Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study

L'adhérence au traitement de maladies chroniques chez les jeunes - Rôle du niveau d'actualisation et de la tolérance au risque

Adolescents with chronic diseases must adhere to medication regimens to control their symptoms and avoid long-term complications. Despite its importance, medication adherence is low among adolescents. This commentary briefly covers the challenges described in the literature associated with measuring and addressing low medication adherence in adolescents. Next, it presents the evidence for the link between medication adherence and two prevalent psychological characteristics that have not been properly assessed so far: delay discounting (i.e., the relative value assigned to the future compared to the present), and risk tolerance. These psychological traits deserve further studies and are potentially amenable to interventions to improve medication adherence in adolescents with chronic conditions.

Multiple Tobacco Product Use among Adolescents with Asthma in Korea

Few studies have examined the use of multiple tobacco products among adolescents with asthma. The purpose of this study was to examine multiple tobacco product use and smoking behaviors. In this study, data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) were used, and 57,303 samples from 400 middle schools and 400 high schools in Korea were classified as study participants. Statistical analysis was performed with a complex sample design, using frequency analysis, chi-square test, and multiple logistic regression analysis. Adolescents with asthma had a higher current smoking rate for combustible cigarettes (CC), e-cigarettes (EC), and heated tobacco products (HTPs) than those without asthma (p < 0.001). The rates of dual use (using two types of tobacco; CC + EC or CC + HTPs or EC + HTPs; OR = 2.62, 95% CI: 1.626−4.240, R2 = 26.8%) and triple use (using three types of tobacco; CC + EC + HTPs; OR = 2.61, 95% CI: 1.678−4.065, R2 = 34.9%) were higher in adolescents with asthma than those without asthma, after adjusting for confounders. The smoking rate of new types of tobacco among adolescents with asthma is on the rise. Therefore, the calculation of basic data related to new tobacco smoking among adolescents is essential for establishing a continuous monitoring system to alleviate the burden of disease on national health.

Profiles of Nicotine and Cannabis Exposure among Young Adults with Asthma

There is a paucity of data on nicotine and cannabis use among young adults (YAs) with asthma. This study aimed to do the following among YAs with asthma: (1) describe YAs' active and passive exposure to nicotine and cannabis; (2) identify latent classes of active use of nicotine and cannabis; and (3) explore predictors of class membership (i.e., demographics, parental and friend use of nicotine and cannabis, and hours of environmental exposure to tobacco smoke, e-cigarette vapor, and marijuana smoke). YAs with asthma (N = 178) self-reported on nicotine and cannabis exposure and the included covariates. Latent class analysis was used to identify latent classes of lifetime nicotine and cannabis use. High rates of nicotine and cannabis use among YAs with asthma were found: 37% reporting a lifetime history of using both nicotine and cannabis. Regarding past year use, 25% had smoked cigarettes, 40% had used e-cigarettes, and 35% had used cannabis. Five classes of lifetime use were identified. The largest class was a non-user class (53%); the other four classes indicate concerning patterns of nicotine and cannabis use. The most consistent predictor of being in a class characterized by more nicotine and cannabis exposure (versus being in the non-user class) was past week exposure to cannabis smoke. This is the first study to identify classes of lifetime nicotine and cannabis use, and examine predictors of class membership, among YAs with asthma. There is a critical need to address environmental and active tobacco and marijuana exposure among YAs with asthma.

The Effect of a "Class Smoke Free Pledge" on Breath Carbon Monoxide in Arabic Male Adolescents

Introduction

Arabic male adolescents have a high smoking prevalence. Introduction of "Class smoke-free" pledges have been successful amongst European adolescents but have not been evaluated using objective valid measures. We tested the impact of adding a smoke free pledge strategy to a proven peer-led asthma and smoking prevention program on breath carbon monoxide level (BCO) in male high-school students in Jordan.

Methods

We enrolled male students from four high-schools in Irbid, Jordan. Schools were randomly assigned to receive either TAJ (Triple A in Jordan, n = 218) or TAJ-Plus (with added class smoke-free pledge, n = 215). We hypothesized that students receiving TAJ-Plus would have greater reduction in BCO levels than those only receiving the TAJ intervention. Asthma and smoking status were assessed by self-administered questionnaires. Smoking outcomes were collected using a BCO Monitor.

Results

Both groups had significant reductions in BCO levels post-intervention (p < .0001), however, decreases were greater in TAJ-Plus group (3.9 ± 0.2 vs. 4.8 ± 0.2, p < .0001). Intervention effects on BCO over time did not vary by smoking status (p = .085), asthma status (p = .602), or a combination of the two (p = .702).

Conclusions

An added smoke-free pledge strategy to a proven peer-led asthma education program appears to be a promising approach to motivate adolescents to abstain from smoking in Jordan. Future research is required to determine if these results can be extended to Jordanian adolescent females.

Implications

A commitment by students via a "class smoke-free" pledge can be an added incentive to motivate adolescents in Arabic-speaking countries to abstain from smoking. Social influence approaches in schools can be useful in countering the aggressive tobacco marketing campaigns targeting Jordanian and other Arabic-speaking youth. The combination of "class smoke-free" pledges and an evidence-based peer-led asthma and smoking education can be implemented in schools to influence adolescents with asthma to abstain from smoking.

Allergic diseases, smoking, and environmental exposure among university students in Lebanon

INTRODUCTION

Smoking habits among university students in Lebanon are not clearly identified, and studies correlating these habits to asthma and allergic diseases are lacking. The primary objective of this study is to assess asthma and allergic diseases' predictors, particularly cigarette and/or waterpipe smoking and other environmental exposures, among university students. A second objective is to evaluate the potential role of these predictors as correlates of health-related self-assessment.

METHODS

A cross-sectional study, using a proportionate cluster sample of 3000 Lebanese students in both public and private universities, was conducted between January 2015 and December 2015.

RESULTS

The number of smokers at home, living close to an electricity generator and exposure to sand and dust significantly increased the odds of having asthma or allergic diseases (p = 0.015; OR = 1.183; p = 0.01; OR = 2.062; p = 0.001; OR = 3.558 respectively). Having tried cigarette smoking and having an air conditioner inside the means of transportation would decrease the odds of having asthma or allergic diseases by around 68% and 56.1% respectively (p = 0.009; OR_a = 0.320; p = 0.01; OR_a = 0.439 respectively).

