Adolescent gender differences in the determinants of tobacco smoking: a cross sectional survey among high school students in São Paulo

Adolescent risk behaviours and family settings in Bulgaria: An evidence-based approach to effective family support policies

BACKGROUND

The paper focuses on Bulgarian adolescents' behaviours that put their health at risk and their relationship to family-related characteristics: structure of family and material status, family support, communication with parents, parental monitoring and school-related parental support. It also discusses intervention programs with a focus on parent support gradient.

MATERIAL AND METHODS

The analysis is based on the Bulgarian sample of Health Behaviour in School-Aged Children survey, the 2018 round. Logistic regression models of current cigarette smoking, regular alcohol consumption, sexual debut and current cannabis use are applied. Main national programs on adolescent health and the parental involvement component in them are also discussed.

RESULTS

The statistical analyses reveal significant gender and age differences in Bulgarian adolescents' health risk behaviours. Girls have significantly higher odds of smoking and are less likely to report an early start of sexual life. Odds of cigarette smoking and regular alcohol consumption increase with age. Children living with one parent have significantly higher odds of smoking, regular alcohol consumption and current cannabis use. Interactions between FAS and family support reveal that students who report low family support, regardless of the material status of the family, have significantly higher odds of health risk behaviours.

CONCLUSION

The main contribution of the analysis reveals the alleviating effect of family support on socio-economic inequalities between families. An evidence-based approach delineating a preventive potential of family support on Bulgarian adolescents' health risk behaviours despite the level of family affluence provides solid arguments for increasing national family support programs.

Prevalence of Cigarette Smoking and Influence of Associated Factors among Students of the University of Banja Luka: A Cross-Sectional Study

Background and Objectives: Cigarette smoking among the youth population has increased significantly in developing countries, including Bosnia and Herzegovina. However, no extant literature assesses the prevalence of tobacco use, nor identifies factors associated with smoking. This study determined the prevalence of cigarette smoking among a specific cohort of students and assessed factors related to tobacco use in this population. Materials and Methods: This cross-sectional study included 1200 students at all faculties of Banja Luka University. Data were collected from questionnaires adapted from the Global Youth Tobacco Survey (GYTS) and the Global Health Professional Student Survey (GHPSS) standardized questionnaires and were analyzed using descriptive statistics, Pearson's χ2 test, and logistic regression. Results: When the prevalence of cigarette smoking within the last thirty days was recorded, we found that 34.1% of students smoked within this period. Nearly three-quarters (74.9%) of the student population had smoked or experimented with cigarette smoking. However, medical students were 27.2% less likely to smoke than their counterparts from other faculties. Overall, 87% of all students were aware of the harmful effects of cigarette smoking, 79% were aware of the harmful effects of secondhand smoke, and 65% reported that it was difficult to quit. Increased spending of personal money was associated with a higher probability of smoking, while exposure to secondhand smoke increased the odds of smoking by 62%. Conclusion: Policies, strategies, and action plans should be introduced in order to reduce the prevalence of smoking among university students and to create a smoke-free environment at the various universities involved.

Youth Perceptions of Parental Involvement and Monitoring, Discrepancies With Parental Perceptions, and Their Associations With First Cigarette Use in Black and White Girls

OBJECTIVE

Low parental involvement and monitoring are risk factors for adolescent cigarette use. Assessments of parental involvement and monitoring by youth and parents may capture an additional source of risk: differences in perceptions of these parenting behaviors. This study tested for unique contributions of youth-reported parental involvement and monitoring and youth-parent discrepancies in reporting to first cigarette use in girls.

METHOD

Data were drawn from interviews at ages 8-17 with 1,869 girls (57.3% Black, 42.7% White) and their primary caregivers (94% mothers) in the Pittsburgh Girls Study. Cox proportional hazards regression analyses were conducted to predict first cigarette use as a function of girls' reports of parental involvement and monitoring, magnitude and direction of youth-parent reporting discrepancies, and the interaction between them, adjusting for neighborhood, socioeconomic, and individual level factors.

RESULTS

High magnitude of discrepancy in parental involvement reports (hazard ratio [HR] = 1.14, 95% confidence interval [CI] [1.03, 1.26]) and lower perceived parental involvement by girls (HR = 1.14, CI [1.03, 1.27]) were associated with an elevated risk for first cigarette use. Girls' reports of low parental monitoring also predicted first cigarette use (HR = 1.14, CI [1.06, 1.21]).

