright IDEAS training program were mapped to RE-AIM constructs. Quantitative findings demonstrate that adaptations appeared to improve adoption and usage overall.

Conclusion

This study provides insight into how contextual factors influence psychosocial practitioners' capacity to adopt, implement, and maintain Bright IDEAS in the clinical setting. This study demonstrates the use of real-time stakeholder feedback to guide intervention translation from research to practice settings.

Evaluation of the Cancer Control P.L.A.N.E.T. Web Portal

CONTEXT

The Cancer Control P.L.A.N.E.T. (P.L.A.N.E.T.) Web portal was designed to ease access to data and evidence-based resources for cancer control practitioners and researchers focused on developing, implementing, and evaluating cancer control programs.

OBJECTIVES

To determine usability, applicability, and opportunities to improve the P.L.A.N.E.T. Web portal after significant changes to the portal over time.

DESIGN

The National Cancer Institute surveyed and interviewed cancer control professionals to assess factors influencing utilization of P.L.A.N.E.T. Data were collected from May 2017 to June 2018 via partner agencies, electronic publications, and online links.

OUTCOME MEASURES

Descriptive statistics with χ test were used to analyze the quantitative data and examine the relationship among variables. Qualitative interviews further informed the quantitative analysis.

RESULTS

Of the 724 participants surveyed, 51% were users of P.L.A.N.E.T., with the majority accessing P.L.A.N.E.T. within the last 6 months. Most users felt that P.L.A.N.E.T. effectively met their needs for accessing specific cancer data, identifying evidenced-based programs, and ascertaining details on various cancer topics. There were statistically significant differences in demographic characteristics between users and nonusers of P.L.A.N.E.T., where users were more likely to have more experience in the cancer field, were older in age, and located in southern states.

CONCLUSION

Results indicate that P.L.A.N.E.T. is seen as a viable and credible source for cancer control program planning and delivery. A reassessment of P.L.A.N.E.T.'s goals is warranted, which may support reaching out to new audiences, amplifying or removing underutilized resources, and adding additional resources and topics. Consideration for training and tutorials on P.L.A.N.E.T. would benefit partner agencies and build capacity for evidence-based program development.

Smoking prevention among youth

For majority of smokers, onset of smoking occurs during adolescence, period of intensive growth and development, and this early smoking initiation is associated with many adverse health effects. Smoking prevention measures include not only prevention of onset, but also prevention of transition from experimentation to chronic tobacco use and dependence and smoking cessation. Effective preventive measures should be based on relevant theory and scientific evidence on behavior determinants. In this review article, we present evidence from researches on effectiveness of school programs, community-based programs, media campaigns and stress the importance of considering new challenges in tobacco control and other promising strategies, as well as the need for early detection of nicotine dependence signs among adolescents. In practice, many preventive measures are not based on theory and some interventions can be contra productive. Regardless of type of intervention and setting in which is implemented, it is of importance to take into account context for its implementation.

A systematic review of the prevalence and risk factors of smoking among Saudi adolescents

OBJECTIVES

To systemically review the evidence concerning the prevalence and reported risk factors of smoking among adolescents in Saudi Arabia. Methods: Following the PRISMA guidelines, studies that examined the prevalence and risk factors of smoking among adolescents in Saudi Arabia were identified through a computerized literature search using the following databases up to March 2018: PubMed, SCOPUS, Web of Science, and BIOSIS. The following search terms were used: smoking OR smok* OR tobacco OR cigar* OR shisha OR shesha OR sheesha AND Saudi Arabia OR KSA. Peer-reviewed articles published within the period from 2007 to 2018 were selected. Studies that reported prevalence data, patterns, and risk factors of smoking among adolescents were included. Extracted data from each study were tabulated, and data were narratively synthesized.

RESULTS

Thirty-two studies that reported the prevalence of smoking in the adolescent age group were included in the narrative evidence synthesis. These studies were conducted on secondary school students (n=11), college students (n=14), and an adolescent age group without educational specifications (n=7). According to published reports between 2007 and 2018, the prevalence of tobacco smoking among adolescents in Saudi Arabia ranged from 2.4% to 39.6%. Influence of friends, and family negligence were the most commonly reported risk factors for smoking. Conclusion: The prevalence of smoking is relatively high among adolescents in Saudi Arabia. The social influence of friends, teachers or parents, low academic performance, having spare time, living away from home, and the desire to relieve stress were the most commonly reported risk factors for smoking.