CONCLUSION

Although students with asthma or allergic diseases tended to avoid all identifiable atopic risk factors, lesser known environmental factors such as living close to an electricity generator, exposure to sand and dust, and exposure to car exhaust fumes were associated with a higher risk of asthma and a decrease in health related self-assessment. Students with asthma and allergic diseases smoked cigarettes and waterpipe at similar percentages, but cigarette smokers had a lower health related self-assessment.

Looking beyond cigarettes: Are Ontario adolescents with asthma less likely to smoke e-cigarettes, marijuana, waterpipes or tobacco cigarettes?

OBJECTIVES

The purpose of this paper is to examine whether high school students in Ontario with asthma smoke cigarettes, waterpipes, marijuana or e-cigarettes more or less than those without asthma.

METHODS

The 2013 Ontario Student Drug Use and Health Survey provides self-report data on tobacco cigarettes, waterpipes, marijuana and e-cigarette smoking and asthma rates from 109 high schools in Ontario, Canada. Individual and social characteristics were also collected. Multiple binary logistic regression models measures the association with the various types of smoking in relation to asthma.

RESULTS

Adolescents with asthma have higher odds of smoking e-cigarettes or smoking any type including either cigarettes, waterpipes, marijuana or e-cigarettes. Respondents of lower socio-economic status had a higher odds of smoking marijuana or any type. Boys were more likely to smoke waterpipes, e-cigarettes or any type, while students in higher grades had a higher odds of smoking cigarettes, waterpipes, marijuana or any type.

CONCLUSIONS

Results from this study suggest that adolescents with asthma have a higher odds of smoking e-cigarettes than those without asthma, but no relationship was found for cigarettes, waterpipes or marijuana. Findings present some new challenges as technology changes how adolescents can smoke. Public health campaigns should target adolescents, especially those with asthma, to raise their awareness of the risks of all types of smoking including e-cigarettes.

Prevalence of and beliefs about electronic cigarettes and hookah among high school students with asthma

PURPOSE

To assess current cigarette, hookah, and electronic cigarette (e-cigarette) use among high school students with and without asthma. Beliefs and use of tobacco products by a household member were also examined.

METHODS

The 2014 Florida Youth Tobacco Survey was administered to high school students to assess current use of cigarettes, hookah, and e-cigarettes (i.e., within past 30 days). Student's home exposure and beliefs about cigarettes, hookah, and e-cigarettes were also assessed. Students were randomly selected using a two-stage cluster probability design.

RESULTS

Adolescents with asthma had a higher prevalence of current hookah (14.0%) and e-cigarette use (12.4%) compared with their peers (10.9%, 10.2%, respectively). Adolescents with asthma were also at increased risk for current use of cigarettes (adjusted odds ratio [AOR]: 1.24), hookah (AOR: 1.32), and e-cigarettes (AOR: 1.34). Adolescents with asthma reported positive beliefs about tobacco products and were more likely to report living with individuals who used cigarettes (31.5%), hookah (12.1%), and e-cigarettes (15.5%) compared with their peers (26.5%, 8.5%, 12.5%, respectively).

CONCLUSIONS

Adolescents with asthma reported tobacco product use, positive beliefs about tobacco products, and high potential home exposure to tobacco products. There is a pressing need for education regarding potential harm of alternative tobacco products among adolescents with asthma.

Association between high school students' cigarette smoking, asthma and related beliefs: a population-based study

BACKGROUND

Smoking has a detrimental effect on the symptoms and severity of asthma, a common chronic disease among adolescents. The purpose of this study was to examine the association between asthma and smoking among high school students and assess provider-patient communication with asthmatic adolescents regarding smoking and adolescents' beliefs about the harms of smoking.

METHODS

In fall 2014, data from high school students, ages 14-18 years, completing the 2009-2010 Virginia Youth Tobacco Survey (N = 1796) were used in descriptive analyses and multivariable logistic regression models adjusting for model-specific confounders as appropriate.

RESULTS

Overall, an estimated 19 % of high school students in Virginia smoked and 16 % had asthma. Odds of smoking did not differ by asthma status; however, asthmatics had 1.5 times higher odds of being asked if they smoke (95 % CI 1.06-2.13) and being advised not to smoke by a health professional (95 % CI 1.10-2.14) compared to non-asthmatics. Asthmatics who believed second-hand smoke or smoking 1-5 cigarettes/day was not harmful had respectively 4.2 and 2.8 times higher odds of smoking than those who thought each was harmful. Further, asthmatics who thought smoking 1-2 years is safe had 3.4 times higher odds of smoking than those who did not (95 % CI 1.57-10.1).

CONCLUSIONS

While asthmatic adolescents are just as likely to smoke as non-asthmatics, less healthy beliefs about the risks of smoking increase the odds of smoking among asthmatics. Thus, targeted asthma-specific smoking prevention and education to change attitudes and beliefs could be an effective tool for adolescents.

MEDICAL COMORBIDITY AND COMPLICATIONS

Like their peers in the general youth population, youth with chronic medical conditions (YCMC) are at risk for substance use, including nonmedical use of prescription medications. However, given dangerous disease-substance interactions, the stakes for detecting and intervening on substance use are perhaps even higher for YCMC. Given the risk for nonadherence with chronic disease management, it is incumbent on primary care providers, specialty providers, and behavioral health specialists to be vigilant in asking about substance use and providing brief counseling and referral to substance use treatment when appropriate.

Smoking cessation strategies for patients with asthma: improving patient outcomes

Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large.

Role of individual-housing-based socioeconomic status measure in relation to smoking status among late adolescents with asthma

PURPOSE

We aimed to assess whether smoking status among individuals in late adolescence (19-22 years) with asthma was associated with socioeconomic status (SES) defined by HOUSES, an individual-housing-based SES measure.

METHODS

A population-based cross-sectional study was conducted among the 1988-1989 Olmsted County, Minnesota Birth Cohort, with physician-diagnosed asthma and that lived in the community during the study period (November 1, 2008-October 31, 2012). Using a z score for housing value, actual square footage, and numbers of bedrooms and bathrooms, HOUSES was formulated and categorized into quartiles. Smoking status (both current and past smoker) was compared among subjects with different SES as measured by HOUSES using logistic regression, adjusting for age and sex.

RESULTS

Among 289 eligible subjects, 287 (99%) were successfully geo-coded to real property data for HOUSES. Of the 257 subjects whose smoke exposure was recorded, 70 (27%) had a history of smoking (either past or current). An inverse association was observed between HOUSES and smoking status after accounting for age, gender, and General Medical Examination status (adjusted OR = 0.39, 95% CI = 0.18-0.87 for comparing highest vs. lowest HOUSES in quartile; overall P = .02).