CONCLUSIONS

Girls whose parents have limited awareness of their whereabouts and friends (i.e., low monitoring) are at an elevated risk for trying cigarettes, but parent-daughter differences in perceived awareness do not affect risk. By contrast, girls who perceive a lower degree of parental involvement than their parents do are at increased risk. Monitoring is one component of parenting that may reduce smoking risk; shared perspectives on the parent's level of involvement are similarly important.

The Viewpoints of Urban High School Male Students, Parents and Teachers About Cigarette Smoking by Adolescents: A Social Marketing-Based Qualitative Study, Shiraz, Iran

Background: Smoking is one of the greatest challenges for public health. It is estimated that 7% - 25% of adolescents have experienced smoking in Iran. Objectives: The present study aimed to investigate the viewpoints of high school male students, their parents, and teachers about smoking by adolescents based on four components of the social marketing mix. Methods: A qualitative study with a phenomenological approach was conducted via 12 focus group sessions in Persian language. To this end, 82 participants (30 students, 28 parents, and 24 teachers) were selected based on purposive sampling method in 2015.The data were analyzed through directed content analysis. Results: All the three studied groups viewed “looking older” as the major cause of adolescent smoking, other factors included getting others’ attention, looking smart person, calmness, decreasing pain, and attractive packaging of cigarette. Some differences were observed between the viewpoints of students, parents, and teachers about the complications of cigarette. The students focused on the social consequences of smoking, but the parents and teachers were more worried about its long term physical side effects and addictive properties. Unlike parents, the teachers and students considered imitating from parents and famous people as the main socio-environmental factor of smoking. All three groups believed that people’s negative social image and negative attention towards smokers should be included in smoking prevention educational programs. However, some differences were reported between their ideas in other educational subjects. Conclusions: Evaluating factors related to tobacco use from three different perspectives can provide a more comprehensive view of these factors and show the reason for the failure of many efforts to prevent student tobacco use and develop a more effective program to promote health.

The Prevalence of Smoking (Cigarette and Waterpipe) among University Students in Some Arab Countries: A Systematic Review

Background:

Tobacco use among university students remains the most alarming problem worldwide. This study aims to systematically review the previous literature for determining the prevalence of smoking (cigarette and waterpipe) among university students in some Arab countries.

Methods:

We electronically searched articles from MEDLINE, PubMed, EMBASE, Google Scholar and Google for the period from April 2018 to June 2019. We conducted a systematic review of eligible studies published in English between 2006 and 2019, for assessing cigarette and waterpipe smoking among university students. The studies were all cross-sectional according to eligibility criteria and contained 469 studies19 meet the inclusion criteria from 12 countries of (Yemen, Kingdom of Saudi Arabia (KSA), Kuwait, Bahrain, Jordan, Lebanon, Tunisia, Egypt, Palestine, Syria, Libya and United Arab Emirates (UAE).

Results:

the study included a total of participants (N=45,306) (33,450 Males vs 11,856 Females). The overall highest rate of current smoking among students was in Egypt (46.7%), Kuwait (46%) and KSA (42.3%). The smoking prevalence among males was significantly higher than females in Yemen (36.3% vs 28.0%,p<0.001), Bahrain (27.0%vs 4.2%, p<0.001), Tunisia (38.4% vs 3.4%, P<0.001), Egypt (61.2% vs 18.9%, P<0.001), Palestine (52.7% vs 16.5%, p<0.001), Syria (26.1% vs 9.5%, p<0.001), KSA (32.7%vs5.9%,P<0.001), and Jordan (54.3%vs11.1%, P<0.005) and (56.9%vs11.4%, P<0.005). Another study in Yemen was significantly higher among women than man (15.7% vs 10.3%, p<0.001). The highest waterpipe smoking rates among gender was in KSA (36.4%-36.3%). For cigarette smoking, the highest rates were in Libya (80.2%), Jordan (80%) and KSA (70.7%). The highest smoking rates among males were in Egypt (61.2%), Jordan (56.9%-54.3%) and Palestine (52.7%), for females the highest rate was in Yemen (28.0%).

Conclusion:

The prevalence of smoking cigarette and waterpipe appears to be alarmingly high among university students in Arab countries. The results were different among students, due to the nature of the region and the different customs, traditions, lineage and multicultural from country to another.

