Experimentation with smokeless tobacco and cigarettes by children and adolescents: relationship to beliefs, peer use, and parental use

The Ominous beginning" Perceptions of Smokeless Tobacco Initiation among the Paniya Tribes of Wayanad: A qualitative Study

BACKGROUND

The prevalence of tobacco chewing, and related oral mucosal lesions is alarmingly high amongst the Paniya tribes of Wayanad. A deeper understanding of their socio-cultural factors, beliefs, attitudes and behaviours would shed greater insights into the indiscriminate use of smokeless tobacco and related products in this community.

METHODS

Ethnography was the theoretical framework adopted with network and convenience sampling. Fifteen in-depth interviews and two focus group discussions were conducted among the key informants from within the tribal colonies of Cheepram and Madikkunnu. The data was audio recorded and converted into verbatim transcripts. Thematic content analysis was done using an inductive approach performed using computer-assisted qualitative data analysis software (NVivo).

RESULTS

This study is suggestive of parental influence and peer pressure as the key factors for smokeless tobacco initiation amongst the adolescent. There was a greater predisposition for women to be chewers of tobacco, particularly after marriage. The key factors influencing initiation of the habit amongst men include peer pressure and availability of tobacco at workplace. The role of contextual factors such as enculturation, marginalization and perceived health benefits also play a substantial role in development of this habit.

CONCLUSION

Targeted strategies for effective tobacco control can be developed through an understanding of the socio-cultural factors leading to initiation of smokeless tobacco use among disadvantaged communities.

Alternative Tobacco Products Use among Late Adolescents in Kelantan, Malaysia

BACKGROUND

The rising prevalence of alternative tobacco and nicotine products (ATNPs) use among adolescents is a global concern that has been attributed to the reemergence of preexisting alternative tobacco products and emergence of new ones in the market. This study examined ATNP use among late adolescents. The association between ATNP use and reasons for using them was explored.

METHODS

This cross-sectional study conducted in 2016 involving 388 late adolescents from six government colleges in Kelantan, Malaysia, aged 18 to 19 years. They were requested to answer self-directed questionnaires with items on sociodemographic information and types of ATNP used. Other variables obtained include the environmental influence and reasons for using the products. Regression analyses between the dependent and independent variables were conducted using IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA).

RESULTS

The prevalence of ATNP use among late adolescents was 14.4%. The male sex, cigarette smoking status, and peer use were significantly associated with ATNP use. Several reasons for use were not significantly associated with ATNP use: perception of ATNP being less harmful and less addictive compared with cigarettes, curiosity, less expensive than cigarettes, to aid smoking cessation, and pleasurable flavors and taste.

CONCLUSION

The prevalence of ATNP use among late adolescents studying in government colleges in Kelantan is significant. There is higher perception on ATNP being less harmful and addictive than the conventional cigarette among the users compared with non-users. Significant associations are seen for the male sex, peer use, and concurrent cigarette smoking.

Prevalence and correlates of lifetime smokeless tobacco use in female military recruits

Although considerable research has been conducted on smokeless tobacco (ST) use in males, much less is known about the characteristics of female ST users. The present study examined the prevalence and correlates of lifetime ST use among female Air Force recruits (N=9,087). Participants were surveyed during Basic Military Training regarding their history of tobacco use and other health risk behaviors. Although the prevalence of current ST use was low (<1%; n=34), 6.6% (n=599) had tried ST. Multivariate logistic regression analysis indicated that lifetime ST use was related to ethnicity, with Native Americans and Whites being most likely to have tried ST. Additional correlates of lifetime ST use included post-high-school education (OR=1.26, 95% CI=1.03-1.55); weekly acts of road rage (OR=1.48, 95% CI=1.06-2.06); frequent arguing (OR=1.71, 95% CI=1.18-2.48); daily or near-daily alcohol consumption (OR=1.71, 95% CI=1.03-2.82); current cigarette use (OR=3.80, 95% CI=2.42-5.94); and experimental use of cigars (OR=4.01, 95% CI=3.22-5.01), pipes (OR=2.23, 95% CI=1.64-3.03), and clove cigarettes (OR=1.23, 95% CI=1.01-1.49), all of which were associated with an increased likelihood of ST use. Results suggest that female recruits who have ever used ST engage in a variety of risk behaviors including use of other tobacco products and alcohol, as well as additional harmful behaviors.

