Parents modelling, peer influence and peer selection impact on adolescent smoking behavior: A longitudinal study in two age cohorts

Perspectives, motivations, and experiences of adolescents and young adults using nicotine vapes: a qualitative review

The emergence of vaping represents a novel phenomenon, highlighting its distinctive role within contemporary society. Nevertheless, the comprehensive understanding of the cultural significance and social norms associated with vaping remains incomplete. This scoping review aimed to report the perspectives, motivations, and experiences of adolescents and young adults (10-25 years) engaging in the use of nicotine vapes. Peer-reviewed primary research published in English from 2003 to February 2024 was identified using the databases PubMed, Scopus, CINAHL, and PsycINFO. Qualitative studies reporting on the perspectives, motivations, and experiences of adolescents and young adults who currently engage in nicotine and tobacco vape use were included. Thematic analysis revealed three key themes in adolescents and young adults vaping: understanding and reasons for vaping, the challenges of addiction and withdrawal, and varied responses from families and caregivers. Adolescents and young adults are often introduced to vaping by peers and siblings, drawn by the desire to fit in and the appealing flavours. Despite awareness of potential health risks, addiction makes quitting difficult, leading to intense cravings and withdrawal challenges. Families show a spectrum of responses, from ignorance to reluctant acceptance, indicating a need for better awareness and intervention strategies to address adolescent vaping. Establishing a withdrawal pathway for vaping is imperative as an intervention strategy to address the prevalence of vaping among adolescents and young adults.

The Social Processes of Excessive Online Gaming Homophily: Peer Selection or Influence?

Adolescents who befriend online game using peers may be at risk for initiated and continued excessive game use (online gaming use homophily). The present article examined how adolescents' severity of online gaming use related to their friends' online gaming behavior bi-directionally across a semester (peer selection or peer influence effect). Students from two universities completed three waves of online surveys within four and a half months (N = 3079; 33.6% female; Mage = 19.16; SD = 0.97). Random-intercepts, Cross-Lagged Panel Model (RI-CLPM) analyses revealed that peer selection and peer influence both promote online gaming use homophily in adolescents' friendship groups. Furthermore, participants were more likely to form new friendships with peers exhibiting similar online gaming behavior as their behavior, subsequently reinforcing their online gaming use behaviors within these relationships. These social processes may exhibit a time lag among girls, which needs to be confirmed through longer-term follow-up. In general, findings suggest that effective prevention programs targeting excessive online gaming should not only focus on promoting social influence skills but also consider the structure of peer environments.

Health literacy and adolescents' substance use behaviors and correlates: a scoping review

From 2011 to 2023, substance use increased by 23% worldwide. Given that substance use initiation is highest during adolescence, it is crucial to identify amenable correlates of substance use prevention [e.g. health literacy (HL)], which, if embedded in interventions, may improve uptake and outcomes. Hence, this study conducted a scoping review to answer the question: What is known from the existing literature about the relationship between HL and substance use correlates and behaviors in adolescents? Five electronic databases and the bibliography of review articles were searched and a total of 1770 records were identified. After removing duplicates and engaging in three levels of screening to identify studies that included adolescents ≤ 25 years old and assessed the relationship between general HL (vs. behavior/disease-specific health knowledge) and substance use behaviors and correlates, 16 studies were retained. Studies assessed alcohol-related (n = 11), tobacco-related (n = 12), electronic vapor product use-related (n = 4), cannabis-related (n = 1), and amphetamines/methamphetamines-related (n = 1) outcomes. Studies spanned Africa, Asia, Europe, and North and Central America. Most studies included substance use as an outcome and found an inverse relationship between HL and use. Few studies examined substance use correlates (e.g. risk perception). There were no longitudinal or intervention studies. This review highlighted that the topic of adolescent HL and its relationship with substance use remains inadequately researched. Notable gaps for future studies include intervention and longitudinal designs, expansion of outcomes (e.g. more studies on marijuana, prescription drug misuse, vaping, substance use-related correlates), and examining HL as a mediator or moderator of substance use and its correlates.

Comparative analysis of e-cigarette prevalence and influencing factors among adolescents in Jiangsu Province, China

Objective

The objectives of this study were to investigate electronic cigarette (e-cigarette) and cigarette use in Jiangsu Province, China, by analyzing the two-year trends of e-cigarette using and to explore the factors influencing the experimentation and use of e-cigarettes.

Methods

We conducted a cross-sectional study following the standard methodology of the Global Youth Tobacco Survey in 2019 and 2021. A three-stage cluster sampling design was applied. Eighty-two schools in 14 districts (counties) in Jiangsu Province were surveyed. All computations were performed using the SPSS 21.0 complex samples procedure. Multivariate logistic regression was used to explore the factors influencing e-cigarette experimentation and use.