Uruguayan secondary school students speak up about tobacco: results from focus group discussions in and around Montevideo

This qualitative research study investigated intrapersonal, interpersonal, and environmental factors that shape young adolescent tobacco use behaviors in Uruguay. Focus groups were conducted in the summer of 2012 and fall of 2013 in four secondary schools in Montevideo, Uruguay, including two private schools and two public schools. A total of four focus groups were led in each school, composed of 4-6 students each, 16 focus groups in total. Data analysis utilized NVivo software and included deductive and inductive content analysis. Overwhelmingly, students reported that the onset of smoking occurred in the second year of secondary school. The primary intrapersonal factors that were found to be universal among respondents identified that smoking was a performance in groups, to garner attention from their peers. Students interviewed most often stated that the greatest interpersonal factors for smoking were to look older, as a rite of passage, and for group membership. Environmental factors cited most often indicate that they smoked during unsupervised time, either at night or around the short Uruguayan school day. Focus group interviews revealed that adolescents had easy access to cigarettes for purchase through small family owned grocery stores, even though laws exist preventing the sale of cigarettes to minors. Few differences were cited between strata related to cigarette use in adolescents. The differences that do exist are most apparent across gender, though there were a few observed differences when stratified by public and private school. Findings from this study indicate that key factors across ecological levels (intrapersonal, interpersonal, and environmental) should be taken into consideration when designing tobacco prevention programs for youth in Uruguay. A multiple-component approach which addresses risk factors at all of these levels, implemented in schools, may be particularly well-suited to this setting.

Knowledge and factors related to smoking among university students at Hodeidah University, Yemen

INTRODUCTION

Tobacco smoking, especially among university students, remains a significant issue worldwide. This survey aims to investigate and evaluate the smoking behavior and smoking-related knowledge and their relationship in students of Hodeidah University, Yemen.

METHODS

A cross-sectional study was performed among students at Hodeidah University. Using a global youth tobacco survey and a global health professional survey, data were collected from three colleges (Commerce and Economics, Engineering, and Medicine) from April to June 2017, from 420 randomly chosen students.

RESULTS

The smoking prevalence among university students was 33.1% (cigarettes 13.6%, waterpipe 9.3%, and 10.2% for dual cigarettes and waterpipe use), with a higher rate of smoking among males than females (36.3% vs 28.0%, p<0.001). The percentage of individuals participating in the three types of smoking among males and females, respectively, were 18.9% vs 5.0% for cigarettes, 1.9% vs 21.1% for waterpipe, and 15.4% vs 1.9% for dual cigarettes and waterpipe use, with a student mean age of 21.93 ± 2.55 years. The regression outcome revealed that year of study was highly associated with smoking (OR=0.87, 95% CI: 0.85-0.89, p<0.001). Age (OR=0.96, 95% CI: 0.94-0.99, p<0.05), residence (OR=1.05, 95% CI: 1.00-1.09, p<0.05) and family income (OR=1.03, 95% CI: 1.00-1.06, p<0.05) were also significant predictors of smoking.

CONCLUSIONS

According to this study, most of the male students were cigarette users, while female students were waterpipe users. The prevalence of waterpipe use among females, as opposed to males, is an issue of concern. Policy makers may need to initiate anti-smoking programmes in Yemeni universities.

The Speed of Progression to Tobacco and Alcohol Dependence: A Twin Study

We investigated the etiological role of genetic and environmental influences for two milestones of tobacco and alcohol use: age of initiation, and speed of progression to dependence (latency). Study participants included 1352 monozygotic and 1422 dizygotic twins (mean age at assessment = 24.31). Earlier ages of initiation significantly increased the likelihood of developing dependence, but were associated with longer dependence latencies for tobacco and alcohol. Latencies to dependence were heritable traits for tobacco (a2 = 0.63) and alcohol (a2 = 0.64). Genetic influences contributing to early age of initiation were associated with faster latencies to dependence but sometimes were counteracted by environmental factors, the extent to which depended on substance and, sometimes, sex. Our findings may have important implications for public policy and add to the literature by characterizing the genetic and environmental contributions to the speed of progression to tobacco and alcohol dependence.

Parental Monitoring and Alcohol Use Across Adolescence in Black and White Girls: A Cross-Lagged Panel Mixture Model

BACKGROUND

The link between parental monitoring and adolescent alcohol use is well established, but the directionality of this relationship is somewhat elusive. The literature suggests that parental engagement serves a protective function with respect to alcohol use, but that parental monitoring may also diminish in response to recurrent risk behavior. The lower rate of alcohol use despite evidence of lower levels of parental monitoring in Black versus White youth raises the question of for whom and under what conditions parental monitoring and alcohol use are associated.

