Cigarette smoking attitudes and first use among third- through sixth-grade students: the Bogalusa Heart Study

Social and anxiety-like behaviors contribute to nicotine self-administration in adolescent outbred rats

Both emotional and social traits interact with genetic factors to influence smoking behavior. We previously established a socially acquired nicotine intravenous self-administration model where social learning of a nicotine-associated odor cue reversed conditioned flavor aversion and promoted nicotine intake. In this study, we first phenotyped ~800 adolescent heterogeneous stock rats in open field, novel object interaction, social interaction, elevated plus maze, and marble burying behaviors. These rats were then phenotyped on socially acquired nicotine self-administration. We found 243 significant correlations between different behavioral tests. Principal component regression analysis found that ~10-20% of the variance in nicotine-related measures, such as intake during the first or the last three fixed-ratio sessions, the progressive ratio session, and reinstatement behavior, can be explained by variations in behavioral traits. Factors corresponding to social behavior and anxiety were among the strongest predictors of nicotine intake and reinstatement of nicotine-seeking behavior. We also found many sex differences in behavioral measures. These data indicated that the genetic diversity of this population, in combination with social behaviour and anxiety, are significant contributors to the divergent nicotine self-administration behavior and indicated a high probability of discovering sex-specific genetic mechanisms for nicotine intake in future genome-wide association studies.

Effect of characteristics and life in cities in China on residents' smoking behaviour

Objective

This study aimed to identify the relationship between city-level economic development and smoking behaviour.

Methods

Using multilevel mixed-effects logistic methods, we examined the relationship between smoking/passive smoking and respondents’ lifestyles in the city.

Results

We found that respondents living in cities with higher per capita gross domestic product (GDP) were less likely to smoke than those living in cities with lower per capita GDP (odds ratio [OR] = 0.977, 95% confidence interval [CI]: 0.958–0.997). Further, respondents with higher levels of life satisfaction and subjective social status were less likely to smoke than those with lower levels of these variables (OR = 0.942, 95% CI: 0.893–0.994; OR = 0.955, 95% CI: 0.928–0.983, respectively). In terms of passive smoking, respondents with higher levels of subjective social status in their cities were less likely to smoke than those with lower levels (OR = 0.972, 95% CI: 0.948–0.996). Smoking and exposure to second-hand smoke were more common among those with lower socioeconomic status.

Conclusions

Smoking is one of the most serious public health hazards in China. People’s smoking behaviour is significantly related to characteristics of their cities and their socioeconomic status. Improved smoking-prevention measures are urgently required in China.

Environmental enrichment enhances conditioned place preference to ethanol via an oxytocinergic-dependent mechanism in male mice

Environmental conditions, such as stress and environmental enrichment (EE), influence predisposition to alcohol use/abuse; however, the underlying mechanisms remain unknown. To assess the effect of environmental conditions on the initial rewarding effects of alcohol, we examined conditioned place-preference (CPP) to alcohol following exposure to EE in mice. Since social context is a major factor contributing to initial alcohol-drinking, we also assessed the impact of EE on the levels of the "social neuropeptide" oxytocin (OT) and its receptor, OTR. Finally, we assessed the effect of pharmacological manipulations of the oxytocinergic system on EE-induced alcohol CPP. While EE increased sociability and reduced anxiety-like behaviors, it caused a ∼3.5-fold increase in alcohol reward compared to controls. EE triggered profound neuroadaptations of the oxytocinergic system; it increased hypothalamic OT levels and decreased OTR binding in the prefrontal cortex and olfactory nuclei of the brain. Repeated administration of the OT analogue carbetocin (6.4 mg/kg/day) mimicked the behavioral effects of EE on ethanol CPP and induced similar brain region-specific alterations of OTR binding as those observed following EE. Conversely, repeated administration of the OTR antagonist L,369-899 (5 mg/kg/day) during EE exposure, but not during the acquisition of alcohol CPP, reversed the pronounced EE-induced ethanol rewarding effect. These results demonstrate for the first time, a stimulatory effect of environmental enrichment exposure on alcohol reward via an oxytocinergic-dependent mechanism, which may predispose to alcohol abuse. This study offers a unique prospective on the neurobiological understanding of the initial stages of alcohol use/misuse driven by complex environmental-social interplay.

Social learning promotes nicotine self-administration by facilitating the extinction of conditioned aversion in isogenic strains of rats

Both social environment and genetic factors are critical for smoking initiation and nicotine addiction. We reported that rats developed conditioned flavor (i.e., taste and odor) aversion to intravenously self-administered (IVSA) nicotine, and that social learning promoted nicotine IVSA with flavor cues. We thus tested the hypothesis that socially acquired nicotine IVSA is a heritable trait by using female rats of six inbred strains and six F1 hybrids. Each strain was tested for 10 daily IVSA sessions. We found that the intake of nicotine (15 and 30 μg/kg/inf) varied among these strains by 33.7–56.6-fold. The heritability of nicotine intake was estimated to be 0.54–0.65. Further, there was a strong correlation in nicotine intake (R² = 0.85, p < 0.0001) between the two nicotine doses. Another cohort of rats was given three daily IVSA sessions followed by five sessions that tested conditioned flavor aversion. Nicotine intake was highly correlated with the extinction of the conditioned aversion (R² = 0.58, p < 0.005). These data showed that nicotine intake in the socially acquired nicotine self-administration model is controlled by genetic factors and that the role of social learning is likely in facilitating the extinction of conditioned aversive response to nicotine.