CONCLUSIONS

A significant proportion of individuals with asthma in late adolescence was smokers during the study period, disproportionally affecting those with lower SES.

Differences in panic psychopathology between smokers with and without asthma

Cigarette smoking is more common among individuals with asthma compared to those without, resulting in increased risk of morbidity and mortality. However, there has been little exploration of psychological factors that differ between smokers with and without asthma. Thus, the aim of the current study was to examine differences between smokers with and without asthma in terms of anxiety sensitivity, panic symptoms, lifetime history of panic attacks, and lifetime history of panic disorder. Participants were 115 smokers with asthma (55.3% male, M_age = 38.4 years, SD = 11.9) and 120 smokers without asthma (70.6% male, M_age = 37.0 years, SD = 12.8) who were administered a structured diagnostic interview and completed self-report measures. As hypothesized, after controlling for the effects of cigarettes per day, gender, race, and education, smokers with asthma reported higher levels of anxiety sensitivity and panic symptoms and were at an increased risk for having a lifetime history of panic attacks (OR = 3.01) and panic disorder (OR = 2.96) compared to smokers without asthma. Further, group differences in anxiety sensitivity and panic symptoms remained even after removing participants with a lifetime history of panic attacks or panic disorder. These findings suggest that smokers with asthma are a particularly 'at-risk' population for panic psychopathology and likely in need of specialized smoking-related prevention and intervention efforts.

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, Mage = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly 'at-risk' population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.

Influence of asthma on the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood using latent growth curve models

Objectives:

While epidemiologic research indicates that the prevalence of risk-taking behaviors including cigarette smoking among young people with asthma is substantial, the longitudinal patterns of cigarette smoking in this vulnerable population have received little attention. The aim of this study was to evaluate differences in the longitudinal trajectories of cigarette use behaviors from adolescence to adulthood between young people with and without asthma.

Methods:

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) during the years 1994 to 1995 (Wave I, adolescence), 2001 to 2002 (Wave III, young adulthood), and 2007 to 2008 (Wave IV, adulthood) were analyzed (n=12 244). Latent growth curve models were used to examine the longitudinal trajectories of cigarette use behaviors during the transition to adulthood according to asthma status.

Results:

Regardless of asthma status, the trajectory means of cigarette use behaviors were found to increase, and then slightly decrease from adolescence to adulthood. In total participants, there were no statistically significant differences in initial levels and changes in cigarette use behaviors according to asthma status. However, in select sex and race subgroups (i.e., females and non-whites), former asthmatics showed greater escalation in cigarette use behaviors than did non-asthmatics or current asthmatics.

Conclusions:

This study indicated that the changing patterns of cigarette use behaviors during the transition to adulthood among young people with asthma are comparable to or even more drastic than those among young people without asthma.

Prevalence, patterns and correlates of cigarette smoking in male adolescents in northern Jordan, and the influence of waterpipe use and asthma diagnosis: a descriptive cross-sectional study

Our study investigates the prevalence, patterns and predictors of tobacco smoking among early adolescent males in Northern Jordan and whether asthma diagnosis affects smoking patterns. A descriptive cross sectional design was used. Males in grades 7 and 8 from four randomly selected high schools in the city of Irbid were enrolled. Data on waterpipe (WP) use and cigarette smoking patterns were obtained (n = 815) using a survey in Arabic language. The overall prevalence of ever having smoked a cigarette was 35.6%, with 86.2% of this group smoking currently. Almost half of the sample reported WP use. The most common age in which adolescents started to experiment with cigarettes was 11–12 years old (49.1%), although 10 years was also common (25.3%). Significant predictors of male cigarette smoking were WP use (OR = 4.15, 95% CI = 2.99–5.76), asthma diagnosis (OR = 2.35, 95% CI = 1.46–3.78), grade 8 (OR = 1.52, 95% CI = 1.10–2.11), and having a sibling who smokes (OR = 2.23, 95% CI = 1.53–3.24). However, this cross-sectional study cannot establish causality, thus longitudinal studies are needed. Public health programs and school-based anti-tobacco smoking interventions that target children in early years at high schools are warranted to prevent the uptake of tobacco use among this vulnerable age group. High school students with asthma should be specifically targeted.

Chronic condition and risk behaviours in Portuguese adolescents

Living with a chronic condition (CC) in adolescence has been historically considered protective for risk behaviours. However, research from the last decade suggest that when compared with healthy peers, adolescents living with a chronic condition can engage in risky behaviours in a similar if not higher rate than their counterparts living with out a CC. This study aims to characterize and evaluate the impact of 1) living with a chronic condition (CC), and 2) how the perception of living with a CC affects school participation, and its association with risk/protective behaviours (drunkenness, physical fight, sadness and self-harm). For this purpose 4 groups were identified: adolescents with mostly healthy behaviours, adolescents with mostly risk behaviours, adolescents with mostly risk-internalizing behaviours and adolescents with mostly risk-externalizing behaviours.

A large sample was included in this study, composed by 3494 Portuguese adolescents with an average age of 15 years, who participated in the Portuguese Survey of Health Behaviour in School-aged Children/WHO (HBSC).

Main results show that adolescents living with a CC have more risk-internalizing behaviours when compared to adolescents without CC, who present more healthy behaviors. Furthermore, adolescents that report that having a CC affects school participation show more risky behaviours than those not affected by a CC who present more healthy behaviours. Boys with a CC show more healthy behaviours, and those who feel that the CC affects school participation present more risky behaviours. On the other hand, girls with a CC have more risk-internalizing behaviours and less healthy behaviours

It is important to point out that dolescents living with a CC represent a vulnerable group, and may engage in experimental/risky behaviours as likely as their non CC peers. Thus, potential benefits can arise from reinforcing interventions within protective contexts (family/peers/school setting). Health/education professionals, more than considering risk behaviours as dangerous in themselves, should offer adolescents with a CC an opportunity to reflect on their own decisions. Educational programs would benefit from looking at risk behaviors more from an experimentation perspective, focusing on constructive ways to help adolescents with CC to proceed into adulthood in a more appropriate developmental way.

The influence of social adjustment on normative and risky health behaviors in emerging adults with spina bifida

OBJECTIVE

To understand the rates of normative and risky health behaviors and the influence of prior and current social adjustment on health risk behaviors in emerging adults with spina bifida (SB).

METHOD

These data are part of a larger longitudinal study of youth with SB; at ages 18-19, 50 emerging adults with SB and 60 typically developing (TD) youth participated. Social adjustment was measured at ages 12/13, 14/15, 16/17, and 18/19. Substance use and sexual activity were self-reported by emerging adults.