METHODS

Data were drawn from a community sample of 1,634 female adolescents (954 Black, 680 White) from 4 age cohorts, assessed annually in an accelerated longitudinal design. This study uses data spanning ages 12 to 17; parental monitoring and alcohol use were assessed via self-report, while demographic and adolescent psychosocial risk factors were derived from parent reports when the girls were age 12. An autoregressive cross-lagged panel mixture model was used to identify discrete patterns of parental monitoring and alcohol use associations across adolescence, and psychosocial factors that differentiate between them.

RESULTS

Two discrete patterns of codeveloping alcohol use and parental monitoring emerged: one with stable bidirectional and autoregressive links (79%) and another differing from the majority profile in terms of the absence (alcohol use to parental monitoring) and direction (parental monitoring to alcohol use) of cross-construct influences (21%). Those in the minority profile were, at age 12, more likely to have received public assistance, resided in single-parent households, reached puberty, and manifest more severe conduct problems.

CONCLUSIONS

Identifying subgroups of girls with distinct patterns of codeveloping alcohol use and parental monitoring is particularly relevant to the development and implementation of family-level interventions, both in terms of targeting those with known demographic risk factors, and tailoring programs to address behavioral correlates, such as conduct problems.

Binge drinking and associated factors among adolescents in a city in southeastern Brazil: a longitudinal study

Abstract: The aim of this study was to investigate changes in the frequency of binge drinking and associated factors in the city of Belo Horizonte, Minas Gerais State, Brazil. The sample consisted of 436 adolescents. Data collection involved the Alcohol Use Disorders Identification Test and the Alcohol, Smoking and Substance Involvement Screening Test. Ordinal logistic regression was used in the multivariate analysis. An increase in the frequency of binge drinking was found among adolescents who lived in areas of greater social vulnerability (OR = 1.64; 95%CI: 1.01-2.68), those whose mothers consumed alcoholic beverages (OR = 1.75; 95%CI: 1.05-2.92), those whose fathers consumed alcoholic beverages (OR = 2.02; 95%CI: 1.11-3.68), those with an increased risk of tobacco use (OR = 2.82; 95%CI: 1.07-7.42) and those who attended religious services (OR = 2.10; 95%CI: 1.30-3.38). Knowledge regarding factors associated with a change in the frequency of binge drinking among adolescents can assist in the establishment of public policies directed at health promotion and the prevention of adverse health conditions.

Prevalence and determinants of cigarette smoking among college students: a cross-sectional study in Douala, Cameroon

Background

Tobacco is the most important avoidable risk for non communicable diseases. While tobacco consumption is stable or declining in developed countries, it is increasing in the developing world with a rate of 3.4 % per annum. The objective of this study was to estimate the prevalence and factors associated with cigarette smoking among college students.

Methods

A cross-sectional study was conducted from December 2012 to April 2013 in secondary schools in Douala, Cameroon. A self-administered questionnaire was used to collect sociodemographic data, smoking behavior and peer smoking among college students. Logistic regression analyses was employed to identify factors associated with cigarette smoking.

Results

Of a total of 2623 students included, 1579 (60.2 %) were female. The mean age of participants was 19.2 ± 2.53 years. The prevalence of current smoking was 11.2 % [95 % confidence interval (CI) 10 – 12], with 20 % in males and 5.3 % in females. Cigarette smoking was with significantly associated with friends smoking [Odds ratio (OR) 6.66; 95 % CI 4.69 – 9.45)], male gender (OR 3.61; 95 % CI 2.52 – 5.16), increase in age (OR 1.10; 1.03 – 1.17), parental smoking 1.69 (1.04 – 2.76), and attending general education (OR 1.85; 1.23 – 2.78).

Conclusions

Cigarette smoking constitutes a significant health hazard in college students in Douala. Youth population and especially male students should be continuously targeted by preventive measures and sensitization campaigns against tobacco use. Parents should be aware on the influence of their smoking behavior on initiation of smoking in their children and should be encouraged to quit smoking.