Oxytocin attenuates aversive response to nicotine and anxiety-like behavior in adolescent rats

Initial tobacco use is initiated with rewarding and aversive properties of nicotine and aversive response to nicotine plays a critical role in nicotine dependency. Decrease of nicotine aversion increases the nicotine use that causes behavioral and neuronal changes of animals. Oxytocin influences drug abuse and reciprocally affect vulnerability to drug use. To assess the effect of oxytocin on initial nicotine aversion and anxiety, we examined voluntary oral nicotine intake and anxiety-like behavior following oxytocin treatment in adolescent rats. Sprague-Dawley male rats (4 weeks old) were used. For oxytocin administration, rats were injected subcutaneously with saline or oxytocin (0.01, 0.1 and 1mg/kg) according to the assigned groups. Voluntary oral nicotine consumption test was performed by two bottle free-choice paradigm. To examine anxiety-like behavior in rats, we performed a light/dark box test. Oxytocin not only significantly increased the nicotine intake but also alleviated nicotine aversion after acclimation to nicotine solution in a concentration dependent manner. Meanwhile, oxytocin significantly reduced anxiety-like behavior. We suggest that oxytocin itself mitigates aversive response toward initial nicotine intake and anxiety-like behavior. These results widen the psychophysiological perspective on oxytocin for better understanding of nicotine addiction related behaviors influenced by diverse social factors.

Adolescent Alcohol, Tobacco, and Marijuana Use: The Influence of Neighborhood Disorder and Hope

Purpose.

To investigate relationships between adolescents' current alcohol, tobacco, and marijuana use; perceptions of neighborhood disorder; and sense of hope.

Design.

Questionnaires were administered to a nonrandom sample of middle school students during the spring of 1999.

Subjects.

The ethnically and geographically diverse sample (n = 369), from a range of low socioeconomic status backgrounds, was considered to be at high risk for alcohol, tobacco, and other drug use because of previous enrollment in low socioeconomic status elementary schools.

Measures.

Alcohol, tobacco, and marijuana use were dichotomized into current and never/no use. Six variables described neighborhood social disorder. Sense of hope was assessed using the Children's Hope Scale.

Results.

Statistically significant relationships were found between perceived neighborhood disorder and current alcohol (p = .01), tobacco (p = .001), and marijuana (p < .001) use. A statistically significant and independent relationship was found between sense of hope and current alcohol (p = .02), tobacco (p = .02), and marijuana (p = .06) use. Results indicated linear trends in participants' increased use of alcohol, tobacco, and marijuana and (1) perception of higher neighborhood disorder and (2) lower sense of hope.

Conclusion.

Substance use prevention programs for youth might usefully be directed not only to agdolescents but also to the neighborhoods in which they live. Additionally, it would be important to emphasize creating safer neighborhood environments that support the development of a stronger sense of hope for the future.

Socially acquired nicotine self-administration with an aversive flavor cue in adolescent female rats

RATIONALE

Establishing a behavioral model for the effect of social environment on nicotine intake in rodents facilitates the investigation of molecular mechanisms critical for the interaction between social environment and cigarette smoking.

OBJECTIVES

Our main objective was to test the hypothesis that nicotine is the primary reinforcer in the socially acquired nicotine intravenous self-administration (IVSA) model by using an aversive flavor cue.

METHODS

Adolescent female rats were placed in operant conditioning chambers equipped with two lickometers. Operant licking triggered concurrent deliveries of a flavor (i.e., taste and odor) cue containing either quinine or saccharin and an i.v. infusion (30 μg/kg nicotine or saline). An audiovisual cue was provided for some groups of rats. A second rat that did not receive nicotine was placed in the operant conditioning chambers to provide either a neutral or an inducing (i.e., by consuming the flavored solution) social environment. These two rats were separated by a divider that allowed orofacial interactions.

RESULTS

Rats acquired stable nicotine IVSA with either the aversive or the appetitive flavor cue in the inducing social environment, and obtained similar amounts of infusions. The neutral social environment did not support nicotine IVSA with either cue. The audiovisual cue per se did not support nicotine IVSA but enhanced nicotine intake. Nicotine increased the number of concurrent nose pokes by the two rats into the center divider, a measure of social interaction.

CONCLUSIONS

Despite its aversive effects, nicotine is the primary reinforcer for the operant responses in the socially acquired nicotine IVSA model.

Carbon disulfide mediates socially-acquired nicotine self-administration

The social environment plays a critical role in smoking initiation as well as relapse. We previously reported that rats acquired nicotine self-administration with an olfactogustatory cue only when another rat consuming the same cue was present during self-administration. Because carbon disulfide (CS₂) mediates social learning of food preference in rodents, we hypothesized that socially acquired nicotine self-administration is also mediated by CS₂. We tested this hypothesis by placing female adolescent Sprague-Dawley rats in operant chambers equipped with two lickometers. Licking on the active spout meeting a fixed-ratio 10 schedule triggered the concurrent delivery of an i.v. infusion (saline, or 30 µg/kg nicotine, free base) and an appetitive olfactogustatory cue containing CS₂ (0–500 ppm). Rats that self-administered nicotine with the olfactogustatory cue alone licked less on the active spout than on the inactive spout. Adding CS₂ to the olfactogustatory cue reversed the preference for the spouts. The group that received 500 ppm CS₂ and the olfactogustatory cue obtained a significantly greater number of nicotine infusions than other groups. After extinction training, the original self-administration context reinstated nicotine-seeking behavior in all nicotine groups. In addition, in rats that received the olfactogustatory cue and 500 ppm CS₂ during SA, a social environment where the nicotine-associated olfactory cue is present, induced much stronger drug-seeking behavior compared to a social environment lacking the olfactogustatory cue. These data established that CS₂ is a critical signal that mediates social learning of nicotine self-administration with olfactogustatory cues in rodents. Additionally, these data showed that the social context can further enhance the drug-seeking behavior induced by the drug-taking environment.