Concurrent use of tobacco products by California adolescents

BACKGROUND

To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age.

METHODS

Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use.

RESULTS

Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use.

CONCLUSIONS

Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Smoking mothers and snuffing fathers: behavioural influences on youth tobacco use in a Swedish cohort

OBJECTIVE

To analyse the influences of parental use of cigarettes and snus (the Swedish variety of smokeless tobacco) on offspring's behaviour.

DESIGN

Prospective cohort study.

SETTING

The Stockholm County of Sweden.

SUBJECTS

2232 adolescents recruited in the fifth grade (mean age 11.6 years) with follow up in the eighth grade.

MAIN OUTCOME MEASURES

Self reported tobacco use (ever and current use of cigarettes and/or snus) in the eighth grade.

RESULTS

Parents' tobacco use was associated with adolescents' current use of cigarettes and snus (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.8 to 3.9 if both parents used tobacco v neither parent). Mother's cigarette smoking was associated with adolescents' current exclusive smoking (OR 2.4, 95% CI 1.6 to 3.6). Father's use of snus was associated with current exclusive use of snus among boys (OR 3.0, 95% CI 1.4 to 6.4), but not with current cigarette use. The overall prevalence of current smoking was lower among children whose fathers used snus than among those whose fathers smoked.

CONCLUSIONS

Parental smoking, especially maternal smoking, enhances the risk of tobacco experimentation in youths, as does paternal use of smokeless tobacco. However, the transition to regular cigarette smoking is not likely to be affected by paternal use of smokeless tobacco. Contextual factors, in particular declining smoking trends and negative social acceptance of smoking, can explain most of these findings.

Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students

We examined the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in Connecticut school children in grades four through 12 (n=31,861). Less than one per cent of students in grades 4-8, and four per cent of those in grades 9-12, used smokeless tobacco. Eighty-two percent of all users were white males. Among high school males, the prevalences of risk-taking behaviors and feelings of stress and depression were significantly higher among users than non-users. Among high school males, the highest prevalences of risky behaviors and stress indicators were reported by joint users of cigarettes and smokeless tobacco.

Oral spit tobacco: addiction, prevention and treatment

The prevalence of smokeless tobacco is significant and reaches as high as 17% past month use in white males aged 18-25. Smokeless tobacco use is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction to smokeless tobacco, examining the nicotine content in smokeless tobacco products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. It also explores the negative health consequences which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, it examines the factors associated with the initiation of smokeless tobacco use, and the current prevention programs that address these factors. Current smokeless tobacco treatment approaches are also discussed as well as predictors for abstinence. Finally, the future directions are discussed in light of the limited amount of research that has been conducted in the smokeless tobacco area, particularly related to prevention and treatment.

Reliability of children's self-reported cigarette smoking

Youth who first smoke cigarettes during childhood are a high risk for habitual smoking. Evaluating the reliability of children's smoking initiation is essential to research efforts to explain or prevent smoking onset. The present study is the first to establish reliability of self-reported smoking behavior with questionnaire data from elementary school children (N = 1,184). Data from a longitudinal investigation are used to examine the consistency of children's self-reported smoking across items and over time. Both cross-sectional and longitudinal analyses demonstrate that children report having tried smoking and lifetime use remarkably consistently. However, only about half the children reliably estimated their grade at first use. The study results suggest that some but not all standard questionnaire items yield reliable self-report data about initial smoking behavior from respondents as young as 8 to 11 years.

Incidence and predictors of smokeless tobacco use among US youth

OBJECTIVES

The purpose of this study was to provide estimates of the cumulative incidence of initiation of smokeless tobacco use in a cohort of young persons and to explore sociodemographic, environmental, behavioral, and personal predictors of experimentation with and regular use of snuff or chewing tobacco.