Estilos parentais como fator de proteção ao consumo de tabaco entre adolescentes brasileiros

Resumo O objetivo foi analisar a associação entre o uso de tabaco (no mês e frequente) com os estilos parentais e o comportamento de fumar dos pais, em uma amostra de estudantes do Ensino Médio. Foram avaliados 17.246 estudantes do Ensino Médio de escolas públicas e privadas das 27 capitais brasileiras. A prevalência do uso de tabaco na vida foi de 25,2%, 15,3% no ano, 8,6% no mês, e 3,2% para uso frequente. Em relação aos estilos parentais, 39,2% dos pais foram classificados como negligentes, 33,3% autoritativos, 15,6% como indulgentes e 11,9% autoritários. Comparados a estudantes com pais autoritativos, filhos de pais negligentes ou indulgentes tiveram maior chance de relatar o uso no último mês ou frequente de tabaco. Observou-se uma associação entre o estilo parental e uso de cigarros por estudantes do Ensino Médio. O estilo parental autoritativo foi associado à proteção ao uso de tabaco no mês e frequente entre os adolescentes.

Tobacco use and friendship networks: a cross-sectional study among Brazilian adolescents

AIM

To determine the prevalence of tobacco use and its association with types of friendship networks, socioeconomic status and gender among Brazilian adolescents.

METHODS

A cross-sectional study was carried out with a representative sample of 905 students aged 15 to 19 years. Information on social networks and tobacco use was collected by the self-administered questionnaire 'Alcohol, Smoking and Substance Involvement Screening Test" and the question "What is your most important group of close friends?'. Socioeconomic status was assessed using an area-based social vulnerability index and type of school. Multinomial logistic regression analysis was employed to test associations between tobacco use and the independent variables.

RESULTS

The overall prevalence of tobacco use was 18.9%. Female adolescents had 3.80-fold greater odds of reporting weekly to daily tobacco use compared to male adolescents. Participants who reported that their most important groups of close friends were from church had a lower risk of reporting weekly to daily tobacco use in comparison to those who reported that their best friends were from school.

CONCLUSIONS

The prevalence of tobacco use was high and was associated with school-based (as compared to church-based) friendship networks, female gender and higher area-level socioeconomic status.

Bidirectional associations between family factors and Internet addiction among adolescents in a prospective investigation

AIMS

This study aimed at evaluating the effect of family factors on the occurrence of Internet addiction and determining whether Internet addiction could make any difference in the family function.

METHODS

A total of 2293 adolescents in grade 7 participated in the study. We assessed their Internet addiction, family function, and family factors with a 1-year follow up.

RESULTS

In the prospective investigation, inter-parental conflict predicted the incidence of Internet addiction 1 year later in forward regression analysis, followed by not living with mother and allowance to use Internet more than 2 h per day by parents or caregiver. The inter-parental conflict and allowance to use Internet more than 2 h per day also predicted the incidence in girls. Not cared for by parents and family APGAR score predicted the incidence of Internet addiction among boys. The prospective investigation demonstrated that the incidence group had more decreased scores on family APGAR than did the non-addiction group in the 1-year follow-up. This effect was significant only among girls.

CONCLUSIONS

Inter-parental conflict and inadequate regulation of unessential Internet use predicted risk of Internet addiction, particularly among adolescent girls. Family intervention to prevent inter-parental conflict and promote family function and Internet regulation were necessary to prevent Internet addiction. Among adolescents with Internet addiction, it is necessary to pay attention to deterioration of family function, particularly among girls.

Family and peer risk factors as predictors of lifetime tobacco use among Iranian adolescents: gender similarities and differences

Introduction:

Family and peer risk factors are considered as important predictors of tobacco use in adolescents. Furthermore, information regarding gender differences in lifetime tobacco use of adolescents is essential for designing gender-specific tobacco prevention policies.

Methods:

In a cross-sectional population-based study, 870 Iranian adolescents (430 boys and 436 girls) aged 15-18 years old, filled out the adopted form of “Communities That Care Youth Survey”. Four family and two peer risk factors were entered in adjusted logistic regression analyses to predict the lifetime tobacco use (cigarette and smokeless tobacco) in boys and girls, separately.

Results:

Boys reported higher prevalence of lifetime cigarettes use compared to girls (22.8% vs. 17.8%, p = 0.04). However, the prevalence of lifetime smokeless tobacco use in girls was the same as boys, even slightly higher (7.9% vs. 7.1%, P=0.5). “Family history of drug use” and “Friends use of drugs” were common risk factors predicting cigarettes and smokeless tobacco use between both genders. On the other hand, other family risk factors included “Poor family management”, “Parental attitude favorable toward drug use” and “Family conflict” were the predictors of lifetime tobacco use only in girls, but not in boys.