Propensity for social interaction predicts nicotine-reinforced behaviors in outbred rats

Social and genetic factors can influence smoking behavior. Using olfactogustatory stimuli as the sensory cue for intravenous nicotine self-administration (SA), we previously showed that social learning of nicotine contingent odor cue prevented rats from developing conditioned taste aversion and allowed them to instead establish stable nicotine SA. We hypothesized that genetic factors influenced socially acquired nicotine SA. A heterogeneous stock (HS; N/NIH) of outbred rats was trained to self-administer nicotine using the social learning protocol. Both male and female HS rats acquired nicotine SA, but females self-administered more nicotine than males. After extinction, the context previously paired with nicotine SA, in conjunction with socially transmitted drug cues, was sufficient to cause reinstatement of drug-seeking behavior. Wide variation in both nicotine intake and reinstatement was observed. Using multiple regression analysis, we found that measures of social interaction were significant predictors of nicotine intake and reinstatement of drug seeking in both males and females. Furthermore, measures of depression were predictors of nicotine intake in both males and females, anxiety was a predictor only in males and response to novelty was a predictor only in females. In males, measures of both depression and anxiety predicted nicotine reinstatement. Together, these data supported the ideas that genetically determined propensities for emotional and social phenotypes are significant determinants for nicotine-reinforced behavior, and that the HS rat is a suitable tool for dissecting genetic mechanisms that may underlie the interaction between social behavior, anxiety, depression and smoking.

Predicting and understanding undergraduate students' intentions to gamble in a casino using an extended model of the theory of reasoned action and the theory of planned behavior

Given that current television programming contains numerous gambling portrayals, it is imperative to understand whether and to what extent these gambling behaviors in media influence individuals' beliefs, attitudes, and intentions. This study explores an extended model of the theory of reasoned action (TRA) by including gambling media exposure as a distal, mediating and mediated factor in predicting undergraduate students' intentions to gamble in a casino. Findings show that the extended model of TRA clearly indicates that the constructs of gambling media exposure, prior gambling experience, and level of gambling addiction contribute to the prediction of undergraduate students' casino gambling intentions. Theoretical implications of gambling media effects and practical implications for public policy are discussed, and future research directions are outlined.

Social interaction promotes nicotine self-administration with olfactogustatory cues in adolescent rats

Cigarette smoking is a social behavior. Smoking is also accompanied by distinctive gustatory and olfactory stimulation. However, none of these factors affecting nicotine intake are modeled in existing preclinical studies. We report a novel model of adolescent nicotine self-administration (SA) in rats where licking on drinking spouts was used as the operant behavior to activate the concurrent delivery of nicotine (i.v.) and an appetitive olfactogustatory (OG) cue, and social interaction was required for stable SA. The operant chamber was divided by a panel that separated the SA rat and another rat serving as the demonstrator, who had free access to the OG cue but did not receive nicotine. Orofacial contacts were permitted by the divider. Conditioned taste aversion prevented solo rats to self-administer nicotine. However, stable nicotine (15-30 μg/kg, free base) SA was established in the presence of demonstrator rats with free access to the OG cue. Omitting the olfactory component of the cue prevented the acquisition of nicotine SA. Mecamylamine, a nicotinic antagonist, reduced licking behavior. Familiar peers were more effective demonstrators in facilitating the acquisition of nicotine SA than were unfamiliar rats. No sex difference in nicotine intake was found. These data indicate that the contingent OG cue is associated with the aversive property of nicotine that prevents subsequent drug intake. Social information encoded in olfaction not only permits the establishment of stable nicotine SA but also enhances nicotine intake. These findings implicate adolescent social interactions in promoting smoking behavior by surmounting the aversive property of nicotine.

Risk factors for elementary school drinking: pubertal status, personality, and alcohol expectancies concurrently predict fifth grade alcohol consumption

Little is known about the correlates and potential causes of very early drinking. The authors proposed this risk theory: (a) pubertal onset is associated with increased levels of positive urgency (the tendency to act rashly when experiencing intensely positive mood), negative urgency (the tendency to act rashly when distressed), and sensation seeking; (b) those traits predict increased endorsement of high-risk alcohol expectancies; (c) the expectancies predict drinker status among fifth graders; and (d) the apparent influence of positive urgency, negative urgency, and sensation seeking on drinker status is mediated by alcohol expectancies. The authors conducted a concurrent test of whether the relationships among these variables were consistent with the theory in a sample of 1,843 fifth grade students. In a well-fitting structural model, their hypotheses were supported. Drinker status among fifth graders is not just a function of context and factors external to children: it is predictable from a combination of pubertal status, personality characteristics, and learned alcohol expectancies.