RESULTS

The SB group reported similar frequencies (i.e., number of days in the previous month) of cigarette and marijuana use. Fewer individuals with SB reported initiation of both alcohol use (i.e., ever used) and sexual activity (i.e., ever had sex) compared to TD peers. The SB group also reported less frequent alcohol use and fewer sexual partners. Better social adjustment during early adolescence (ages 12/13) predicted more frequent alcohol use and a greater number of sexual partners for all youth. Social adjustment also mediated the effect of group status on health risk behaviors.

CONCLUSIONS

Emerging adults with SB lag behind TD peers in terms of normative initiation of alcohol use and sexual activity. However, this population participates in some risky health behaviors at similar rates compared to their TD peers (e.g., smoking). Youths' health risk behaviors may be influenced by their level of social adjustment. A challenge for future interventions for this population will be finding methods of improving social functioning without increasing the rate of health risk behavior.

The link between asthma and smoking explained by depressive feelings and self-efficacy

OBJECTIVE

Adolescents with asthma consistently smoke at higher or similar rates as non-asthmatic peers, although smoking might involve more health risks. This study examined possible mechanisms (i.e. depressive feelings and self-efficacy to refrain from smoking) explaining the association between asthma and smoking initiation.

METHODS

An indirect path from asthma to self-efficacy through depressive feelings was examined in two independent samples. Sample 1 consisted of 4531 adolescents (mean age 12.8) and sample 2 consisted of 1289 children (late childhood, mean age 10.1). Data were gathered from maternal and self-report. In the adolescent sample, whether the relationship between depressive feelings at baseline and smoking initiation two years post-baseline runs via self-efficacy was also examined.

RESULTS

Higher amounts of depressive feelings decreased adolescents' self-efficacy to refrain from smoking, which subsequently increased the risk to initiate smoking. A diagnosis of asthma was also associated with higher levels of depressive feelings which in turn decreased self-efficacy. A marginal significant indirect effect was found in the childhood sample.

CONCLUSION

Smoking prevention efforts should start as early as mid to late childhood. The results indicate that focus should be placed on preventing depressive feelings with the aim of increasing children's self-efficacy to refrain from smoking. This is especially important for children and adolescents with asthma.

Goals, beliefs, and concerns of urban caregivers of middle and older adolescents with asthma

OBJECTIVE

Caregiver goals, an integral part of a partnership for asthma management, have been found to influence asthma outcomes in children. These goals are likely to change during the transitional period of adolescence to address the needs of teenagers as they mature and assume greater responsibilities for their own care. Little is known about the goals, beliefs, and concerns of caregivers as they begin to shift responsibilities for asthma management to teens. This study sought to identify the asthma management goals, beliefs, and concerns of primarily African American caregivers of urban middle and older adolescents.

METHODS

Fourteen caregivers of urban African American adolescents aged 14-18 years with asthma participated in a focus group session. An iterative process was used to identify themes from the session related to asthma management goals, concerns, and beliefs of caregivers.

RESULTS

Caregivers identified goals that related to supporting their teens' progress toward independent asthma self-management. They described significant concerns related to the teens' ability to implement asthma self-management, especially in school settings. Caregivers also revealed beliefs that represented knowledge deficits related to asthma medications and factors that improved or worsened asthma. Most caregivers identified grave concerns about school policies regarding asthma medication administration and the lack of knowledge and support provided by teachers and staff for their teen.

CONCLUSION

Caregivers are an invaluable resource in the care of adolescents with asthma. An opportunity exists to improve caregiver understanding of asthma medications and to provide support through improvements in asthma care for adolescents in school-based settings.

Association of asthma symptoms with cigarette smoking and alcohol consumption in Korean adolescents

The association of asthma symptoms with cigarette smoking and alcohol consumption in Korean adolescents was investigated in this study using the data of Korean Youth Risk Behavior Survey. Associated risk factors for experiencing asthma symptoms were explored in 3432 adolescents. In the symptomatic group, 21.7% were current smokers, compared to 10.9% in the asymptomatic group. Current smokers in the symptomatic group also smoked more cigarettes than those in the asymptomatic group. In the symptomatic group, 27.4% were current drinkers, compared to 17.9% in the asymptomatic group. Current drinkers in the symptomatic group were more likely to drink alcohol and to have experienced severe intoxication than those in the asymptomatic group. Participants who had been diagnosed within one year (odds ratio = 5.19, 95% confidence interval = 4.17-6.44) and those who had smoked over 20 days during the past 30 days (odds ratio = 1.77, 95% confidence interval = 1.26-2.49) were more likely to experience asthma symptoms. Healthcare providers should identify the risk behaviors of adolescents with asthma and counsel them and their parents simultaneously.

Smoking in non-student Mexican adolescents with asthma: relation with family structure, educational level, parental approval of smoking, parents who smoke, and smoking friends

INTRODUCTION

The association between some factors of the familial and social environment with smoking in non-student adolescents with asthma has not been explored. The aim of the study was to determine the association between family structure, educational level, parental approval of smoking, parents who smoke, and smoking friends with smoking in non-student adolescents with asthma.

SUBJECTS AND METHODS

In a cross-sectional study, data were obtained by means of a structured questionnaire applied to 4,778 non-student adolescents aged 13-18 years. Diagnosis of asthma was performed using a questionnaire based on the International Study of Asthma and Allergy in Childhood questionnaire. The smoking habit was determined by application of a self-administered questionnaire. Odds ratios (OR) were determined for smoking using logistic regression.

RESULTS

From the total sample, asthma prevalence was 6.6% and of active smoking, 34.2%. Age at initiation of asthma symptoms was 5.15±3.52 years, and that of active smoking was 13.65±2.07 years. Percentage of non-intact family (40.1 vs. 32.7%) was greater in the group of adolescents with asthma. Logistic regression models show that parental approval of smoking (adjusted OR=5.57; 95% confidence interval=2.48-12.51) and smoking friends (adjusted OR=2.92; 95% confidence interval=1.04-8.19) are associated with smoking in non-student adolescents with asthma.

CONCLUSION

In this study, parental approval of smoking and having friends who smoke appear to be associated with smoking among non-student adolescents with asthma.

Modifying effect of suicidal ideation on the relationship between asthma and cigarette use behaviors among Korean adolescents

Objectives

Although cigarette smoking is known to be related to the exacerbation of asthma symptoms, several studies have indicated that the prevalence of cigarette smoking among asthmatic adolescents is similar to or even higher than that among non-asthmatic adolescents. The aim of this study was to evaluate the relationship between asthma and cigarette use behaviors and whether or not the presence of suicidal ideation modifies this relationship among Korean adolescents.