Results

A total of 12,410 and 12,880 students were surveyed in 2019 and 2021, respectively. E-cigarette experimentation increased from 9.34% in 2019 to 13.07% in 2021 (P < 0.001). E-cigarette use increased from 2.23% in 2019 to 3.74% in 2021 (P < 0.001). The main factors associated with e-cigarette use were cigarette experimentation (OR = 2.700, P < 0.001); male gender (OR = 1.416, P = 0.011); junior high school students (OR = 1.551, P = 0.005) and vocational high school students (OR = 1.644, P = 0.001); more pocket money per week (OR1 = 1.214, P = 0.187; OR2 = 1.686, P = 0.001); exposure to second-hand smoke (SHS) at home (OR = 1.239, P < 0.001); exposure to e-cigarette advertising (OR = 1.855, P < 0.001); believe SHS is harmful (OR = 0.933, P = 0.026); closest friends smoking (OR = 2.501, P < 0.001); believe smoking makes youth look more attractive (OR1 = 1.469, P = 0.040; OR2 = 1.305, P = 0.049); believe tobacco helps youth feel more comfortable in social situations (OR1 = 2.161, P < 0.001; OR2 = 1.635, P = 0.001); will use an e-cigarette product if offered by best friends (OR = 1.322, P < 0.001); intend to use an e-cigarette product in the next 12 months (OR = 1.486, P < 0.001).

Conclusion

E-cigarette use among adolescents has been on the rise in recent years. E-cigarette use is associated with past cigarette use and a strong desire to smoke. It is crucial to take health education and tobacco control efforts to reduce adolescents' e-cigarette use rate.

The associations of parental smoking, quitting and habitus with teenager e-cigarette, smoking, alcohol and other drug use in GUI Cohort '98

We analyse parental smoking and cessation (quitting) associations with teenager e-cigarette, alcohol, tobacco smoking and other drug use, and explore parental smoking as a mechanism for social reproduction. We use data from Waves 1-3 of Growing Up in Ireland (Cohort '98). Our analytic sample consisted of n = 6,039 participants reporting in all 3 Waves. Data were collected in Waves 1 and 2 when the children were 9 and 13 years old and in Wave 3 at age 17/18 years. Generalized Estimating Equations (GEE) models were used to analyse teenage substance use at Wave 3. Parental smoking was associated with significantly increased risk of all teenage substance use, adjusted odds ratios were aOR2.13 (ever e-cigarette use); aOR1.92 (ever alcohol use); aOR1.88 (current alcohol use); aOR1.90 (ever use of other drugs); aOR2.10 (ever-smoking); and aOR1.91 (current smoking). Primary caregiver smoking cessation (quitting) was associated with a lower risk for teenager current smoking aOR0.62, ever e-cigarette use aOR 0.65 and other drug use aOR 0.57. Primary caregiver smoking behaviour had greater associations than secondary, and age13 exposure more than age 9. Habitus seems to play a role and wealth was protective for teenage smoking. The findings suggest that prevention interventions should target both caregivers and their children.

The influence of anti-smoking messages to Indonesian youth smoking behavior: the Indonesian 2019 Global Youth Tobacco Survey (GYTS)

INTRODUCTION

Various anti-tobacco promotions have emerged in order to reduce the detrimental impacts of tobacco advertising on adolescents. The objective of this study is to explore the relationship between the exposure to anti-smoking messages and Indonesian youth smoking behavior.

METHOD

We used secondary data from the Indonesian 2019 Global Youth Tobacco Survey (GYTS). The participants were students from grades seven to twelve. We used multiple logistic regression to assess the relationship of anti-smoking messages exposure on the smoking behavior variable. We used complex samples process logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (CIs) and controlling for relevant covariables.

RESULTS

The percentage of the exposure to anti-smoking messages in all types were not more than 25% in each outcome variables. The results also showed that in the current smoker variables, adolescent who exposed to the two variables of anti-smoking messages increased the odds to become current smoker. The variables were anti smoking messages in media (AOR 1.41; 95% CI 1.15-1.73) and in school (AOR 1.26; 95% CI 1.06-1.50). On the other hand, in the smoking susceptibility variables, there were no variables of anti-smoking messages that had relation with it.

CONCLUSIONS

The study concluded that there were only two variables of the anti-smoking messages that had relation with the Indonesian youth smoking behavior, which were current smokers. Unfortunately those variables increased the odds of the respondents to become current smokers. Indonesia government should develop media following international best practices to convey the anti-smoking messages.