Cardiovascular disease risk in adolescent smokers: evidence of a 'smoker lifestyle'

This study assessed the prevalence of traditional cardiovascular disease risk factors in 119 adolescent smokers, compared to an age-matched sample of non-smokers. Participants were assessed for body mass index (BMI), relative body fat, systolic/diastolic/mean arterial blood pressure, total serum cholesterol, aerobic fitness, family (parents or siblings) smoking habits and history of cardiovascular disease. The results showed that BMI and relative body fat were significantly increased, while aerobic fitness was significantly decreased in smokers. Male smokers further demonstrated increased diastolic blood pressure and mean arterial pressure. Smokers also showed increased prevalence for family smoking habits and cardiovascular disease history. Prevalence rates for all other cardiovascular disease risk factors were increased in smokers, but the differences between groups did not reach statistical significance. It is concluded that the studied adolescent smokers demonstrated a higher risk for developing cardiovascular disease later in life, compared to their non-smoking counterparts.

Neighborhood residence and cigarette smoking among urban youths: the protective role of prosocial activities

OBJECTIVES

We examined the association between neighborhood characteristics and cigarette use among adolescents and explored the protective effects of participation in prosocial activities to better understand strengths in adolescents' lives and help identify protective factors for the prevention of adolescent smoking.

METHODS

We interviewed ninth graders who had grade point averages of 3.0 or lower and who were not developmentally disabled. Participants' addresses were geocoded so that interview data could be linked to 1990 US census data on neighborhood characteristics.

RESULTS

Neighborhood disadvantage and the percentage of Black residents in a neighborhood had different effects on cigarette smoking among Black and White adolescents. Living in a neighborhood with a high percentage of Black residents had favorable effects for Blacks but not for Whites. For both groups, a low percentage of Black residents was a risk factor for cigarette use, and risk effects were higher in the more disadvantaged neighborhoods. Involvement in prosocial activities moderated neighborhood risks.

CONCLUSIONS

Neighborhood effects on adolescent cigarette use were contingent upon both contextual and individual characteristics. Participation in prosocial activities had a protective effect among adolescents in high-risk neighborhoods. Engaging adolescents in such activities may help offset the adverse effects of living in a disadvantaged neighborhood.

Differences between Black and White elementary school children's orientations toward alcohol and cocaine: a three-study comparison

To trace the origins of race differences in substance use, this study examined differences between Black and White elementary school children's knowledge of alcohol and cocaine, beliefs about their short- and long-term effects, and attitudes toward and intentions to use them across three independent samples (N = 181, N = 287, N = 234). Black children were more negatively oriented toward alcohol and cocaine than White children from an early age. Most notably, in all samples Black children had less positive attitudes toward adult alcohol use and lower intentions to use alcohol. Black children were also more likely to attribute negative long-term health and social effects to alcohol and cocaine use, but there were few significant race differences in knowledge or in expectancies regarding short-term effects of use. Since race differences in beliefs, exposure to alcohol, and socioeconomic factors could not explain race differences in attitudes toward substance use, other cultural differences must be considered.

Survey of smoking attitudes in grade school children in Greece: a preliminary study

AIMS

Tobacco use among children and adolescents is a major public health concern. Past literature has indicated that smoking attitudes are reliable predictors of teen smoking. The present study explored the smoking attitudes of 4th-6th grade Greek pupils.

METHODS

Data were obtained from 379 Greek elementary school students who completed a smoking attitudes survey, based on the Bogalusa Heart Study.

FINDINGS AND CONCLUSIONS

Analysis of variance indicated that 4th graders expressed significantly more positive attitudes towards tobacco use in three statements related to the psychological consequences of cigarette use, and to peer pressures to smoke. No gender differences were evident. Overall, pupils across grades expressed relatively negative attitudes towards smoking. Differences between school grades in certain statements denoting the psychological properties of tobacco use, and in peer pressures were attributed to 4th graders' lack of knowledge in the particular areas.

Peer influences on adolescent cigarette smoking: a theoretical review of the literature

This article reviews several classes of theories to elucidate the relationship between adolescent cigarette smoking and friends' cigarette smoking. Perceived influence theories hinge upon an adolescent's perception of friends' smoking behavior. External influence theories are those in which friends' smoking behavior overtly influences adolescent smoking. Group level theories examine how differences at the level of subculture, gender, and race/ethnicity influence the relationship under study. Network theories are also discussed. A model integrating relevant theories into a longitudinal model representing friend influences on adolescent smoking is presented, along with implications of the results presented for adolescent tobacco prevention programs.

Formative development of an intervention to stop family tobacco use: the Parents and Children Talking (PACT) intervention

Intervening with families is a promising strategy for addressing the continuing problem of adult and youth tobacco use. A four-step formative process was used to develop an innovative self-directed family-based intervention: (1) planning and strategy development through structured telephone interviews, a focus group, and a literature review; (2) development and pretesting of concepts, messages, and materials by using feedback from children and adults on prototypic materials; (3) implementing the program by mailing 6 modules to 50 families (composed of at least one adult smoker and a 9-12-year-old) with overall high levels of engagement; and (4) assessing effectiveness and making refinements by measuring the intervention effect on smoking-related communication, skills, and attitudes. Inconsistent intervention effects related to the difficulty of cessation and the influence of parental smoking suggested needed refinements. Engaging smokers willing to make a quit attempt during the intervention time frame may augment children's appreciation for the difficulty of cessation. Content related to stress management may need greater emphasis. Enhancing the personal context in which the influence of parental behavior is conveyed may be needed. Although the family context offers the opportunity to address the parent-child reciprocal nature of tobacco use, it requires sensitivity to the challenges of addressing this topic.