Methods

We analyzed data from the 2008 Korea Youth Risk Behavior Web-based Survey, which included a nationally representative sample of middle and high school students. Multiple logistic regression models were used to calculate odd ratios and 95% confidence intervals of cigarette use behaviors among current asthmatics, former asthmatics, and non-asthmatics, after adjusting for gender, grade, school records, socioeconomic status, current alcohol use, and suicidal ideation.

Results

Of 75 238 study participants, 3.5% were current asthmatics and 4.5% were former asthmatics. Compared with non-asthmatics, asthmatics were more likely to report current cigarette use, frequent and heavy cigarette use, and cigarette use before 13 years of age. There were statistically significant interactions between asthma and suicidal ideation in cigarette use behaviors.

Conclusions

This study demonstrated that asthmatic adolescents are more likely than non-asthmatic adolescents to engage in cigarette use behaviors and the presence of suicidal ideation is an effect modifier of the relationship between asthma and cigarette use behaviors. Particular attention should be paid to the awareness of health risks of cigarette smoking and mental health problems among asthmatic adolescents.

Smoking and asthma: disentangling their mutual influences using a longitudinal approach

BACKGROUND

The association between smoking and asthma remains unclear and has mostly been assessed in cross-sectional studies, with potential selection bias ("healthy smoker effect").

AIMS

Using a longitudinal approach, the aims were to assess whether 1) childhood asthma modifies smoking initiation, 2) active smoking influences asthma incidence in adults and 3) active smoking among subjects with asthma influences the persistence of the disease or the 12-year evolution in lung function in children and adults.

METHODS

Subjects (513 children and 1190 adults) were recruited and followed-up for 12 years in the context of the EGEA study (Epidemiological study on the Genetics and Environment of Asthma).

RESULTS

Childhood asthma was not associated with a decreased probability of starting active smoking (Hazard Ratio, HR = 0.96; 95% confidence interval (CI): 0.72, 1.27). Smoking at baseline was associated with a higher risk for asthma incidence in adulthood (HR = 1.95, 95% CI: 1.00, 3.77). Among subjects with asthma, smoking was unrelated to lung function evolution; however, among children with moderate to severe asthma at inclusion, smoking tended to slow down the lung function growth (P = 0.04).

CONCLUSION

These findings support the hypothesis that childhood asthma does not prevent smoking initiation and confirm that active smoking has a deleterious role on asthma. Altogether this study emphasizes the importance of active smoking as a serious public health problem particularly for children and women.

Early smoking in school-aged children with and without a diagnosis of asthma

BACKGROUND

Research has shown that adolescents with asthma are as likely as and sometimes even more likely to smoke than their peers without asthma. The current study examined whether the prevalence of the first active smoking experience differs for children (9-12 years of age) diagnosed with asthma compared with children who do not have asthma. The association between asthma and smoking was evaluated with logistic regression analysis, controlling for socio-economic status, parental smoking and child's internalizing and externalizing behaviours.

METHOD

A nation-wide sample of 1476 mother and child dyads participated, of which 220 children (14.9%) had been diagnosed with childhood asthma.

RESULTS

Children diagnosed with asthma were 2.45 times more likely to have taken a puff of a cigarette compared with children without asthma. In addition, the association between asthma and early smoking remained significant after including potential confounders in the regression equation.

DISCUSSION

Suggestions are provided for preventing school-aged children, especially youths with asthma, from smoking. Additional research is needed to gain further insights into the mechanisms underlying the higher likelihood of early smoking among children with asthma.

Asthma in childhood reduces smoking initiation in subsequent teens among males

BACKGROUND

The association between smoking habits and asthma is complex because subjects with asthma could avoid smoking, whereas smoking could increase asthma severity or incidence.

PURPOSE

The relation between asthma in childhood (0-10 years) and smoking initiation in the second decade (11-20 years) was investigated using the database of the Italian Study on Asthma in Young Adults, performed in 1998-2000 on people aged 20-45 years.

METHODS

The cumulative incidence of smoking initiation was compared among (1) subjects not reporting asthma attacks in the first 20 years of life (n = 17,384), (2) subjects reporting asthma onset in the first decade and no disease remission by the age of 20 years (n = 305), (3) subjects reporting asthma onset in the first decade and remission in the first and second decades (n = 573).

RESULTS

Among men, the cumulative incidence of smoking onset was higher among nonasthmatics (49%) than among asthmatics (35.6%), and intermediate among asthmatics with disease remission (44.2%) (p = .001). These differences were larger in males born between 1953 and 1965, and tended to decrease in males born between 1966 and 1979: cumulative incidence of smoking onset decreased from 54.3% to 43.8% in nonasthmatics, whereas it remained stable in asthmatics (from 36.8% to 35%). Women, instead, had similar cumulative incidence of smoking initiation, irrespective of asthma onset or remission (p = .849).

CONCLUSION

Asthma in childhood reduces smoking initiation during the subsequent teenage in men, but not in women. This protective effect tends to fade when asthma remission occurs. In the last decades, smoking initiation has decreased among nonasthmatic males, but not among asthmatic males.

Role of age at asthma diagnosis in the asthma-obesity relationship

OBJECTIVE

To determine whether age at asthma diagnosis has an impact on the previously described relationship between asthma and obesity.

METHODS

Data were provided from Cycle 1.1 (2000⁄2001) of the Canadian Community Health Survey, a nationally representative health survey that included 6871 participants (2464 males and 4407 females) with asthma. Body mass index was used to categorize participants as normal weight (18.5 kg/m2 to 24.9 kg/m2), overweight (25 kg/m2 to 29.9 kg/m2) or obese (30 kg/m2 or greater). Multivariate logistic regression analyses were used to estimate the odds of overweight and obesity by self-reported age at asthma diagnosis, after accounting for current age and other covariables.

RESULTS

In fully adjusted models, males diagnosed with asthma during adolescence (12 to 20 years of age) were at elevated odds of obesity (OR 1.58; 95% CI 1.03 to 2.43) compared with asthmatic patients diagnosed during childhood (0 to 11 years of age). Women diagnosed with asthma in mid life (21 to 44 years of age) and later life (45 to 64 years of age) were 43% (OR 1.43; 95% CI 1.08 to 1.90) and 56% (OR 1.56; 95% CI 1.00 to 2.44) more likely to be obese than those diagnosed in childhood, respectively.