What public health strategies work to reduce the tobacco demand among young people? An umbrella review of systematic reviews and meta-analyses

OBJECTIVE

To perform an umbrella review of systematic reviews and meta-analyses of health policy and health promotion strategies to reduce the tobacco demand in adolescents, youth and young adults.

METHODS

Reviewers independently performed an electronic database search, reviewed titles and abstracts, assessed articles' eligibility for inclusion and quality, and extracted relevant data. Only systematic reviews and meta-analyses reporting data on tobacco policies and interventions focusing on individuals aged <25 years were included. The Framework Convention on Tobacco Control was used to guide data synthesis.

RESULTS

13 articles were included. Studies were of mixed quality with five studies ranked as critically low and seven as high quality. Overall, mixed results were found on the effectiveness for tobacco policies and interventions. Strategies such as increasing taxes on tobacco products were most promising.

CONCLUSION

Though data on a variety of measures to reduce smoking is available, conclusions concerning the effectiveness are inconclusive. Tobacco policies and interventions have the potential to reduce smoking, but conclusions are hampered due to both lack of high-quality trials and numerous biases in primary studies. Further high-quality research is required to examine the effectiveness of interventions and policies to reduce the tobacco demand in adolescents, youth and young adults.

Nicotine dependence among adolescents in the European Union: How many and who are affected?

Background

Nicotine dependence during adolescence increases the risk of continuing smoking into adulthood. The magnitude of nicotine dependence among adolescents in the European Union (EU) has not been established. We aimed to estimate the number of nicotine dependent 15-year-old adolescents in the EU, and identify high-risk groups.

Methods

The number of nicotine dependent 15-year-olds in the EU was derived combining: (i) total number of 15-year-olds in the EU (2013 Eurostat), (ii) smoking prevalence among 15-year-olds (2013/2014 HBSC survey) and (iii) proportion of nicotine dependent 15-year-olds in six EU countries (2013 SILNE survey). Logistic regression analyses identified high-risk groups in the SILNE dataset.

Results

We estimated 172 636 15-year-olds were moderately to highly nicotine dependent (3.2% of all 15 years old; 35.3% of daily smokers). In the total population, risk of nicotine dependence was higher in males, adolescents with poor academic achievement, and those with smoking parents or friends. Among daily smokers, only lower academic achievement and younger age of smoking onset were associated with nicotine dependence.

Conclusion

According to our conservative estimates, more than 172 000 15-year-old EU adolescents were nicotine dependent in 2013. Prevention of smoking initiation, especially among adolescents with poor academic performance, is necessary to prevent a similar number of adolescents getting addicted to nicotine each consecutive year.

Comparison of toxicant load from waterpipe and cigarette tobacco smoking among young adults in the USA

OBJECTIVES

To form population-level comparisons of total smoke volume, tar, carbon monoxide and nicotine consumed from waterpipe tobacco smoking (WTS) and cigarette smoking using data from a nationally representative sample of smokers and non-smokers aged 18-30 years.

METHODS

In March and April 2013, we surveyed a nationally representative sample of 3254 US young adults to assess the frequency and volume of WTS and cigarette smoking. We used Monte Carlo analyses with 5000 repetitions to estimate the proportions of toxicants originating from WTS and cigarette smoking. Analyses incorporated survey weights and used recent meta-analytic data to estimate toxicant exposures associated with WTS and cigarette smoking.

RESULTS

Compared with the additive estimates of WTS and cigarette smoking combined, 54.9% (95% CI 37.5% to 72.2%) of smoke volume was attributed to WTS. The proportions of tar attributable to WTS was 20.8% (95% CI 6.5% to 35.2%), carbon monoxide 10.3% (95% CI 3.3% to 17.3%) and nicotine 2.4% (95% CI 0.9% to 3.8%).

