Cigarette smoking and its risk factors among elementary school students in Beijing

Epidemiology of substance use in adolescence: prevalence, trends and policy implications

This paper reviews the epidemiology of substance use among adolescents. There is a public health imperative in all countries to assess the population rates of tobacco, alcohol and illicit drug use among adolescents. In addition, monitoring trends over time may reflect the net effects of activities and programs carried out to prevent adolescent substance use. School based surveys provide prevalence estimates of substance use, but do not capture street and homeless youth and other high risk adolescents not found in the school environment. Overall, the results of this review suggest that tobacco, hazardous alcohol use, and most categories of illicit drug use have shown consistent increases in prevalence since about 1990 in most developed countries, for school-based adolescents, suggesting that the substance use problem among adolescents remains unsolved. These trends are remarkably similar across substance use behaviours, and among most developed countries, although limited data has emanated from adolescents in the developing world. Interventions to reduce or prevent substance use have shown mixed results, with those focusing on the adolescents' social environment showing the most promise. Broader public health approaches, including the linkage to community-wide prevention, and greater enforcement or regulatory and legislative approaches to tobacco and alcohol access are future directions for research and practice.

Psychosocial factors related to adolescent smoking: a critical review of the literature

OBJECTIVE

To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking.

DATA SOURCES

General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files.

STUDY SELECTION

Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking.

DATA SYNTHESIS

Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables.

CONCLUSIONS

Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy.

One-year predictors of smoking initiation and of continued smoking among elementary schoolchildren in multiethnic, low-income, inner-city neighbourhoods

OBJECTIVE

To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers.

DESIGN

Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme.

SETTING

24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal.

SUBJECT

1824 schoolchildren aged 9-12 years with baseline and one-year follow-up data.

MAIN OUTCOME MEASURES

Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses.

RESULTS

The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/"junk food" consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6)).

CONCLUSIONS

Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.

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.

Smoking behavior among French and American women

BACKGROUND

This paper presents an analysis of the sociodemographic factors related to cigarette smoking prevalence and the number of cigarettes smoked daily among nationally representative samples of 18- to 64-year-old French (n = 1,956) and American (n = 20,234) women.

METHODS

This analysis combines 2 separate years (1992 and 1993) of data collected by the National Health Interview Survey in the United States and the Comité Francais d'Education pour la Santé in France. Weighted data analysis of the effects of age, employment status, education, and socioprofessional status was conducted using both SPSS and the SUDAAN complex sample survey analysis program.

RESULTS

The prevalence of smoking among French female smokers was significantly higher than among American women (30.8% vs 26.3%) and particularly among the younger age groups. However, the average number of cigarettes smoked per day was appreciably and significantly lower for French women (12.3) than for American women (18.2). Multivariate logistic regression analysis revealed statistically significant interaction terms differentiating the impact of marital status, age, and education on the smoking status of French and American women, as well as the sociodemographic determinants of the number of cigarettes smoked. Education was inversely related to smoking among American women but positively associated with the smoking behavior of French women.

CONCLUSIONS

Differences in the smoking behavior of French and American women support the view that sociodemographic factors do not affect the smoking behavior of women in Western industrialized countries similarly and reinforce the importance of international public health measures targeting the increasing rate of smoking among women.

The degree and type of relationship between psychosocial variables and smoking status for students in grade 8: is there a dose-response relationship?

BACKGROUND

While most research focuses on simply analyzing the differences between smokers and non-smokers, dose-response analyses may be used to find evidence of the nature of the association between psychosocial variables and involvement with smoking in adolescence.

METHODS

For the study, 1,614 grade 8 students from Scarborough, Ontario, Canada, completed a self-administered questionnaire that included items on sociodemographic characteristics, experience with smoking, lifestyle, health and weight, work status, and social involvement as well as parental education, occupation, and family and peer smoking. A series of scales measuring self-esteem, stress, coping, social support, mastery, social conformity, and rebelliousness was incorporated.

RESULTS

Dose-response relationships were evidenced for all categories of variables and were demonstrated for the total group and, in most cases, for males and females when analyzed separately.

CONCLUSIONS

Relationships between variables are not "all or none," but may vary depending on amount or level of other factors. These relationships provide insight into the mechanisms underlying initiation to, maintenance of, and cessation of smoking and should be taken into account in programs to reduce or prevent adolescent tobacco use.

Tobacco advertisements: one of the strongest risk factors for smoking in Hong Kong students

STUDY OBJECTIVE

To describe the prevalence of smoking in junior secondary school students in Hong Kong and to analyse the relationship between a range of risk factors and ever-smoking experience, including tobacco advertisements.

METHODS

Cross-sectional survey using an anonymous standardised self-administered questionnaire.

SETTING

61 randomly selected secondary schools in Hong Kong.

PARTICIPANTS

6,304 form 1 to 3 Chinese students from 172 classes (51% girls and 49% boys; 90% were aged 12 to 15 years).

RESULTS

The smoking status (95% confidence interval) was: (1) never smoker, 71.1% (70.0%-72.2%), (2) tried only, 15.5% (14.6%-16.4%), (3) used to smoke but not now, 4.2% (3.7%-4.7%), (4) smoked < 1 cigarette per week, 2.9% (2.5%-3.4%), (5) smoked 1-6 per week, 1.7% (1.4%-2.0%), and (6) smoked > 6 per week, 4.5% (4.0%-5.0%). In a backward stepwise logistic regression model, ever-smoking (including categories 2 to 6 above) was independently associated with thirteen factors, including gender (boys), increasing age, place of birth (outside Hong Kong, mainly China), poor knowledge of the hazards of smoking, positive attitudes to smoking, smoking in family members, participation in tobacco promotional activities, and perception of cigarette advertisements as attractive. Among the strongest associations observed was the youth's perception of cigarette advertisements as attractive, with the adjusted odds ratio (95% confidence interval) of 2.68 (2.33-3.07).

CONCLUSIONS

Smoking among young people is an important public health problem. Although the causes are multifactorial, in Hong Kong environmental tobacco advertising is an important risk factor that can be removed by banning all forms of tobacco promotion to young people.

Smoking among male teenagers in Dhaka, Bangladesh

BACKGROUND

Smoking is now recognized as a major public health problem in the developing world. Despite this, there is a dearth of relevant data on smoking prevalence and on the characteristics and attitudes of smokers: in particular, studies are lacking among teenagers and young adults, the group in which the habit frequently begins. The present study addresses this issue by examining the smoking patterns of a sample of teenagers in Dhaka, Bangladesh, during 1991.

METHODS

The study investigated smoking behavior and attitudes among two groups of male teenagers: the first consisted of 555 students, age 12-20 years, selected from two metropolitan high schools; the second, chosen to provide a broad comparison group from a different socioeconomic stratum, contained 112 males of similar age residing in an urban slum. Data were collected largely by interview supplemented by some direct observation and relevant secondary data.

RESULTS

The results showed that 29% of the students and 68% of the slum dwellers said they were regular smokers. In addition, the slum youths smoked substantially more and had smoked for longer than the students. While the study suggests both groups of smokers had been influenced to take up smoking by the smoking behavior of peers and parents, peers were more important for the students. Advertising may also have been a important influence on students since smokers in this group could better identify tobacco advertisements compared with their nonsmoking peers. No significant association was found between respondents' knowledge of the health risks of smoking and their actual smoking behavior.

CONCLUSIONS

This study demonstrates that in Bangladesh, smoking is very common among middle-class male teenagers and even more prevalent among youths from nearby slums. Clearly, local and national programs that draw on relevant knowledge from other countries, but are appropriate to Bangladesh, need to be developed to tackle a major epidemic.