Transition to retirement impact on smoking habit: results from a longitudinal analysis within the Survey of Health, Ageing and Retirement in Europe (SHARE) project

BACKGROUND

In an ageing society, retirement impacts on behavioural risk factors and health outcomes should be carefully assessed. Scant evidence exists from longitudinal studies on the short- and long-term consequences of the transition to retirement on smoking habit.

METHODS

We conducted a longitudinal study based on the Survey of Health, Ageing and Retirement in Europe (SHARE) data from 27 European countries plus Israel collected in 2004-2020. To estimate relative risks (RR) and corresponding 95% confidence intervals (CI) for smoking status and intensity at seven time periods before and after retirement, we fitted adjusted generalised estimating equation (GEE) models for repeated measures.

RESULTS

We selected a cohort of 8998 individuals employed at baseline and retired at follow-up (median follow-up time: 9 years; maximum: 16 years). As compared to the year of retirement, the RR of smoking was 1.59 (95% CI 1.44-1.76) at 10 years or more before retirement, 1.35 (95% CI 1.25-1.46) from 5 to 9 years before retirement, and 1.18 (95% CI 1.10-1.27) from 1 to 4 years before retirement. Smoking steadily decreased after retirement, being 0.94 (95% CI 0.87-1.01) from 1 to 4 years after retirement, 0.76 (95% CI 0.69-0.84) from 5 to 9 years, and 0.58 (95% CI 0.46-0.74) 10 years or more after retirement. In smokers, the estimated number of cigarettes smoked/day decreased from about 27 cigarettes/day at 10 years or more before retirement to 9 cigarettes/day at 10 years or more after retirement (p trend < 0.001).

CONCLUSION

Longitudinal data suggest that lifestyles might favourably change with retirement. Further studies are needed to direct healthy ageing promotion policies better.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Social determinants of smoking among school adolescents in Beijing, China

INTRODUCTION

Understanding the social determinants that influence adolescent smoking behavior has a meaningful impact on adolescent health. Few studies have simultaneously analyzed the impact of teacher smoking and peer smoking on adolescent smoking. Therefore, the present study aims to investigate the impact of teacher smoking, peer smoking, and other social factors, on adolescent smoking.

METHODS

The participants were drawn from schools in Beijing, China, in 2011, 2013, and 2015, using a multi-stage random group sampling method. The number of schools selected for each year was 160. The study participants were 57240 adolescents aged 8-19 years. The generalized linear model with a binomial distribution and logarithmic link function was used to estimate the influence of social determinants on adolescent smoking behavior.

RESULTS

The results show that both teacher smoking and peer smoking were significantly associated with adolescent smoking. Compared to adolescents whose teachers did not smoke, the prevalence ratio (PR) was 1.28 for adolescents with one teacher who smoked and 1.34 for adolescents with two or more teachers who smoked (95% CI: 1.16-1.41/1.23-1.46, p<0.001/0.001, respectively). Compared to adolescents whose peers did not smoke, the prevalence ratio (PR) was 3.73 for adolescents with one peer who smoked and 8.52 for adolescents with two or more peers who smoked (95% CI: 3.20-4.35/7.48-9.69, p<0.001/0.001, respectively).

CONCLUSIONS

Teacher smoking and peer smoking are significant social determinants of adolescent smoking. Prevention programs should concurrently target peer groups, school settings, and individual students.

Influence of Personal, Environmental, and Community Factors on Cigarette Smoking in Adolescents: A Population-Based Study from Taiwan

Understanding the factors that influence cigarette smoking among adolescents is critical. We identified personal, community, and environmental factors associated with current cigarette smoking among adolescents. This population-based cross-sectional analysis study was conducted using the 2012 Taiwan Global Youth Tobacco Survey and the sociodemographic statistics of the city or county from Taiwan’s Ministry of the Interior. A total of 27,524 participants (age: 12–18-years) was included. The associated factors were identified through logistic regression. A path analysis was performed to examine the pathway from the associated factors to current cigarette smoking. According to this analysis, the following factors were prominently and positively associated with adolescent cigarette smoking: one personal factor (pocket money), five environmental factors (home secondhand smoke (SHS) exposure, smoker friends, outside SHS exposure, school SHS exposure, and smoker parents), and two community factors (free cigarettes from tobacco companies and indigenous population). By contrast, five personal factors (feeling less comfortable smoking at social occasions, feeling indifferent about smoking or not smoking at social occasions, female sex, feeling that quitting is difficult, and feeling that quitting after having smoked is harmful to health) and one environmental factor (school antismoking education) had negative effects. Thus, comprehensive interventions promoting the perception of harm caused by smoking and interrupting access to cigarettes through social networks can reduce cigarette smoking in adolescents.