CONCLUSIONS

WTS accounted for over half of the tobacco smoke volume consumed among young US adult waterpipe and cigarette smokers. Toxicant exposures to tar, carbon monoxide and nicotine were lower, but still substantial, for WTS alone compared with WTS and cigarette smoking. Public health and policy interventions to reduce harm from tobacco smoking in young US adults should explicitly address WTS toxicant exposures.

Physical Activity and Quit Motivation Moderators of Adolescent Smoking Reduction

OBJECTIVES

We examined participant characteristics as moderators of adolescents' smoking cessation outcomes as a function of intervention: Not-on-Tobacco (N-O-T), N-O-T with a physical activity (PA) module (N-O-T+FIT), or Brief Intervention (BI).

METHODS

We randomly assigned youth (N = 232) recruited from public high schools to an intervention, and measured their baseline levels of PA and motivation to quit. The number of cigarettes/day for weekdays and weekends was obtained at baseline and 3-month follow-up.

RESULTS

Across timepoints, cigarette use declined for youth in N-O-T (p = .007) and N-O-T+FIT (ps < .02), but not BI (n.s.). For N-O-T+FIT youth, the steepest declines in weekday smoking occurred for those with high PA levels (p = .02). Weekend cigarette use decreased for N-O-T+FIT youth with moderate-high levels of intrinsic motivation to quit (ps < .04).

CONCLUSIONS

Adolescents may benefit from interventions designed to address the barriers faced during a quit attempt, including their motivation to make a change and their engagement in other healthy behaviors such as physical activity.

Overview of systematic reviews on the health-related effects of government tobacco control policies

BACKGROUND

Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.

METHODS

An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.

RESULTS

Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.

CONCLUSION

When designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy's effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.

Spousal resemblance for smoking: Underlying mechanisms and effects of cohort and age

BACKGROUND

In this study we ask why spouses resemble each other in smoking behaviour and assess if such resemblance depends on period of data collection or age. Spousal similarity may reflect different, not mutually exclusive, processes. These include phenotypic assortment (choice of spouse is based on phenotype) or social homogamy at the time spouses first meet, and marital interaction during the relationship.

METHODS

Ever and current smoking were assessed between 1991 and 2013 in surveys of the Netherlands Twin Register for 14,230 twins and 1,949 of their spouses (mean age 31.4 [SD=14.0]), and 11,536 parents of twins (53.4 [SD=8.6]). Phenotypic assortment and social homogamy were examined cross-sectionally by calculating the probability of agreement between twins and their spouses, twins and their co-twin's spouse and spouses of both twins as a function of zygosity. Marital interaction was tested by investigating the association between relationship duration and spousal resemblance.

RESULTS

Between 1991 and 2013 smoking declined in all age groups for both genders. Spousal resemblance for ever and current smoking was higher when data were more recent. For ever smoking, a higher age of men was associated with lower spousal resemblance. Phenotypic assortment was supported for both smoking measures, but social homogamy could not be excluded. No effect of marital interaction was found.

CONCLUSIONS

Differences in smoking prevalence across time and age influence spousal similarity. Individuals more often choose a spouse with similar smoking behaviour (phenotypic assortment) causing higher genotypic similarity between them. Given the heritability of smoking this increases genetic risk of smoking in offspring.

Evaluation of a tobacco prevention programme among teenagers in Sweden

OBJECTIVE

To study the prevalence of tobacco use among teenagers, to evaluate a tobacco prevention programme and to study factors related to participation in the prevention programme.

DESIGN AND SETTING

Population-based prospective cohort study.

METHOD

Within the Obstructive Lung disease in Northern Sweden (OLIN) studies, a cohort study about asthma in schoolchildren started in 2006. All children aged 7-8 years in three municipalities were invited to a questionnaire survey and 2585 (96%) participated. The cohort was followed up at age 11-12 years (n=2612, 95% of invited) and 14-15 years (n=2345, 88% of invited). In 2010, some of the children in the OLIN cohort (n=447) were invited to a local tobacco prevention programme and 224 (50%) chose to participate.