METHODS

The data for this cohort study were derived from the 1989 Teenage Attitudes and Practices Survey and its 1993 follow-up. The study included 7830 young people 11 through 19 years of age at baseline.

RESULTS

During the 4 years, 12.7% of participants (20.9% of male participants) first tried smokeless tobacco, and 4.0% (8.0% of male participants) became self-classified regular users. This suggests that, each year, approximately 824000 young people in the United States 11 to 19 years of age experiment with smokeless tobacco and about 304 000 become regular users. Cumulative incidence was highest for male non-Hispanic Whites. Predictors of regular use included age, geographic region, cigarette smoking, participation in organized sports, and perceived friends' approval or indifference.

CONCLUSIONS

Public health approaches to preventing use of smokeless tobacco should include development of skills for responding to pressures to use tobacco.

Sociobehavioral influences on smoking initiation of Hispanic adolescents

PURPOSE

To study the sociobehavioral influences on smoking initiation of Hispanic adolescents over a 3-year period using a national sample.

METHODS

Hispanic adolescents (N = 385), ages 15-22 years, from the 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS I and II), were selected for analyses. Data collected included measures of smoking initiation and attitudes, beliefs toward smoking of the adolescent, and smoking status of family and peers.

RESULTS

At the 3-year follow up, 43.4% of nonsmokers at TAPS I had initiated smoking. Risk factors associated with initiating smoking were having male and/or female friends who smoked, and positive attitudes and beliefs towards smoking. Parental and sibling smoking status had little effect on adolescent smoking status.

CONCLUSIONS

The peer influence on Hispanic adolescent smoking is consistent with previous research on Caucasian and African-American adolescents. The formation of attitudes and beliefs toward smoking in this population warrants further examination given the influence of attitudes and beliefs on smoking initiation in this study.

Cardiac risk evaluation for elementary school children

This study examined cardiac risk factors in school-age children. Specific risk factors focused on were smoking, hypertension, elevated blood cholesterol, obesity, physical inactivity, and nutritional imbalances. All consenting students in grades one through five participated. Components of the study included screenings and a questionnaire. Children (N = 357) were screened for height/weight, resting pulse, blood pressure, cholesterol, skin-fold thickness, and fitness. The questionnaire included an assessment of family diseases and family health practices. Results showed no significant relationships between cholesterol and family history of hypercholesterolemia or coronary heart disease, cholesterol and overweight, cholesterol and amount of time students exercised and the amount of time student's mothers exercised (r = -0.25, p = .0028), cholesterol elevation and exercise (r = -0.25, p-value = 0.007), and exercise and the frequency of eating out in a restaurant (r = -0.18, p-value = 0.03).

Principles of brief intervention for adolescent alcohol, tobacco, and other drug use

Early intervention within a primary health-care setting for problems with ATOD use includes screening, assessment, and referral services, and cognitive and behavioral brief interventions. All health-care providers who care for adolescents should possess the basic skills to communicate effectively with young patients and with parents about their concerns about ATOD use problems, should be able to identify appropriate substance-abuse services in their communities, and should be able to determine the appropriate referral options for a given adolescent patients. Some difficulties will be encountered with the introduction of behavioral technologies into medical practice. As such, more research is needed to determine the most effective approach to incorporate brief interventions into the health-care setting. Health-care providers should incorporate the principles of effective patient-provider communication and the concepts of behavior-changing strategies into their daily practices.

Tobacco use among adolescents. Strategies for prevention

Tobacco use is a major public health problem that has its onset during childhood and adolescence. To prevent the onset, physicians can reach children and their parents in their offices beginning in the prenatal period and continuing through adulthood. For pediatricians and other physicians who care for children, NCI recommends five office-based activities that begin with the letter A. The 5 As include anticipatory guidance, ask, advise, assist, and arrange follow-up visits. Elimination of tobacco use requires a comprehensive strategy that includes health professional interventions, policy changes, advertising restrictions, comprehensive school-based programs, community activities, and advocacy approaches. Physicians and health professionals have major roles to play in each of these interventions.