CONCLUSIONS

The impact of age at asthma diagnosis on the asthma-obesity relationship differed between males and females. However, the identification of high-risk groups of asthmatic patients may strengthen primary prevention strategies for obesity and related comorbidities at multiple levels of influence.

Asthma and cigarette smoking: a review of the empirical literature

The purpose of this review paper is to present and evaluate the empirical literature on the association between asthma and cigarette smoking. The authors conducted a literature search utilizing electronic search engines (i.e., PsycINFO and MEDLINE) to examine databases using the following key word algorithms: smoking OR nicotine OR tobacco AND asthma. Only articles that focused on active tobacco smoking and analyzed groups with asthma patients only were examined in the present review. Overall, empirical evidence suggests that (1) smoking is more prevalent among individuals with asthma than those without; (2) smoking is a risk candidate for the development of asthma; (3) smoking is associated with decreased asthma control and increased risk of mortality and asthma attacks and exacerbations; (4) smokers with and without asthma may have different risk factors for smoking onset as well as different smoking motives and outcome expectancies; and (5) smoking cessation is associated with improvements in lung functioning and asthma symptoms. Future work in this domain of study will lead to clinically relevant health care advances as well as the development of theoretically driven, methodologically diverse lines of research exploring asthma-smoking comorbidity issues.

Depressive mood and smoking onset: A comparison of adolescents with and without asthma

This prospective population-based study aimed to compare associations between depressive feelings and smoking behaviour of adolescents with and without asthma. Data were collected from a two-wave 22-24 months prospective study among 5938 adolescents who completed self-report questionnaires. Logistic regression analyses showed that depressive feelings and smoking were related both cross-sectionally and longitudinally. Smoking behaviour was similar for adolescents with and without asthma, as well as its correlation with depressive feelings. However, participants with asthma were more likely to report depressive feelings than those without asthma, implying an indirect relationship between asthma and smoking behaviour. Implications for prevention are addressed.

Efficacy of smoking prevention program 'Smoke-free Kids': study protocol of a randomized controlled trial

BACKGROUND

A strong increase in smoking is noted especially among adolescents. In the Netherlands, about 5% of all 10-year olds, 25% of all 13-year olds and 62% of all 17-year olds report ever smoking. In the U.S., an intervention program called 'Smoke-free Kids' was developed to prevent children from smoking. The present study aims to assess the effects of this home-based smoking prevention program in the Netherlands.

METHODS/DESIGN

A randomized controlled trial is conducted among 9 to 11-year old children of primary schools. Participants are randomly assigned to the intervention and control conditions. The intervention program consists of five printed activity modules designed to improve parenting skills specific to smoking prevention and parent-child communication regarding smoking. These modules will include additional sheets with communication tips. The modules for the control condition will include solely information on smoking and tobacco use.Initiation of cigarette smoking (first instance of puffing on a lighted cigarette), susceptibility to cigarette smoking, smoking-related cognitions, and anti-smoking socialization will be the outcome measures. To collect the data, telephone interviews with mothers as well as with their child will be conducted at baseline. Only the children will be examined at post-intervention follow-ups (6, 12, 24, and 36 months after the baseline).

DISCUSSION

This study protocol describes the design of a randomized controlled trial that will evaluate the effectiveness of a home-based smoking prevention program. We expect that a significantly lower number of children will start smoking in the intervention condition compared to control condition as a direct result of this intervention. If the program is effective, it is applicable in daily live, which will facilitate implementation of the prevention protocol.

TRIAL REGISTRATION

Netherlands Trial Register NTR1465.

Decision-making program for rural adolescents with asthma: a pilot study

Although a high prevalence of substance use and its adverse effects on the course of the disease have been reported in adolescents with asthma, no studies have attempted to ameliorate the risk through adequate interventions. This pilot study evaluates and supports the feasibility and the effectiveness of a decision-making program in improving decision-making quality and reducing risk motivation over a 6-month study period. Differential effectiveness of the intervention was observed by race and gender. Although the improvement of decision-making quality was observed only in Whites, changes in risk motivation were detected only in non-Whites and girls. No significant reduction in actual substance use behavior was found. The intervention was favorably received by participants. An approach enhancing decision-making quality can be effective in addressing the risk of substance use in adolescent with asthma by altering motivations.

Health risk behaviors in adolescents with chronic conditions

OBJECTIVE

The objective of this study was to compare the frequency of risk behaviors and to measure the extent of co-occurrence of these behaviors in chronically ill and healthy adolescents.

METHODS

Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative survey of 7548 adolescents in postmandatory school aged 16 to 20 years. There were 760 subjects who reported a chronic illness and/or a disability. The comparison group consisted of 6493 subjects who answered negatively to both questions. We defined 8 risk behaviors: daily smoking, alcohol misuse, current cannabis use, current use of any other illegal drug, early sexual debut, eating disorder, violent acts, and antisocial acts. We analyzed each behavior and the sum of behaviors, controlling for age, gender, academic track, parents' education level, depression, and health status. Results are given as adjusted odds ratios using the comparison group as the reference category.

RESULTS

Youth with a chronic condition were more likely to smoke daily, to be current cannabis users, and to have performed violent or antisocial acts. Youth with a chronic condition were also more likely to report 3 or >or=4 risk behaviors.

CONCLUSIONS

These results indicate that having a chronic condition carries additional risks for engaging in health risk behaviors and emphasize the importance of health risk screening and preventive counseling for young people in general and among those suffering from chronic conditions in particular.

Asthma-specific predictors of smoking onset in adolescents with asthma: a longitudinal study

OBJECTIVE

Despite even occasional smoking being more risky for adolescents with asthma, the smoking rate in this vulnerable population remains high. This is the first longitudinal study investigating asthma-specific predictors of smoking initiation.

METHODS

A three-wave longitudinal survey study (22 months) among 257 adolescents with asthma was conducted. The effects of asthma-specific factors [symptom severity, medication adherence, coping, attitude towards asthma, and quality of life (QOL)] on smoking onset were tested with logistic regression models.

RESULTS

Poorer self-reported adherence and the maladaptive coping strategy of hiding asthma predicted smoking onset. Poorer QOL predicted smoking in boys only.

CONCLUSIONS

Our findings underscore the importance of recognizing and addressing adherence problems during adolescence as low adherence is a risk factor for smoking initiation. Moreover, psychosocial factors, such as coping and QOL for boys, were associated with smoking initiation. This highlights the importance of attending to the psychosocial needs of youth with asthma.