RESULTS

At the age of 14-15 years, the prevalence of daily smoking was 3.5%. Factors related to smoking were female sex, having a smoking mother, participation in sports and lower parental socioeconomic status (SES). The prevalence of using snus was 3.3% and risk factors were male sex, having a smoking mother, having a snus-using father and non-participation in the prevention programme. In the prevention programme, the prevalence of tobacco use was significantly lower among the participants compared with the controls in the cohort. Factors related to non-participation were male sex, having a smoking mother, lower parental SES and participation in sports.

CONCLUSIONS

The prevalence of tobacco use was lower among the participants in the tobacco prevention programme compared with the non-participants as well as with the controls in the cohort. However, the observed benefit of the intervention may be overestimated as participation was biased by selection.

Exploring recommendations for an effective smoking prevention program for indonesian adolescents

BACKGROUND

The present qualitative study assessed the need, acceptability and appropriateness for implementing effective and culturally appropriate smoking prevention programs for adolescents in schools in Indonesia.

METHODS

Snowball sampling was used to recruit participants. The study sample comprised a mixture of staff in the education department, junior high school teachers and individuals who had taught junior high school students in Aceh Province, Indonesia. Data were collected through one hour in-depth face to face or telephone interviews and analyzed using a descriptive content analysis procedure.

RESULTS

School teachers and policy makers in education firmly supported the implementation of a school-based smoking prevention program in Aceh. An appropriate intervention for smoking prevention program in schools in Aceh should involve both health and Islamic based approaches, and be provided by teachers and external providers. Potential barriers to the program included smoker teachers and parents, time constraints of students and/or teachers, lack of teachers' ability, increase in students' load, the availability of tobacco advertising and sales, and lack of tobacco regulation and support from community and related departments. To increase program effectiveness, involvement of and coordination with other relevant parties are needed.

CONCLUSIONS

The important stakeholders in Indonesian childhood education agreed that school-based smoking prevention program would be appropriate for junior high school students. An appropriate intervention for smoking prevention program for adolescents in schools in Indonesia should be appropriate to participants' background and involve all relevant parties.

Ethics and Community Involvement in Syntheses Concerning American Indian, Alaska Native, or Native Hawaiian Health: A Systematic Review

BACKGROUND

The objective of the research was to review reporting of ethical concerns and community involvement in peer-reviewed systematic reviews or meta-analyses concerning American Indian, Alaska Native, or Native Hawaiian (AI/AN/NH) health.

METHODS

Text words and indexed vocabulary terms were used to query PubMed, Embase, Cochrane Library, and the Native Health Database for systematic reviews or meta-analyses concerning AI/AN/NH health published in peer-reviewed journals, followed by a search through reference lists. Each article was abstracted by two independent reviewers; results were discussed until consensus was reached.

RESULTS

We identified 107 papers published from 1986-2012 that were primarily about AI/AN/NH health or presented findings separately for AI/AN/NH communities. Two reported seeking indigenous reviewer feedback; none reported seeking input from tribes and communities. Approximately 7% reported on institutional review board (IRB) approval of included studies, 5% reported on tribal approval, and 4% referenced the sovereignty of AI/AN tribes. Approximately 63% used evidence from more than one AI/AN/NH population study, and 28% discussed potential benefits to communities from the synthesis research.

CONCLUSIONS

Reporting of ethics and community involvement are not prominent. Systematic reviews and meta-analyses making community-level inferences may pose risks to communities. Future systematic reviews and meta-analyses should consider ethical and participatory dimensions of research.

The Ligurian high-school educational project on palliative care: development and piloting of a school-based intervention on bereavement and severe illness

This study was aimed at developing and piloting a school-based intervention on severe illness-induced bereavement through a project focused on spreading knowledge of palliative care among high school students (phases 0-II Medical Research Council Framework). The intervention entailed the screening of a topic-related movie and a classroom meeting. Eight classes from 2 high schools participated, and a before-after evaluation was used to assess intervention feasibility and impact. Valid questionnaires, including 2 open-ended questions focusing on bereavement and strategies for coping with loss, were filled in by 89% (before) and 84% (after) of the 159 students. In the after evaluation, content analysis on the "strategies" question showed that answers concerning closeness and sharing were reported more frequently. Positive feedback was collected as regards the overall experience.