Public knowledge of prevention of dental disease

The authors present data describing the level and extent of the general public's knowledge of oral diseases and their prevention. They discuss data from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement in the context of national oral health objectives. They focus on demographic and socioeconomic differences seen in the public's knowledge of the preventive purposes of fluorides and dental sealants for dental caries and of symptoms of gum disease. Reported low levels of knowledge regarding oral disease symptoms and their prevention show the continuing trend reported during the past decade. Racial and ethnic minorities and groups with low levels of formal education demonstrate the least knowledge of prevention of oral diseases. For example, 76 percent of those with more than 12 years of schooling know the preventive purpose of water fluoridation, compared with 61 percent of those with 12 years, and 36 percent of those with less than 12 years of school. Efforts to increase levels of knowledge about oral disease prevention are required to achieve national objectives for oral health.

Prevention of tobacco use during childhood and adolescence. Five steps to prevent the onset of smoking

BACKGROUND

Most tobacco users become addicted during childhood and adolescence. To reduce the prevalence of tobacco-related illnesses, more emphasis must be placed on preventing the onset of tobacco use. Physicians can play a major role.

METHODS

Based on a series of clinical trials, the National Cancer Institute (NCI) developed recommendations to help patients stop smoking. Behavioral and developmental research have identified factors that contribute to the onset of smoking. The American Academy of Pediatrics (AAP) has developed guidelines for health supervision from birth to adulthood, including engaging parents and children as partners in health care. The NCI recommendations, behavioral research results, and AAP guidelines were integrated to develop a strategy to prevent the onset of tobacco use.

RESULTS

The NCI proposes five steps to prevent tobacco use during childhood and adolescence. There are five physician activities, beginning with the letter A, including anticipatory guidance, ask, advise, assist, and arrange follow-up. Anticipatory guidance, the practice of counseling for potential problems, is a key part of health care for the young. The nature of these steps varies, depending on the child's age, developmental stage, and behavior, as well as smoking habits of family members.

CONCLUSION

Despite the long-term consequences of smoking, onset and addiction to tobacco use usually begins in childhood. Therefore, physicians who care for children have a major role in eliminating tobacco use by preventing its onset.

Knowledge, intent to use, and use of smokeless tobacco among sixth grade schoolchildren in six selected U.S. sites

Questionnaires on smokeless tobacco use were completed by 781 sixth grade students in 15 schools at six locations in the United States. The students were both American Indian-Alaska Native and non-American Indian-Alaska Native. The Indian and Alaska Native schoolchildren were experimenting with and regularly using smokeless tobacco at higher rates that non-Indian schoolchildren. At Indian Health Service sites, 28.1 percent of the children reported current use of smokeless tobacco, compared with 3.3 percent of the children elsewhere. For girls reporting smokeless tobacco experimentation, the comparison was 68.9 percent at Indian Health Service sites and 8.7 percent at non-Indian sites; for boys, it was 79.1 percent from the Indian sites and 35.4 percent from the non-Indian sites. For those students who had tried smokeless tobacco, more than half also reported having tried cigarettes. The majority of all sixth grade students surveyed were aware of the health risks of smokeless tobacco use in that it is an increased risk for cancer. Additional research is needed to determine appropriate interventions.

The clinician's role in preventing smoking initiation

Initiation of tobacco use begins primarily during childhood and adolescence, and physicians can play a major role in preventing the onset of tobacco use. The National Cancer Institute recommends that physicians incorporate the four A's in their practices--four activities that promote smoking cessation and prevention: ask, advise, assist, and arrange follow-up. Physicians who care for children should include a fifth A, anticipatory guidance. Anticipatory guidance is the practice of providing counsel regarding potential problems. By providing messages that are appropriate to the patient's age and developmental stage, physicians can intervene in early stages of tobacco use. As role models and leaders, physicians can also influence attitudes in the schools and community.