Training improves physical fitness and decreases CRP also in asthmatic conscripts

To study the respiratory and physical health of young men, 224 asthmatic and 668 non-asthmatic military conscripts were recruited from the intake groups of July 2004 and January 2005 in Kajaani, Finland. Factors affecting respiratory health were elicited by a questionnaire at the beginning of the service, and results of high sensitive C-reactive protein (hsCRP) determination, peak expiratory flow (PEF), and 12-minute running test were collected at the beginning and the end of the service. Respiratory infections were diagnosed by a study physician. Upon entering military service, asthmatics had frequent exercise- and cold-related asthma symptoms (69.6% and 76.3%), and 48% of them had no medication for asthma. At the beginning, 25.8% of asthmatics and 19.1% of non-asthmatics had a poor result of less than 2,200 m (p = 0.05) in the 12-minute running test, and after 180 to 362 days of service, the corresponding percentages were 11.7% and 9.7% (p = 0.434). The levels of hsCRP, a marker of low-grade systemic inflammation, decreased significantly among both asthmatics, 1.5 (p = 0.001), and non-asthmatics, 1.6 mg/L (p < 0.001). Asthmatic men had 0.2 and non-asthmatics 0.1 respiratory infections per month (p < 0.001). In summary, asthmatic conscripts can enhance their physical fitness by training similarly to non-asthmatic ones. Their levels of hsCRP also decrease.

An integration of parents' and best friends' smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: a comparison between adolescents with and without asthma

OBJECTIVE

To study the impact of parents' and best friends' smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma.

METHODS

Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma.

RESULTS

Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends' smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma.

CONCLUSIONS

Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Smoking behavior in asthmatic and non-asthmatic adolescents: the role of smoking models and personality

Despite the particular health risks for asthmatics, recent international studies have reported that tobacco use among asthmatics is similar to, or even higher than, non-asthmatics. This study examined the role of personality and environment in smoking among asthmatic and non-asthmatic adolescents. In 2003 a random sample of 33 schools (first and second class of secondary education) was obtained in The Netherlands (N = 4,951). The mean age of the participants was 12.83 (SD = .75), and 52.8% were females. Information about asthma, smoking, personality, and environmental smoking was assessed via self-reports on standard epidemiology survey items (asthma, smoking) and the Quick Big Five (personality). Both personality and environmental smoking were associated with smoking. Asthmatics were similarly or even more exposed to environmental smoke than non-asthmatic adolescents and asthmatic adolescents were less emotionally stable and extravert. Associations between personality and own smoking behavior, as well as between smoking models and own smoking behavior were similar for asthmatic and non-asthmatics. Limitations of the study are taken notice of, and implications of the results are briefly discussed.

Smoking cessation attempts among adolescent smokers: a systematic review of prevalence studies

OBJECTIVE

To synthesise estimates of the prevalence of cessation attempts among adolescent smokers generally, and according to age and level of cigarette consumption.

DATA SOURCES

PubMed, ERIC, and PsychInfo databases and Internet searches of central data collection agencies.

STUDY SELECTION

National population-based studies published in English between 1990 and 2005 reporting the prevalence, frequency and/or duration of cessation attempts among smokers aged >or=10 to <20 years.

DATA EXTRACTION

Five reviewers determined inclusion criteria for full-text reports. One reviewer extracted data on the design, population characteristics and results from the reports.

DATA SYNTHESIS

In total, 52 studies conformed to the inclusion criteria. The marked heterogeneity that characterised the study populations and survey questions precluded a meta-analysis. Among adolescent current smokers, the median 6-month, 12-month and lifetime cessation attempt prevalence was 58% (range: 22-73%), 68% (range 43-92%) and 71% (range 28-84%), respectively. More than half had made multiple attempts. Among smokers who had attempted cessation, the median prevalence of relapse was 34, 56, 89 and 92% within 1 week, 1 month, 6 months, and 1 year, respectively, following the longest attempt. Younger (age<16 years) and non-daily smokers experienced a similar or higher prevalence of cessation attempts compared with older (age >or=16 years) or daily smokers. Moreover, the prevalence of relapse by 6 months following the longest cessation attempt was similar across age and smoking frequency.

CONCLUSIONS

The high prevalence of cessation attempts and relapse among adolescent smokers extends to young adolescents and non-daily smokers. Cessation surveillance, research and program development should be more inclusive of these subgroups.

Bidirectionality in the relationship between asthma and smoking in adolescents: a population-based cohort study

PURPOSE

Several cross-sectional studies have showed higher smoking rates among adolescents with asthma, but hardly any study has investigated this relation longitudinally. This study examines whether these cross-sectional results are caused by higher smoking onset among adolescents with asthma, or by the development of asthma after smoking onset.

METHODS

This was a longitudinal study (22 months) among 7,426 Dutch adolescents (mean age at baseline = 12.9 years). Asthma was assessed with self-report questionnaires of the International Study of Asthma and Allergies in Childhood (ISAAC) and the student questionnaire of the American College of Allergy, Asthma and Immunology. Adolescents' smoking and parental smoking were also assessed by adolescent-report. All analyses were controlled for age, gender, education, ethnicity, and parental smoking.

RESULTS

In baseline non-smokers, adolescents with current diagnosed asthma and with more severe asthma had an increased risk to become regular smokers. Among girls and adolescents with a smoking mother, having asthma symptoms was a risk factor for starting experimental smoking. In contrast, among boys and adolescents with a non-smoking mother, having asthma symptoms was protective for experimental smoking. With regard to the effect of smoking on asthma, adolescent smoking predicted a higher incidence of asthma symptoms. In addition, smoking predicted increased symptom severity scores, and this effect was stronger in girls. Adolescent smoking was a stronger predictor for the development of asthma symptoms when the mother smoked.

CONCLUSIONS

The relationship between asthma and smoking in adolescence seems to be bidirectional, with relations in both directions being stronger in females and when the mother smokes.

Impact of smoking on asthma symptoms, healthcare resource use, and quality of life outcomes in adults with persistent asthma

BACKGROUND

Smoking habits of asthmatics are similar to those of the general population. However, little attention has been paid to the associations between smoking and asthma-related outcomes.

OBJECTIVE

To evaluate relationships between cigarette smoking, asthma symptoms, and asthma-related resource utilization in subjects with persistent asthma.

METHOD

A stratified, random sample of adults from France, Germany, and the UK with persistent asthma were surveyed in 2001 through 2004. Statistical analyses compared asthma symptoms and healthcare resource utilization for cigarette smokers compared with those for non-smokers.

