A longitudinal study on determinants of the intention to start smoking among Non-smoking boys and girls of high and low socioeconomic status

Smoking prevention within social work organizations: a qualitative study about youngsters' and youth workers' perceptions

Tobacco smoking uptake is still a major public health concern, especially among youngsters living in vulnerable situations. Finding optimal ways to engage youngsters in smoking prevention is important. Compared to traditional settings such as schools, social work settings providing sports-based and recreational activities (SR-settings) tend to reach and engage youngsters more. This study aimed to gain insight into the reasons for smoking uptake among youngsters living in vulnerable situations and the conditions through which SR-settings are potentially beneficial for smoking prevention initiatives. Data were collected in two SR-settings in Flanders, Belgium, by means of five focus group discussions and six individual interviews with youngsters (n = 38, mean age = 12.9 ± 2.61 years, 69.7% boys) and eight individual interviews with youth workers (n = 8, mean age = 27.5 ± 7.95 years, 87.5% men). A thematic analysis (TA) approach was applied to analyse the data. Besides individual factors, such as attitudes towards smoking, the desire to be part of a group and conformity to group norms seem to be important drivers of smoking uptake among youngsters in vulnerable situations. The presence of powerful role models in SR-settings with whom youngsters identify may counteract group norms by encouraging healthy behaviour. SR-settings seem suitable for questioning perceptions of vulnerable youngsters, unlike other settings where they may struggle to be heard. The conditional characteristics of SR-settings, such as authentic group processes, having meaningful roles, and being heard, make these contexts promising venues for smoking prevention efforts among vulnerable youngsters. Youth workers who have established trusting relationships with youngsters seem well-suited to communicate smoking prevention messages. A participatory approach, in which youngsters are involved in developing smoking prevention programs, is desirable.

Factors associated with intention to smoke cigarettes among never smoker school going adolescents in Zambia

Background

Cigarette smoking intention is a strong predictor of cigarette smoking initiation. There is limited data on predictors of cigarette smoking intentions among adolescents in developing countries.

Objective

To determine factors associated with cigarettes smoking intentions among never-smoked adolescents.

Methods

The study utilized the Zambia 2011 Global Youth Tobacco Survey dataset on adolescents.

Results

Being in grade nine compared to grade seven (AOR 0.43, 95%CI 0.23-0.82). Having a smoking father (AOR 2.38, 95%CI 1.25-453) mother (AOR 11.77, 95%CI 4.16-33.33), or both parents (AOR 7.05, 95%CI 2.91-17.10) showed significantly higher chance of having smoking intentions than having non-smoker parents. Also, having some (AOR 1.97, 95%CI 1.12-3.47), most (AOR 5.37, 95%CI 2.82-10.25), or all (AOR 3.75, 95%CI 1.64-8.56) smoker close friend was significantly associated with smoking intention compared to having none-smoker friends. Being around others who smoked in out-door places 1-2 days (AOR 2.16, 95%CI 1.19-3.93), 5-6 days (AOR 3.21, 95%CI 1.51-6.83) and 7 days/week (AOR 2.73, 95%CI 1.41-5.30) were also associated with one's intention to smoke cigarettes compared to not being around smokers in outdoor public places 7 days/week.

Conclusion

Having smoking parents, smoking friends or around people who smoke in public places were associated with cigarette smoking intentions among adolescents.

Academic Performance and Peer or Parental Tobacco Use among Non-Smoking Adolescents: Influence of Smoking Interactions on Intention to Smoke

BACKGROUND

Intention to smoke is an important predictor of future smoking among adolescents. The purpose of our study was to examine the interaction between academic performance and parents/peer tobacco use on adolescents' intention to smoke.

METHODS

A multi-stage stratified sampling was used to select participants, involving 9394 students aged between 9-16 years in Changchun city, northeastern China. Multiple logistic regression analyses were conducted to examine the individual effect of academic performance and peer/parental smoking behavior. Stratified logistic regressions were conducted to examine the protective effect of academic performance based on peer or parental smoking. Interaction effects of academic performance × peer/parental smoking on adolescents' intention to smoke were tested.

RESULTS

Of all the non-smoking students sampled, 11.9% intended to smoke within the next five years. The individual effect of academic performance and peer/parental smoking was significant. The protective effect of academic performance on the intention to smoke was significant regardless of whether peers smoked or not. However, the protective effect was not significant among adolescents with only maternal smoking and both parental smoking. The current study found the significant interaction effects of academic performance × peer smoking and the academic performance × both parents' smoking. Students with poor academic performance were more likely to intend to smoke if their peers or both parents smoked.