Conclusion:

Design and implementation of preventative programs for adolescents tobacco use should be conducted with emphasis on the role of smoker parents at home, and friendship with substance user peers with antisocial behaviors. It seems that family risk factors may have more value in prevention of tobacco use in female adolescents.

Socioeconomic inequalities in youth smoking in Brazil

OBJECTIVE

The contribution of smoking to socioeconomic inequalities in health is increasing worldwide, including in Brazil. Youth smoking may play an important role in the increasing social inequalities related to smoking. This study investigates social determinants of smoking among 15-year-old to 19-year-old individuals.

DESIGN

Cross-sectional study.

SETTING

The study uses data of 3536 participants aged 15-19 years of age of the Global Adult Tobacco Survey (GATS) and the National Household Sample Survey (Pesquisa Nacional por Amostragem de Domicilio, PNAD) obtained from household interviews. Smoking was defined as currently smoking tobacco products, regardless of frequency. Household socioeconomic indicators included per capita income, the educational level and sex of the head of the household, the presence of smoking restrictions and the number of smokers (excluding adolescents). Adolescent social factors included years of delaying school and social status (full-time student, working, and neither working nor studying). The hierarchical logistic regression analysis considered the effect of the complex sampling design.

RESULTS

From 3536 participants, 6.2% were smokers (95% CI 5.4 to 7.1). More men than women had the habit of smoking (7.2%; 5.9 to 8.6 vs 3.6%; 2.7 to 4.6). The likelihood of smoking was significantly greater for men and older teens. There was an upward trend in the OR of smoking according to the number of smokers in the house. Adolescents living in households with no smoking restrictions had a greater likelihood of being smokers. OR of smoking rose as the number of years of delaying school increased, being about three times greater among adolescents who were working and five times greater among those who were neither studying nor working.

CONCLUSIONS

Results demonstrate that socioeconomic inequality in smoking is established at younger ages and that school delay as well as school abandonment may contribute to increased smoking-related inequalities. Smoking restrictions at home were protective against adolescents becoming smokers. Living with other smokers was a strong predictor of adolescents becoming smokers.

To start and quit smoking cigarettes: an evaluation of students in a Nigerian city

INTRODUCTION

Several factors have been shown to influence cigarette smoking and are important in creating measures for tobacco control. The aim of this study is to identify the factors responsible for making decisions to start or stop cigarette smoking among students.

METHODS

This was a cross-sectional study which sampled 280 youths in tertiary institutions using multi-stage sampling technique. The data was collected using self-administered questionnaire that had been pretested and validated. Data analysis was done using SPSS version 16. Frequency tables and cross-tabulations were generated with a 95% confidence interval and predetermined p-value at less than 0.05.

RESULTS

All the current smokers (100%) were males, most (73.2%) were within 21 to 25 years of age and 87.8% of them had a relative or friend who smoked. Some (29%) of the students who currently smoked were willing to quit smoking while 73.2% of them had ever attempted to quit smoking. Students who smoked to relieve stress were willing to stop smoking (100.0%), while 40% of those who smoked for pleasure/relaxation were willing to stop smoking. Students who had received lectures on smoking were significantly willing to quit (100.0%) compared with those who had not received such lectures (0.0%) (p = 0.000).

DISCUSSION

Understanding the role of the factors associated with smoking initiating and cessation is very crucial in planning appropriate intervention for the control of cigarette smoking among the youths and there is need for more youth oriented health education directed towards a proper attitude to tobacco control.

Determinants of cigarette smoking among school adolescents in eastern Ethiopia: a cross-sectional study

BACKGROUND

The World Health Organization (WHO) attributes more than 4 million deaths a year to tobacco, and it is expected that this figure will rise to 10 million deaths a year by 2020. Moreover, it is now a growing public health problem in the developing world.

OBJECTIVE

To assess the prevalence of cigarette use and its determinant factors among high school students in eastern Ethiopia.

METHODS

A cross-sectional study was conducted using structured self-administered questionnaires among 1,721 school adolescents in Harar town, eastern Ethiopia. Univariate and multivariate logistic regression analyses were performed to examine associations.