Role of parents and peers in influencing the smoking status of high school students in Taiwan

OBJECTIVES

To assess parental influence on smoking behaviour by high school students in an Asian culture and to compare the relative importance of parental and peer influence.

METHODS

A 5% nationally representative sample, including 44 976 high school students in 10th to 12th grade (aged 15-18 years) in Taiwan, were surveyed in 1995. Each completed a long self administered questionnaire. Parental influence was measured by examining both parental behaviour (smoking status) and attitudes (perceived "tender loving care" (TLC) by adolescents). Changes in smoking status were used to determine peer influence, defined as the increase in the likelihood of smoking from grade 10 to 12 in a steady state environment. Odds ratios (ORs) were calculated for parental and peer influence, using logistic regression.

RESULTS

Adolescents of smoking parents with low TLC had the highest smoking rates and those of non-smoking parents with high TLC had the lowest. The difference was more than twofold in boys and more than fourfold in girls. When either parental smoking status or TLC alone was considered, parental influence was similar to peer influence in boys, but larger than peer influence in girls. However, when smoking status and TLC were considered jointly, it became larger than peer influence for both groups (OR 2.8 v 1.8 for boys and OR 3.9 v 1.3 for girls).

CONCLUSION

When parental influence is taken as parental behaviour and attitude together, it plays a more important role than peer influence in smoking among high school students in Taiwan. This study, characterising such relationships among Asian populations for the first time, implies that future prevention programmes should direct more efforts toward the parental smoking and parent-child relationships, and not aim exclusively at adolescents in schools.

Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior

The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.

Profiles of the adolescent smoker: models of tobacco use among 9th grade high school students: Acadiana Coalition of Teens against Tobacco (ACTT)

BACKGROUND

Tobacco use, underreported among Louisiana youth, was examined among 9th grade students in south central Louisiana; profiles of tobacco use were developed to inform adolescent tobacco control programs.

METHODS

Cross-sectional Health Habits Survey was administered to 4,808 students who were about 15 years old, predominantly white, with gender almost evenly distributed. Saliva samples were collected from 1,966 students. Analysis of a subsample resulted in good concordance between self-reported daily tobacco use and cotinine.

RESULTS

About 58% of students ever smoked a cigarette, 25% had a cigarette within the previous 30 days, 17% smoked within the past 7 days and almost 8% reported smokeless tobacco use. Smokeless tobacco use was greater for males than females. Caucasians, native Americans, and Latinos were more likely to smoke than African-Americans. Social relationships associated with adolescent smoking included having a friend, parent and/or sibling who smoked, having a friend who consumed alcohol, and being around people who used alcohol for "kicks." The attitudes of nonsmokers were consistently in the positive direction relative to disapproval of tobacco and alcohol use. The profiles differed demographically between black and white students.

CONCLUSIONS

These data provide the needed information for guiding health promotion and tobacco control efforts, specifically regarding black/white differences.

Differential contribution of parents and friends to smoking trajectories during adolescence

The purpose of this study was to assess the relative contribution of friends' and parents' smoking on the age of smoking initiation. A sample of 812 preadolescents, who were part of an accelerated longitudinal design, participated in the study over a 4-year period. Three smoking trajectory groups were first established: an age 11-12 starters group (5.7% of the sample), an age 12-13 starters group (11.1% of the sample), and an age 13-14 starters group (7.9% of the sample). A fourth trajectory group included the children who had not started smoking by age 15 years and who represented the majority of the participants (75.4%). After controlling for parental education, gender, and participants' behavioral and academic maladjustment, a series of logistic regressions revealed that parents' smoking assessed during the same year predicted membership in the age 11-12 starters trajectory group. Both parents' and friends' smoking predicted membership in the age 12-13 starters group. Finally, only friends' smoking predicted membership in the age 13-14 starters group. The results are discussed in light of the controversy about the contribution of parents' and friends' smoking behavior to smoking initiation in adolescents.

Prevalence and correlates of initiation of smoking behavior among preteen black and white children

This study estimated smoking prevalence and identified factors associated with initiation among preteens in Nashville, TN. An anonymous, self-administrated questionnaire was given to 238 fifth- and sixth-graders in a middle-class neighborhood school. The mean age at initiation was 8.5 years (range 6-11 years). Overall, 10.5% of students had ever smoked; 16.1% of blacks and 9.3% of whites. Eighty-six percent continued to smoke. Black sixth-graders smoked (26.9%) four times the rate of black fifth-graders and 2.5 times that of white sixth-graders. Relatives initiated 78% of blacks while friends initiated 68% of whites. One-quarter of smokers got their cigarettes at home. Regular attendees of religious services had a lower smoking rate (6.9% versus 16.4%; p=0.01). Smoking rates decreased with increased knowledge of risks (p=0.00001). Among smokers, none believed that smoking is a risk factor for heart disease, 96% did not believe that smoking has any short-term health effects or is a risk factor for stroke. Few ever-smokers had a complete understanding of the health risks. Targeted messages and curriculum should be developed to teach preteens about the short- and long-term dangers of smoking. Clinicians can play a major role in educating their clients about the risks of smoking.