CONCLUSION

These preliminary results suggest that peer smoking or smoking by both parents reinforces the association between low academic performance and the intention to smoke among adolescents. Enhancing school engagement, focusing on social interaction among adolescents with low academic performance, and building smoke-free families may reduce adolescents' intention to smoke.

Gender differences in attitudes towards a school-based smoking prevention intervention

AIMS

There are well-known gender differences in smoking, including the pattern of use and the effectiveness of smoking prevention programs. However, little is known about the differences between boys and girls in their attitudes towards smoking prevention interventions. This study explores gender differences in attitudes towards a school-based intervention to prevent smoking.

METHODS

We used data from the X:IT II intervention study conducted in 46 Danish elementary schools.

RESULTS

Compared to boys, girls were more positive towards smoke-free school time, both concerning rules for teachers smoking (odds ratio (OR) = 1.69, 95% confidence interval (CI): 1.35-2.12) and for students smoking (OR = 1.41, 95% CI: 1.13-1.76). No difference was observed in students signing the smoke-free agreement. However, a larger proportion of girls reported that the agreement was a good occasion to talk about smoking with their parents (OR = 1.36, 95% CI: 1.13-1.76). Girls were also more positive towards the smoke-free curriculum (OR = 1.52, 95% CI: 1.19-1.94).

CONCLUSIONS

This study showed that girls were, overall, more positive towards the components of the smoking preventive intervention. Our findings highlight the importance of considering differences in intervention preferences for boys and girls in future health prevention initiatives.

Using Digital Media to Empower Adolescents in Smoking Prevention: Mixed Methods Study

BACKGROUND

There is a critical need for effective health education methods for adolescent smoking prevention. The coproduction of antismoking videos shows promising results for adolescent health education.

OBJECTIVE

This study explored the feasibility of a smoking prevention program using the coproduction of antismoking videos in order to empower adolescents in smoking prevention and tobacco control. A smoking prevention program based on coproduction of antismoking videos over eight sessions was implemented in a low-income neighborhood.

METHODS

A mixed methods design with a concurrent embedded approach was used. In total, 23 adolescents participated in the program. During the prevention program, small groups of participants used video cameras and laptops to produce video clips containing antismoking messages. Quantitative data were analyzed using the Wilcoxon signed-rank test to examine changes in participants' psychological empowerment levels between pre- and postintervention; qualitative interview data were analyzed using content analysis.

RESULTS

Pre- and postcomparison data revealed that participants' psychological empowerment levels were significantly enhanced for all three domains-intrapersonal, interactional, and behavioral-of psychological empowerment (P<.05). Interviews confirmed that the coproduction of antismoking videos is feasible in empowering participants, by supporting nonsmoking behaviors and providing them with an opportunity to help build a smoke-free community.

CONCLUSIONS

Both quantitative and qualitative data supported the feasibility of the coproduction of antismoking videos in empowering adolescents in smoking prevention. Coproduction of antismoking videos with adolescents was a beneficial health education method.

The association between smoke-free school policies and adolescents' anti-smoking beliefs: Moderation by family smoking norms

BACKGROUND

Smoke-free school policies (SFSPs) may influence adolescents' smoking through the development of anti-smoking beliefs. We assessed which types of anti-smoking beliefs (health, social and societal) are associated with SFSPs and whether these associations were different for adolescents in smoking permissive versus prohibitive families.

METHODS

Survey data was collected in 2016-2017 from 10,980 adolescents between 14-16 years old and 315 staff in 55 schools from seven European cities. We separately measured adolescent-perceived SFSP and staff-reported SFSP at the school-level. Associations between SFSP and anti-smoking health, social and societal beliefs were studied using multi-level logistic regression, adjusting for demographics and school-level smoking prevalence. We tested for interactions between family norms and SFSP, and estimated associations for adolescents in permissive and prohibitive families, respectively.

RESULTS

Adolescent-perceived SFSP was not significantly associated with anti-smoking health (OR:1.08, 95%CI:0.94-1.25), social (OR:0.89, 95%CI:0.75-1.04) and societal beliefs (OR:1.15, 95%CI:0.99-1.33). Staff-reported SFSP were associated with anti-smoking health beliefs (OR:1.12, 95%CI:1.01-1.24), but not with social (OR:0.94, 95%CI:0.83-1.07) or societal beliefs (OR:1.02, 95%CI:0.90-1.14). Most results were comparable between adolescents in smoking prohibitive and permissive families. However, in smoking prohibitive families, adolescent-perceived SFSP were associated with societal beliefs (OR:1.24, 95%CI:1.06-1.46), but not in permissive families (OR:1.06, 95%CI:0.90-1.25). Also, in smoking permissive families, staff-reported SFSP were associated with more pro-smoking social beliefs (OR:0.83, 95%CI:0.72-0.96), but not in prohibitive families (OR:1.05, 95%CI:0.92-1.16).