Interventions for tobacco use prevention in Indigenous youth

BACKGROUND

Tobacco use in Indigenous populations (people who have inhabited a country for thousands of years) is often double that in the non-Indigenous population. Addiction to nicotine usually begins during early adolescence and young people who reach the age of 18 as non-smokers are unlikely to become smokers thereafter. Indigenous youth in particular commence smoking at an early age, and a disproportionate burden of substance-related morbidity and mortality exists as a result.

OBJECTIVES

To evaluate the effectiveness of intervention programmes to prevent tobacco use initiation or progression to regular smoking amongst young Indigenous populations and to summarise these approaches for future prevention programmes and research.

SEARCH METHODS

The Cochrane Tobacco Addiction Group Specialised Register was searched in November 2011, with additional searches run in MEDLINE. Online clinical trial databases and publication references were also searched for potential studies.

SELECTION CRITERIA

We included randomized and non-randomized controlled trials aiming to prevent tobacco use initiation or progression from experimentation to regular tobacco use in Indigenous youth. Interventions could include school-based initiatives, mass media, multi-component community level interventions, family-based programmes or public policy.

DATA COLLECTION AND ANALYSIS

Data pertaining to methodology, participants, interventions and outcomes were extracted by one reviewer and checked by a second, whilst information on risk of bias was extracted independently by a combination of two reviewers. Studies were assessed by qualitative narrative synthesis, as insufficient data were available to conduct a meta-analysis. The review process was examined by an Indigenous (Aboriginal) Australian for applicability, acceptability and content.

MAIN RESULTS

Two studies met all of the eligibility criteria for inclusion within the review and a third was identified as ongoing. The two included studies employed multi-component community-based interventions tailored to the specific cultural aspects of the population and were based in Native American populations (1505 subjects in total). No difference was observed in weekly smoking at 42 months follow-up in the one study assessing this outcome (skills-community group versus control: risk ratio [RR] 0.95, 95% CI 0.78 to 1.14; skills-only group versus control: RR 0.86, 95% CI 0.71 to 1.05). For smokeless tobacco use, no difference was found between the skills-community arm and the control group at 42 weeks (RR 0.93, 95% CI 0.67 to 1.30), though a significant difference was observed between the skills-only arm and the control group (RR 0.57, 95% CI 0.39 to 0.85). Whilst the second study found positive changes for tobacco use in the intervention arm at post test (p < 0.05), this was not maintained at six month follow-up (change score -0.11 for intervention and 0.07 for control). Both studies were rated as high or unclear risk of bias in seven or more domains (out of a total of 10).

AUTHORS' CONCLUSIONS

Based on the available evidence, a conclusion cannot be drawn as to the efficacy of tobacco prevention initiatives tailored for Indigenous youth. This review highlights the paucity of data and the need for more research in this area. Smoking prevalence in Indigenous youth is twice that of the non-Indigenous population, with tobacco experimentation commencing at an early age. As such, a significant health disparity exists where Indigenous populations, a minority, are over-represented in the burden of smoking-related morbidity and mortality. Methodologically rigorous trials are needed to investigate interventions aimed at preventing the uptake of tobacco use amongst Indigenous youth and to assist in bridging the gap between tobacco-related health disparities in Indigenous and non-Indigenous populations.

Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000-08

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control. A national representative sample of youth 12-17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth. More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose-response relation. Reduction in smoking was related to increased quitting in 2000-02, to increased quitting and declined initiation in 2003-05, and to initiation, quitting and relapse in 2005-08. Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.

The prevalence and determinants of tobacco use among adolescents in Saudi Arabia

BACKGROUND

Adolescent tobacco use has been a serious public health issue, resulting in longer duration of tobacco use and higher nicotine dependence in adulthood. This study identified the current status of tobacco use among middle schools students in Jeddah, Saudi Arabia and the factors leading to tobacco use, to provide information on how to effectively prevent tobacco use among adolescents.

METHODS

A cross-sectional survey was administered to measure the prevalence of tobacco use and profile tobacco users. School selection was stratified by region, gender, and type (public or private). Altogether, 1186 seventh- to ninth-grade students were selected. Of those, 1019 questionnaires were used for analysis.