Teachable moments for promoting smoking cessation: the context of cancer care and survivorship

BACKGROUND

There has been a call for comprehensive cancer care that gives greater consideration to changing lifestyle risk factors such as smoking to improve prognosis and long-term health. Cancer diagnosis, treatment, and survivorship offer challenges and opportunities ("teachable moments") to promote smoking cessation.

METHODS

This review provides a rationale for the importance of smoking cessation programs in the cancer context, highlights practice guidelines for the delivery of these interventions, summarizes the challenges to smoking cessation unique to cancer patients, and recommends approaches to capitalize on the cancer context to promote smoking cessation.

RESULTS

Barriers to smoking cessation by patients with cancer include heavy nicotine dependence, urgency of cessation, fatalistic attitudes about cessation benefits, cancer-related psychological distress, treatment factors, and the presence of smokers in the social network. Opportunities to promote cessation include the transition from inpatient to outpatient care, involvement in cancer patient care by family members who smoke, and distribution of clinical feedback (eg, test results).

CONCLUSIONS

Teachable moments in the cancer context are not being fully utilized to promote smoking cessation. Evidence-based guidelines can assist cancer care teams in promoting cessation.

Smoking, exercise and dietary behaviors among mothers of elementary school-aged children in a rural North Carolina county

Tobacco use, poor diet, and physical inactivity are risk behaviors established during childhood and influenced by parents. Improving health habits of rural families poses particular challenges because resources may be limited in number and reach. To characterize the kinds of prevention programs needed by rural families, 501 surveys were mailed to caregivers of elementary school children living in a rural North Carolina county. Health behaviors, related attitudes, and demographic characteristics were assessed. Risk behaviors were defined as eating less than 5 fruits and vegetables a day, exercising less than 20 minutes 3 times a week, and being a smoker. Two hundred and sixty-one adults (55%) completed the surveys. Two hundred and forty-four (93%) were female, with a mean age of 37 years, 55% had a high school or less education, 89% reported at least one risk behavior, and 57% reported 2 or more risk behaviors. Female caregivers with multiple risk behaviors had lower educational levels (p < 0.007) and placed less importance on children's health behaviors (p < 0.009) than other caregivers. Female caregivers with multiple risk behaviors were no less confident they could change their behavior than those with only one risk behavior. The majority of female caregivers of elementary school children in this rural population engaged in and modeled multiple health risk behaviors for their children. Health promotion activities that address multiple risk factors and involve children are needed by young families in rural communities.

Smoking habits and attitudes towards smoking among university students in Jordan

The aim of this study was to estimate the prevalence of smoking and to describe the habits, attitudes, and practices related to smoking among students of Jordan University of Science and Technology (JUST), Irbid, Jordan. Students (n = 650) were recruited in randomly selected, cluster samples drawn from the medical and engineering colleges of JUST. They were made familiar with a modified Arabic version of the World Health Organisation Smoking Questionnaire and the Attitudes towards Smoking Questionnaire to study their habits, attitudes, and beliefs in relation to smoking. The study revealed that the prevalence of smoking was 28.6% (50.2% among males and 6.5% among females). Friends, not family, were the main source of the first smoking, and this most often occurred after 15 years of age (82.3%). Males preferred smoking in the cafeteria, females in the bathroom. The main advantage of smoking for males was calming down, while for females it was independence. Non-smokers chose not to smoke because of health and hatred of the habit. The non-smokers had more positive attitudes against smoking and were more aware of the adverse effects of smoking. The reasons smokers gave for starting smoking were pleasure, followed by stress and curiosity. Two-thirds of smokers intended to quit smoking in the future. Some smokers disagreed with some criticisms against smoking, and reasons why they did not want to quit included social attitudes, addiction, and not knowing how to quit. Results of this study may provide baseline data to develop an anti-smoking program in the university and encourage policy makers to limit smoking in the university by strengthening the policies against smoking.

Smoking addiction among university students in Istanbul

In this study, we investigated smoking addiction and some risk factors among university students in Istanbul. A questionnaire survey of 236 university students studying in Istanbul Medical Faculty (n: 148) and other faculties (n: 88) was performed with cross-sectional and responding-under-observation methods in March-May 1999. Thirty-six per cent of the university students with mean age 24.0 (2.9 were addicted to smoking (n: 85): 41.3% males and 26.7% females; 67.5% were using imported and 32.5% were using local product cigarettes. Of the subjects, 18.1% were smoking 1-10 cigarettes a day, 61.4% 11-20 cigarettes a day and 20.5% more than 20 cigarettes a day. When alcohol and smoking addiction were compared with logistic regression analysis, with respect to gender, age, school, parents' educational levels, living style and the sources of income, the risk factor for alcohol addicts was found to be more 2.54 times than smoking addicts (OR = 2.54, 95% CI = 1.38-4.67; p = 0.003). The study has emphasized the association of alcohol and smoking addiction in university students and the prevalence of smoking addiction among adolescent females.

Socioeconomic differences in children's health: how and why do these relationships change with age?