CONCLUSIONS

We found evidence that SFSP are associated with some anti-smoking beliefs, but more so among adolescents from smoking prohibitive families than from permissive families.

Smoking beliefs across genders, a comparative analysis of seven European countries

BACKGROUND

Most European countries have seen a decrease in the prevalence of adolescent smoking. This decrease has, however, been patterned by gender. Girls' smoking rates have now overtaken boys' in many European countries. The two genders may not, however, share the same smoking beliefs and this could explain differences between the genders in smoking prevalence. We describe gender differences in smoking beliefs and investigate variations between countries, along with their gender context.

METHODS

In 2016, we conducted the SILNE R study (Smoking Inequalities Learning from Natural Experiments - Renew) in 55 schools located in seven European countries: Belgium, Italy, The Netherlands, Portugal, Finland, Ireland, and Germany. We surveyed 12,979 students aged 14-16 years (50% were girls). We classified smoking beliefs into four categories: positive individual, positive social, negative individual, and negative social beliefs. We expected girls to score higher on the last three of those categories and we hypothesized that countries with a more gender-equal culture would have less gender difference in beliefs about smoking.

RESULTS

One out of two smoking beliefs differed significantly between genders. Negative social beliefs were more common in girls, while beliefs about the dating-related aspects of smoking were more common in boys. We identified Germany and Belgium as the only countries with no gender differences in any of the belief scales. No correlation was found, however, between these scales and the Gender Inequality Index.

CONCLUSIONS

In some countries, gender-specific interventions might be implemented; however, two opposing strategies might be used, depending on whether such programs are aimed at boys or girls.

Factors Associated With Smoking Intentions Among Chinese College Students

Smoking intention is a strong predictor of future smoking behavior. The aim of this study is to identify the significant factors associated with smoking intention among Chinese college students. A total of 2,827 students in Eastern, Middle, and Western regions of China, randomly selected using a multistage sampling method, completed the self-administered questionnaires. The association of independent variables with smoking intention was evaluated using the logistic regression model. Overall, the proportion of college students with a strong smoking intention was 6.9%. Male students (odds ratio [OR] 2.205, 95% confidence interval [CI] [1.374, 3.538]), those students whose mothers smoked (OR 3.328, 95% CI [1.527, 7.252]), those whose mothers had a higher educational level (OR 0.583, 95% CI [0.346, 0.984]), current smokers (OR 14.081, 95% CI [9.306, 21.307]), former smokers (OR 3.824, 95% CI [1.728, 8.463]), and those for whom most (OR 2.663, 95% CI [1.348, 5.261]) or a few (OR 1.826, 95% CI [1.045, 3.191]) of their closest friends were smokers had statistically significant associations with the smoking intentions of Chinese college students. Further studies are needed to elucidate mechanisms and pathways across various factors, and these factors should be incorporated into future multilevel interventions designed to decrease smoking intention among college students.

Socioeconomic position over the life course from childhood and smoking status in mid-adulthood: results from a 25-year follow-up study

Background

It remains unclear how life course socioeconomic position (SEP) variations impact later smoking status. We aimed to investigate the associations using a novel methodology – a structured regression framework and to explore the potential underlying mechanisms.

Methods

Data were from an Australian national cohort (n = 1489). SEP was measured in childhood (aged 7–15 years), young- (aged 26–36 years) and mid-adulthood (aged 31–41 years), including highest parental occupation in childhood and self-occupation in young- and mid-adulthood. Smoking status was self-reported in mid-adulthood. Four smoking-related variables in childhood including exposure to parental smoking, smoking experimentation, self-rated importance to be a non-smoker and intention to smoke were tested as potential mediators. A structured life course modelling approach was used to select the best-fit life course model(s). The log multinomial model was used to estimate the smoking risk in mid-adulthood with never smokers as the excluded category.