RESULTS

The analysis revealed that prevalence of ever cigarette smoking was 12.2% (95% CI 10.8% - 13.9%). Reasons mentioned for smoking cigarettes were for enjoyment (113, 52.8%), for trial (92, 42.9%), and for other reasons (9, 4.3%). The main predictors of cigarette smoking were sex (OR 4.32; 95% CI 2.59-7.22), age (OR 1.20; 95% CI 1.05-1.38) and having friends who smoke (OR 8.14; 95% CI 5.19-12.70). Living with people who smoke cigarettes was not significantly associated with smoking among adolescents (OR 1.25; 95% CI 0.81-1.92).

CONCLUSION

This study concluded that high proportion of school adolescents in Harar town smoked cigarettes. Sex, age and peer influence were identified as important determinants of smoking. There is a need for early cost-effective interventions and education campaigns that target secondary school students.

Prevalence of alcohol and tobacco use among Brazilian adolescents: a systematic review

OBJECTIVE: To analyze alcohol and tobacco use among Brazilian adolescents and identify higher-risk subgroups. METHODS: A systematic review of the literature was conducted. Searches were performed using four databases (LILACS, MEDLINE /PubMed, Web of Science, and Google Scholar), specialized websites and the references cited in retrieved articles. The search was done in English and Portuguese and there was no limit on the year of publication (up to June 2011). From the search, 59 studies met all the inclusion criteria: to involve Brazilian adolescents aged 10-19 years; to assess the prevalence of alcohol and/or tobacco use; to use questionnaires or structured interviews to measure the variables of interest; and to be a school or population-based study that used methodological procedures to ensure representativeness of the target population (i.e. random sampling). RESULTS: The prevalence of current alcohol use (at the time of the investigation or in the previous month) ranged from 23.0% to 67.7%. The mean prevalence was 34.9% (reflecting the central trend of the estimates found in the studies). The prevalence of current tobacco use ranged from 2.4% to 22.0%, and the mean prevalence was 9.3%. A large proportion of the studies estimated prevalences of frequent alcohol use (66.7%) and heavy alcohol use (36.8%) of more than 10%. However, most studies found prevalences of frequent and heavy tobacco use of less than 10%. The Brazilian literature has highlighted that environmental factors (religiosity, working conditions, and substance use among family and friends) and psychosocial factors (such as conflicts with parents and feelings of negativeness and loneliness) are associated with the tobacco and alcohol use among adolescents. CONCLUSIONS: The results suggest that consumption of alcohol and tobacco among adolescents has reached alarming prevalences in various localities in Brazil. Since unhealthy behavior tends to continue from adolescence into adulthood, public policies aimed towards reducing alcohol and tobacco use among Brazilians over the medium and long terms may direct young people and the subgroups at higher risk towards such behavior.

Prenatal tobacco exposure is related to neurobehavioral modifications in infants of adolescent mothers

INTRODUCTION

Prenatal tobacco exposure interferes with neonatal outcomes.

OBJECTIVE

To determine the neonatal neurobehavioral effects of in utero tobacco exposure.

METHODS

This prospective cross-sectional study included healthy, term, with birth weight appropriate for gestacional age neonates without exposure to alcohol, drugs, or infections, born to adolescent mothers without psychiatric disorders or post-traumatic stress. Infants were classified according to in utero tobacco exposure, as identified by the Composite International Diagnostic Interview administered to mothers. Neurobehavior was assessed by the Neonatal Intensive Care Unit Network Neurobehavioral Scale. Both tools were administered between 24 and 72 hours after birth. Neurobehavioral outcomes were compared between exposed and nonexposed infants by ANOVA. The associations between neurobehavioral scores and number of cigarettes smoked were studied by linear correlation.

RESULTS

During the study, 928 newborns of adolescent mothers were born, and 388 were included in the study. Of these, 23 were exposed to tobacco, and 365 neonates were not exposed. There were no differences between the groups in gestational age, birth weight, post-natal age at the exam, or time between last feeding and exam. Exposed neonates showed higher scores on arousal (p = 0.004), excitability (p = 0.003), and stress/abstinence signals (p = 0.019) and a lower score on regulation (p = 0.025). After adjusting for the type of anesthesia, mode of delivery, gender, age at neurologic exam, exam duration and time between last feeding and exam, differences in arousal and excitability remained significant. The mean number of cigarettes consumed daily was positively correlated with lethargy (p = 0.013) and inversely with attention (p = 0.043).

CONCLUSIONS

Neonates exposed in utero to tobacco showed worse neurobehavioral performance between 24 and 48 hours of life.