RESULTS

The mean age of the participants was 14.3 years (SD = 1.2) and boys comprised 54% of the sample. The prevalence of tobacco use among students was 9.72% with a significant difference between sexes (12.43% for boys and 6.65% for girls). Bivariate and multivariate analyses results showed that students whose families had higher income, had larger daily allowances, spent less time studying, skipped class more frequently, were less religious, spent more time out of home, drank more Coca-Cola, intended to use tobacco in the next year, and were males who were more likely to use tobacco.

CONCLUSION

Prevention programs designed to reduce adolescent tobacco use need to consider these sociodemographic characteristics. Understanding the characteristics of adolescent tobacco users and the associated sociocultural context is critical for developing effective tobacco prevention programs targeted at adolescents.

The Association of Parental Self-Efficacy and Parent-Youth Connectedness With Youth Smoking Intentions

Little attention has been paid to understanding how parents of differing race/ethnicity perceive their effectiveness in exercising anti-smoking parenting practices and how these behaviors affect youth's smoking intentions. We explored the association of parent-youth connectedness and parental self-efficacy and youths' smoking intentions in a group of African American and Caucasian never-smokers. Based on Social Bonding Theory and Social Learning Theory, a questionnaire was administered to nonsmoking, 9-16-year-old youth and parent dyads, assessing youth smoking intentions and parental measures of connectedness and self-efficacy. Youth risk factors for intending to smoke were increased parent-youth conflict and protective factors were increased parental monitoring, increased parental rule setting, and higher parental self-efficacy. Parent-youth connectedness and parental self-efficacy did not differ by parental smoking status or by race/ethnicity. Our findings underscore the importance of strong parenting practices and parental self-efficacy in protecting against youth intention to smoke and these may be important to target in future interventions.

Using the systematic review methodology to evaluate factors that influence the persistence of influenza virus in environmental matrices

Understanding factors that influence persistence of influenza virus in an environment without host animals is critical to appropriate decision-making for issues such as quarantine downtimes, setback distances, and eradication programs in livestock production systems. This systematic review identifies literature describing persistence of influenza virus in environmental samples, i.e., air, water, soil, feces, and fomites. An electronic search of PubMed, CAB, AGRICOLA, Biosis, and Compendex was performed, and citation relevance was determined according to the aim of the review. Quality assessment of relevant studies was performed using criteria from experts in virology, disease ecology, and environmental science. A total of 9,760 abstracts were evaluated, and 40 appeared to report the persistence of influenza virus in environmental samples. Evaluation of full texts revealed that 19 of the 40 studies were suitable for review, as they described virus concentration measured at multiple sampling times, with viruses detectable at least twice. Seven studies reported persistence in air (six published before 1970), seven in water (five published after 1990), two in feces, and three on surfaces. All three fomite and five air studies addressed human influenza virus, and all water and feces studies pertained to avian influenza virus. Outcome measurements were transformed to half-lives, and resultant multivariate mixed linear regression models identified influenza virus surviving longer in water than in air. Temperature was a significant predictor of persistence over all matrices. Salinity and pH were significant predictors of persistence in water conditions. An assessment of the methodological quality review of the included studies revealed significant gaps in reporting critical aspects of study design.

Aging images as a motivational trigger for smoking cessation in young women

Recruiting adolescents into smoking cessation programs has been challenging, and there is a lack of effective smoking cessation interventions for this age group. We aimed to assess whether the approach of using aging images can be used to recruit young, female smokers for a smoking cessation course. In this study, 853 14- to 18-year-old subjects were photographed (2006–2007). After software-aided aging, the images evoked strong emotions, especially in subjects with an advanced motivational stage to quit. Twenty-four percent of current smokers reported that the aging images increased their motivation to quit smoking (pre-contemplation: 8%; contemplation: 32%; and preparation: 71%). In multivariate analyses, the aged images had a high motivational impact to quit smoking that was associated with an increased readiness to stop smoking and the individual’s assessment of the aging images as shocking, but not with the number of previous attempts to quit and the assessment of the pictures as realistic. However, it was not possible to recruit the study population for a smoking cessation course. We concluded that aging images are a promising intervention for reaching young women and increasing their motivation to stop smoking. However, smoking cessation courses may not be appropriate for this age group: none of the recruits agreed to take a cessation course.