RESULTS

Analyses included 1109 subjects with persistent asthma symptoms in 2001-2003 and 852 subjects with persistent asthma symptoms in 2004. Using multivariate analysis of data from eligible subjects in 2004 that did not have concomitant chronic obstructive pulmonary disease and adjusting for subjects' baseline and demographic characteristics, cigarette smokers were more likely to experience nighttime symptoms (OR 1.46, 95% CI 1.07, 1.97 P = 0.015) and were more likely to use healthcare resources than were non-smokers (P < or = 0.004). Findings were similar in a secondary analysis of subjects < or =55 years of age.

CONCLUSIONS

Cigarette smoking appears to be associated with more asthma symptoms and more ED visits and hospitalizations in adults with persistent asthma.

The challenge of asthma in adolescence

The adolescents with asthma are a distinct group of patients with different problems and needs compared to children and adults. Specific issues of asthma in adolescence are the variability of the clinical spectrum, the presence of particular risk factors for the persistence of symptoms, underdiagnosis and undertreatment of the disease. Refusal of the sick role, denial of symptoms, carelessness about dangerous inhalation exposure, erratic self-medication, overexertion without taking precautions against exercise-induced asthma, and a poor relationship between patients, their families, and often doctors are the main obstacles to successful management of asthma in this critical age. There are also major problems of compliance for these patients. The goal of optimal quality of life will be achieved only if the physician thoroughly understands the adolescent's needs and provides optimal care.

[Associations between family history of allergy, exposure to tobacco smoke, active smoking, obesity, and asthma in adolescents]

OBJECTIVE

The relationships between asthma in adolescents and various environmental and social exposures needs to be clarified. The aim of this study was to determine the association between family history of allergy, passive or active tobacco smoking, obesity, and asthma in adolescents.

SUBJECTS AND METHODS

A population-based case-control study was carried out. A random sample of 4003 students aged 13 to 18 years old was selected from secondary and preparatory schools in an urban area in northeastern Mexico. Data was gathered in physical examinations and with a questionnaire administered by trained staff. Two study groups were formed: a group of 253 adolescents with asthma and a control group of students without asthma.

RESULTS

Variables associated with asthma were family history of allergy (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.28-2.06), passive smoking (OR, 1.53; 95% CI, 1.18-1.99), and obesity (OR, 1.96; 95% CI, 1.45-2.65). Female gender and active smoking were unrelated to asthma. The percentage of obese adolescents was higher in the group of asthmatics (18.2%) than in the control group (12.8%).

CONCLUSIONS

Family history of allergy, passive tobacco smoking, and obesity seem to be the main risk factors for the development of asthma in adolescents. The relationship of active smoking and asthma requires further study.

A longitudinal test of the theory of planned behavior predicting smoking onset among asthmatic and non-asthmatic adolescents

Despite the particularly detrimental health risks of smoking for adolescent with asthma, several studies demonstrated higher smoking rates among asthmatic adolescents than among healthy adolescents. To gain insight into underlying mechanisms, longitudinal studies on differences in smoking predictors between asthmatic and non-asthmatic adolescents are essential. This longitudinal study with two waves with an 18 months interval tests the Theory of Planned Behavior (TPB) among 346 asthmatic adolescents and 3,733 non-asthmatic adolescents aged 12-16 years. Structural equation models were used to test the predictive value of the TPB in these two groups. The results show, consistent with the TPB, that smoking-related cognitions (attitude, perceived behavioral control, and subjective norm) predict smoking onset via intention among both asthmatic and non-asthmatic adolescents. The TPB predicted smoking onset even stronger among adolescents with asthma. These findings may contribute to the development of tailored interventions for the prevention of smoking among asthmatic adolescents.

Adolescents with a chronic condition: challenges living, challenges treating

In this review, we aim to focus attention on the interaction between adolescents with chronic conditions and the health systems that support them. At least 12% of adolescents live with a chronic condition. Some conditions are characterised by increasing incidence (eg, diabetes) or improving survival rates (eg, cystic fibrosis), while others are concerning because of differentially poorer outcomes in adolescents in comparison to both children and adults (eg cancer). Growing evidence suggests that young people with chronic conditions are doubly disadvantaged--engaging in risky behaviours to at least similar if not higher rates as healthy peers, while having the potential for greater adverse health outcomes from these behaviours. In addition to efforts at improving survival, in order to improve their life chances, we need to better understand how the social and emotional outcomes of young people with a chronic disease can be improved, and better support young people's emerging capacity for self-management.

Allergy in bakers’ apprentices and factors associated to non-participation in a cohort study of allergic sensitization

OBJECTIVE

To describe the prevalence of atopy and respiratory symptoms among baker apprentices at the start of the education and factors associated with non-participation in the study.

METHODS

A total of 346 students, 22.1(0.6) years of age, mean (SD), from the food production programme of technical colleges in Denmark were invited to participate in a 3 year study. Of the students, 187 agreed to participate and filled in a physician-administered questionnaire. The presence of atopy was determined by skin prick test (SPT) and serum allergen specific IgE (SpIgE). Bronchial hyper responsiveness to methacholine (PD(20) <or= 1,440 microg) was determined.

RESULTS

Prevalence of atopy was 32%. The prevalence of symptoms from the lungs and nose was 19.8 and 25.5%, respectively. Significantly, more SPT reactions were seen in males compared to females (39 vs. 22%, P < 0.05). Sensitization towards flour was significantly more frequent if determined as SpIgE (7.3%) compared to SPT (0.5%). We found a positive association between atopy and lung symptoms OR 6.1 (2.8-13.2 SD) and nasal symptoms OR 3.7 (1.8-7.5 SD). The major reason for non-participation was fear of blood sampling (25.5%).

CONCLUSION

The prevalence of atopy in bakers' apprentices was of the same magnitude in the general Danish population. Significantly, more male bakers' apprentices had atopy. This finding has major impact on the diagnostic procedures of occupational allergy in bakery workers emphasizing the need for standardization of the clinical tests. The main reasons for non-participation were, fear of blood-sampling (57%) and the 3 years commitment to the follow-up study (39%).

Factors related to tobacco use among teenagers

AIM

To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program.

METHODS

From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years.

RESULTS

Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0-9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2-3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2-0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation.

CONCLUSION

The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.

Tobacco and other drug use among high school students with asthma

The 2003 national Youth Risk Behavior Survey data were analyzed to compare drug use among high school students with and without asthma. High school students with current asthma used cigarettes, cigars, marijuana, and inhalants (huffing) at rates equal to or greater than high school students without current asthma.