The effects of socioeconomic status (SES) on health are well documented in adulthood, but far less is known about its effects in childhood. The authors reviewed the literature and found support for a childhood SES effect, whereby each decrease in SES was associated with an increased health risk. The authors explored how this relationship changed as children underwent normal developmental changes and proposed 3 models to describe the temporal patterns. The authors found that a model's capacity to explain SES-health relationships varied across health outcomes. Childhood injury showed stronger relationships with SES at younger ages, whereas smoking showed stronger relationships with SES in adolescence. Finally, the authors proposed a developmental approach to exploring mechanisms that link SES and child health.

Determinants of youth smoking--evidence from Turkey

This paper investigates the determinants of smoking among middle- and high-school students in Ankara, Turkey. Data were collected from 4800 students in the second semester of the 1997-98 academic year to investigate substance use prevalence among young people. In addition to classical independent variables, factors which are not frequently used in the literature--such as school type, neighborhood, family religiosity, and factors reflecting the cultural background of the students--are included in the analysis. The results of binomial logistic regression offer evidence for the effects of school type, a smoking-related attitude, presence of a stepmother, father's use of alcohol, sister and brother who smoke, student's alcohol use, and participation in art activities.

Attitudes toward smoking and family-based health promotion among rural mothers and other primary caregivers who smoke

The family milieu provides a potential context for integrating smoking cessation and prevention activities to complement school-based efforts. In this study, surveys were mailed to caregivers of elementary school children to assess demographics, smoking characteristics and attitudes, and receptivity to and preferred format for health promotion programs. Fifty-three percent (n = 276) of 501 caregivers responded. Among smokers, most did not want their children to smoke, and they wanted to quit themselves; 91% considered it important to involve their children in their smoking cessation attempts; and 70% expressed willingness to participate in health promotion for the entire family. Written materials either mailed home or brought home from school were the preferred program formats. These findings suggest the feasibility of a program in which adults and children work together at home on smoking cessation and prevention activities that might increase the effectiveness of school-based smoking prevention messages.

Area-level characteristics and smoking in women

OBJECTIVES

This study examined whether area-level characteristics are associated with individual smoking behavior among women.

METHODS

Analyses included 648 women enrolled as control patients in the Carolina Breast Cancer Study (1993-1996). Smoking and covariate information was obtained from interviews. Area-level characteristics included census block-group education level, poverty, unemployment, car-home ownership, crowding, and, for 431 women, city-level crime rates.

RESULTS

In multivariate logistic regression models, no area characteristics were clearly associated with a history of smoking. Among those who had ever smoked, continued smoking was associated with living in low-education areas (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.0, 2.9), high-unemployment areas (OR = 1.7, 95% CI = 1.0, 2.8), and high-crime areas (OR = 1.6, 95% CI = 0.8, 3.2).

CONCLUSIONS

The present findings are consistent with a growing literature suggesting that area-level social and economic disadvantage influences individual smoking behavior.

[Prevalence of smoking habits of Upper Austria students of the 7th and 8th grade and effect of smoking habits of family and peers]

The aim of the study was to explore the prevalence of different smoking habits in a population of Austrian pupils, 12 to 15 years old, and the relationship of familial and peer group smoking customs with these habits. In 1997 a population-based survey (International Study of Asthma and Allergies in Childhood, ISAAC) was conducted of all 7th and 8th grade school children of a district of Upper Austria. Information on the smoking habits of the adolescents, the family members, and of the peer as well as smoking habits of the teacher, gender, and age of the children was collected. The overall-prevalence of having ever smoked in this population is 57.8%. The percentage of eversmokers among the 12-year-olds is 50%. This amount increases to 63.8% among the 14- to 15-year-olds. The odds ratios for smoking daily is highest among those whose best friend smokes (OR: 70.63, CI: 9.19, 542.40). The risk of daily smoking increases also if the siblings of the juvenile (OR: 4.71, CI: 1.15, 19.35) or the mother (OR: 4.95, CI: 1.67, 14.70) smoke. If the father smokes the risk to smoke monthly is increased (OR: 2.09, CI: 1.28, 3.40). These results point to the fact that smoking prevention programes should take into account the influence of peers and family of the adolescents.

Tobacco use among high school students in Buenos Aires, Argentina

OBJECTIVES

This study assessed the prevalence and correlates of tobacco use among high school students in Buenos Aires, Argentina.

METHODS

Anonymous, self-administered questionnaires were given to 3909 8th and 11th graders in a stratified random sample of 49 public and private schools. The instrument included items from American surveys, translated and validated among Argentinean teens. Multiple logistic regression analysis was used to estimate possible effects on smoking behavior of environment, students' personal characteristics, and their knowledge, beliefs, and attitudes regarding smoking.

RESULTS

Of 8th and 11th graders, 20% and 43%, respectively, were classified as current smokers. Overall, 29% of males and 32% of females were current smokers. Students attending public schools were more likely to smoke than those in private schools (P < .05). Current smoking was associated with having a best friend who smokes, reporting that more than 50% of friends of the same sex smoke, having positive attitudes and beliefs toward smoking, and having a positive intention to smoke within the next year (all P < .001).

CONCLUSIONS

Over 20% of the 8th graders in our sample were current smokers; prevention efforts must therefore start early.

Women and smoking in Hollywood movies: a content analysis

OBJECTIVES

We analyzed the portrayal of smoking in Hollywood films starring 10 popular actressess.