Psychosocial correlates of adolescent substance use: a review of current etiological constructs

This article reviews psychosocial correlates of adolescent substance use by focusing on the recent empirical literature. Using a tabular format, an attempt is made to provide a facile tool for referencing the literature. Examination of the literature reveals considerable diversity among explanations regarding the variance explained by many of the correlates studied. While the field strives toward a consistent theoretical base from which effective interventions may be developed, researchers must specify the nature of their study populations, designs, methodological approaches, and any issues of generalizability. Only in this way will inconsistencies in study findings be reconciled and progress toward culturally specific intervention techniques be furthered.

Women and smoking: current trends and issues for the 1990s

Despite significant change in smoking patterns among women during the 1980s, the toll in tobacco-related morbidity and mortality remains high and will continue to rise for some diseases (e.g., lung cancer). Women with lower educational attainment are at particularly high risk for smoking initiation and continuation. Advances in gender-specific knowledge regarding the processes of initiation, cessation, and relapse provide more specific opportunities for targeted intervention. Strategies for change involve media, clinical approaches, and public health efforts. Emphasis needs to be placed on tailoring the message and on utilizing innovative channels through which women can be effectively reached. Advocacy groups are targeting public policies affecting women. Ongoing gender-specific research is needed in the next decade.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

Attitudes and behaviors of dental hygienists concerning tobacco use

This study surveyed a proportionate random sample of licensed dental hygienists in five states and the District of Columbia, to assess their antitobacco use behaviors and attitudes. The response rate was 79.4 percent. Descriptive data as well as chi-square, analysis of variance (ANOVA), and Duncan's multiple range test statistical results were reported. Only 6.9 percent of the hygienists sampled currently smoked. These hygienists appeared to exhibit significantly different aggregate attitudes and select clinical practice behaviors than their nonsmoking counterparts. Years of employment and geographic location showed no significant relationship to aggregate clinical practice behaviors or attitudes, although each was related to individual behaviors and attitudes. Overall, dental hygienists appeared committed to involvement in both individualized and community-based antitobacco-use efforts. Measures to coordinate hygienists' involvement at both of these levels need to be enhanced.

The role of parents and older peers in school-based cardiovascular prevention programs: implications for program development

This article describes a set of studies which compare the effectiveness of innovative interventions led by older peers and which included a parent component with teacher-led interventions for nutrition, blood pressure, and smoking prevention. Information about the agreement between parents' and children's (grades six through eight) perception of the children's health behavior and family interaction was also found, by surveying parents and children in 1051 households. Both teacher-led and older peer-led interventions were successful in increasing behavioral capabilities for nutrition and blood pressure, measured one year after the interventions. Results of the parent-child survey showed reasonable agreement between parents and children for reports of the child's exercise, dieting, and fast food consumption, but poorer agreement for smoking and perceptions of family interaction. Results are discussed in relation to the planning of future programs designed to address the importance of peer and parental role models.

Smokeless tobacco use by youth in the U.S

Oral snuff and chewing tobacco, commonly referred to as smokeless tobacco, are being used by many adolescent and young adult males, and no indication exists that use by this group is declining. Users are at risk for oral cancer, noncancerous oral pathology such as leukoplakias, and addiction. Information about patterns of smokeless tobacco use and motivations of users may help planners develop and implement interventions. Variables include the importance of peer and family influences, social image, knowledge of harmful effects, regional differences, use of other substances, and addiction. Due to the addictive nature of smokeless tobacco, older youth may need cessation programs. Health educators are encouraged to include smokeless tobacco in their tobacco use prevention programs and to develop and implement comprehensive tobacco interventions appropriate for their youth population.

Smokeless tobacco use among Ontario students

The use of smokeless tobacco among adolescents has emerged as a public health concern. We report here estimates of use and characteristics of users among a probability sample of 4,267 Ontario (Canada) students aged thirteen to nineteen years. The results indicated that smokeless tobacco use was not common, varying from 1 percent to 3 percent depending upon age and gender, but was more likely to occur among smokers (10% to 32%). The group most prone to use was young smoking males.