Results

63.6% of participants were classified as stable non-manual occupation across the life course from childhood. The sensitive period and the accumulation model described the data equally as well as the saturated model. In the sensitive period model, compared to the non-manual group, those who had highest parental occupation of manual had a 21% lower risk of being former smokers and a 32% greater risk of being current smokers in mid-adulthood, and those who were occupied manually in mid-adulthood reported a 55% greater risk of being current smokers in mid-adulthood. In the accumulation model, compared to those who consistently reported non-manual occupations across the life course, those with manual occupations for longer had higher risk of being current smokers in mid-adulthood, with a 43% risk increase per time point in a manual occupation. Exposure to parental smoking and intention to smoke during childhood explained up to 40.2% of the excess risk of being current smokers in mid-adulthood associated with manual occupations in the sensitive period and the accumulation model.

Conclusions

Childhood, young- and mid-adulthood are all important, but SEP in childhood and mid-adulthood may be of more importance in determining mid-adulthood smoking status. Exposure to parental smoking and intention to smoke in childhood seems to moderately mediate the associations.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6483-0) contains supplementary material, which is available to authorized users.

Intention to Try Tobacco Among Middle School Students in a Predominantly Rural Environment of Central Appalachia

BACKGROUND

Disparities in tobacco use exist across regions in the United States. The Central Appalachian region carries some of the very high rates of tobacco use prevalence but research on tobacco use initiation is sparse.

OBJECTIVE

To investigate the intention to try tobacco and its associated factors among nonsmoking youth.

METHOD

Data were obtained from school-based tobacco surveys (n = 539) conducted in 11 middle schools (6th-8th grades; aged 10-15 years) in Northeast Tennessee in 2015-2016. Nonsmoking participants without firm commitment to abstain from trying tobacco in the next year were considered to have an intention to try tobacco. The Full Information Maximum Likelihood estimation (FIML) method in Mplus was employed to conduct a multivariable logistic regression analysis to delineate correlates of intention to try tobacco.

RESULTS

Overall, 20.0% of participants had intention to try tobacco. Among participants with intention to try tobacco, 53.7% owned tobacco-branded item(s), 86.1% believed that tobacco users have more friends, and 88.9% lived with tobacco users. In the adjusted logistic model, ever use of tobacco products, home smoking rules, owning tobacco-branded item(s), living with tobacco users, believing that tobacco users have more friends, and perception of easy access to tobacco products were significantly associated with intention to try tobacco (p < .02).

CONCLUSION

This study suggests that individual, interpersonal, and community level factors influence intention to try tobacco in this environment where tobacco pre-emption laws impede development of local tobacco control policies and regulations. Thus, efforts should focus on tobacco use initiation preventive programs, including school-based tobacco control programs.

Feasibility of a Peer-Led Asthma and Smoking Prevention Project in Australian Schools with High Indigenous Youth

BACKGROUND

The high global burden of asthma and tobacco smoking among Indigenous people may potentially be reduced by appropriate interventions that target prevention of tobacco smoke uptake and improved asthma management. The latter includes targeted treatment based on airway inflammation. We undertook a feasibility study in two Darwin schools with a high proportion of Indigenous youth to determine the feasibility of an innovative, peer-led, school-based education program called the Asthma and Smoking Prevention Project (ASPP). A subset of children with reported persistent respiratory symptoms were also clinically evaluated to determine the lower airway inflammatory profile and optimize asthma management.

METHODS

The ASPP is founded on an evidence-based three-step program and targets improving asthma management and preventing the uptake of tobacco smoking. The program uses a student-centered approach in which senior students (peer leaders) deliver the ASPP to Grade 7 students using activities, videos, and games. Students completed questionnaires related to asthma and smoking at baseline and 3 months after program delivery. Students with respiratory symptoms at 3 months were invited for a comprehensive clinical evaluation and tests including sputum induction.

RESULTS

The ASPP was well received. Of the 203 students involved, 56 (28%) were Indigenous and 70% completed baseline and follow-up questionnaires. Self-reported asthma was high (19%), 10% of students reported smoking and 63% reported exposure to tobacco at home. Of the 22 students who were clinically evaluated, 41% were Indigenous. Clinically important airway inflammation was high; 23% had Fractional Exhaled Nitric Oxide Levels ≥35 ppb, 88% had airway neutrophilia (>15%), and 29% had airway eosinophilia (>2.5%). Optimization of medication and management was required in 59% of students.

CONCLUSION

Our study has demonstrated the implementation of the ASPP was well received by the schools as well as by the students. The high prevalence of clinically important airway inflammation and suboptimal asthma management highlights the need for a community-based study on persistent respiratory symptoms in adolescents to reduce the burden of chronic lung disease particularly for Indigenous Australians.

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.