METHODS

Five movies were randomly sampled for each actress, for a total of 96 hours of film footage that was analyzed in 1116 5-minute intervals.

RESULTS

Leading female actors were as likely to smoke in movies aimed at juvenile audiences (PG/PG-13) as in R-rated movies, whereas male actors were 2.5 times more likely to smoke in R-rated movies. PG/PG-13-rated movies were less likely than R-rated movies to contain negative messages about smoking.

CONCLUSIONS

Smoking is highly prevalent in Hollywood films featuring popular actressess and may influence young audiences for whom movie stars serve as role models.

Adolescents' use of tobacco, health locus of control, and self-monitoring

This study examined the association of the traits, health locus of control, and self-monitoring with adolescents' tobacco uptake. Participants were 112 rural adolescents (12 to 19 years old, M = 15.3). Of that sample, 33% used tobacco. Tobacco users were found to score lower on the dimension of Internality and higher on the dimension of Chance, as compared with nonusers of tobacco, indicating a more external Health Locus of Control. In addition, tobacco users were lower self-monitors than were nonusers. These results suggest that adolescents who use tobacco feel less in control of their lives in relation to nonusers, believe that chance plays a larger role in their health, and believe they may be unable to monitor and adapt their communication to achieve positive outcomes.

Substance use in high school students in New South Wales, Australia, in relation to language spoken at home

PURPOSE

To examine for the first time adolescent substance use by ethnicity, given the high proportion of migrants from non-English-speaking countries in New South Wales, (NSW), Australia.

METHODS

Data from four surveys of NSW secondary school students in 1983, 1986, 1989, and 1992 were used for this analysis. The prevalence of substance use by whether English was spoken at home was stratified by sex and age using data from the most recent survey year. Adjusted odds ratios and 95% confidence intervals were produced by simultaneous logistic regression, adjusting for sex, age group, and the interaction term of sex and age for each of these substances, and for each survey year separately. Data from 1989 and 1992 were pooled together to examine rates of substance use by ethnic subgroups which reflect migration patterns.

RESULTS

The prevalence of smoking and alcohol and illicit drug use was consistently lower among NSW adolescents speaking a language other than English at home, compared with those speaking English at home in all survey years. Only the prevalence of solvent sniffing was higher among younger adolescents speaking a language other than English at home. Students from Southeast Asia showed consistently lower rates of usage of all substances compared to all other groups.

CONCLUSIONS

There may be different opportunities for the prevention of adolescent substance use among native English speakers to be gained from non-English-speaking cultures.

Teenage smoking in China

China's production and consumption of cigarettes have ranked first in the world. One of every three cigarettes manufactured in the world is consumed in China. Three of every five Chinese smokers begin smoking at the age of 15-20 years. Teenage smoking is increasingly becoming a problem in modern China. At least 50 million of the children now living in China will be killed by smoking. Therefore China's top priority in control of smoking is to educate the youth against smoking so as to prevent them from starting and reduce the overall number of new smokers. Adults smoke; children follow. Thus a major feature of China's smoking control efforts has been the mobilization of primary school children to advise their parents to stop smoking. The goal of the Chinese Association on Smoking and Health is to achieve a male (age 15+) smoking rate below 58% and a female (age 15+) smoking rate below 5% by the year 2000. Although the number of smoke-free schools is on the increase and many more teenagers are quitting, China still has a long way to go.

Which adults do underaged youth ask for cigarettes?

OBJECTIVES

This study identified adults' demographic and smoking behavior characteristics that are related to being asked to provide tobacco to a minor.

METHODS

Telephone interviews were conducted with 6352 California adults. Predictors included age, sex, household income, and smoking status.

RESULTS

Only 10.1% of California adults had been asked to provide tobacco to a minor in the previous year. Fewer than 3% of individuals 55 years and older had been asked to provide tobacco, but among younger smokers 59.0% of 18- and 19-year-olds and 39.3% of 20- to 24-year-olds had been approached.

CONCLUSIONS

Interventions to reduce the social availability of tobacco are needed.

Prevalence and correlates of early smoking among elementary schoolchildren in multiethnic, low-income inner-city neighborhoods

PURPOSE

The prevalence and correlates of early smoking were investigated among schoolchildren in grades 4-6 living in multiethnic, low-income neighborhoods in Montreal.

METHODS

As part of the evaluation of a school-based heart health promotion program, baseline data on the prevalence of early smoking were collected from 2285 students aged 9-13 years in 24 inner-city elementary schools during May-June 1993.

RESULTS

Overall, 28.7% of boys and 20.3% of girls had smoked. Girls began trying later than boys, but by age 13 the prevalence of experimental or regular smoking by girls overtook that of boys. Univariately, ever smoking varied considerably by family origin, from 2.1% among Vietnamese girls, to 35.8% among Portuguese boys. In multivariate analysis, age, perceived smoking habits of friends, and smoking by family members, were strong correlates of smoking. Being of Asian family origin was negatively associated with smoking. None of the indicators of social class were significantly associated with ever smoking.

CONCLUSIONS

Smoking prevention should begin with children even younger than age 9 in multiethnic, low-income, inner-city neighborhoods. With the exception of a lower prevalence of smoking among Asian children, ethnicity and social class were not strong influences on early smoking behavior in this population.