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

BACKGROUND

Despite a steady decline in adolescent smoking globally, it remains a prevalent risk factor for non-communicable disease. Previous research points to differences in socio-environmental and psychosocial risk factors for smoking and how they vary across different settings with disparate social and cultural characteristics. As a result, smoking rates have remained disproportionately higher in some settings while decreasing in others. This study explored the socio-environmental and psychosocial risk factors for smoking susceptibility in a high-income and upper-middle income setting.

METHODS

Cross-sectional data were obtained from 1,573 male and female adolescents aged 11-15 years who completed self-administered questionnaires in schools in Northern Ireland and Bogotá, Colombia. Using logistic regression analysis, we examined how socio-environmental and psychosocial predictors of smoking susceptibility compared across the two countries.

RESULTS

In Northern Ireland, reduced odds of smoking susceptibility were significantly associated with less family smoking (OR: 0.64, 95% CI: 0.41-1.00); having access to information about smoking in school (OR: 0.75, 95% CI: 0.59-0.96); negative attitudes towards smoking (OR: 0.35, 95% CI: 0.23-0.51); higher levels of openness (OR: 0.59, 95% CI: 0.50-0.69); and higher levels of self-reported wellbeing (OR: 0.57, 95% CI: 0.44-0.74). Increased odds of smoking susceptibility were associated with reporting less smoking of a mother (OR: 1.37, 95% CI: 1.06-1.76); higher levels of extraversion (OR: 1.40, 95% CI: 1.04-1.90); and receiving pocket money (OR: 1.20, 95% CI: 1.06-1.37). In Bogotá, reduced odds of smoking susceptibility were significantly associated with reporting less smoking among friends (OR: 0.86, 95% CI: 0.76-0.98); higher levels of self-efficacy (OR: 0.58, 95% CI: 0.40-0.83); greater perceived behavioural control to quit smoking (OR: 0.71, 95% CI: 0.56-0.90); and lower levels of truancy (OR: 0.69, 95% CI: 0.52-0.92). In Bogotá, no factors were associated with increased odds of smoking susceptibility in the final model.

CONCLUSIONS

The findings illustrate that there were differences in predictors of adolescent smoking susceptibility across the two settings. By using a comparative approach we demonstrate that smoking interventions and policies must be sensitive to the cultural and normative context within which they are implemented.

With a Little Help from Their Peers: The Impact of Classmates on Adolescents' Development of Prosocial Behavior

Peer groups are critical socialization agents for the development of social behavior in adolescence, but studies examining peer-group effects on individuals' prosocial behavior are scarce. Using a two-wave, multilevel data set (N = 16,893, 8481 male; 8412 female; mean age at Time 1: 14.0 years) from 1308 classes in 252 secondary schools in Germany, main effects of the classroom level of prosocial behavior, cross-level interactions between the classroom and the individual levels of prosocial behavior at Time 1, and the moderating role of gender were examined. The results showed that adolescents in classrooms with high collective levels of prosocial behavior at Time 1 reported more prosocial behavior at Time 2, about two years later, reflecting a class-level main effect. A significant cross-level interaction indicated that a high classroom level of prosocial behavior particularly affected individuals with lower levels of prosocial behavior at Time 1. The influence of same-gender peers was larger compared with opposite-gender peers. The findings are discussed with respect to social learning mechanisms in the development of prosocial behavior and their implications for interventions to promote prosocial behavior.

Ecological Exploration of Knowledge and Attitudes Towards Tobacco and E-Cigarettes Among Primary School Children, Teachers, and Parents in Wales: A Qualitative Study

Experimentation with e-cigarettes has grown rapidly among UK adolescents. To date, this topic has been primarily researched in secondary schools, with less understanding of development of attitudes and behaviours at an earlier age. This research reports qualitative data from interviews with pupils, parents, and teachers at 4 case study schools in Wales (N = 42). It draws on Bronfenbrenner's Ecological Systems Theory to consider how the intersection of systems surrounding primary school-age children and their interaction with these systems, shape knowledge, and attitudes towards e-cigarettes and tobacco. Findings indicate that consistent messaging on smoking from school and family was reflected in strong disapproval among pupils and clear understanding of harms. This was less evident for e-cigarettes, where messages were mixed and inconsistent between home and school, with concerns over what to tell children about e-cigarettes in light of mixed messages and absence of official guidance. Implications of findings for policy and teaching are discussed.

The Viewpoints of Urban High School Male Students, Parents and Teachers About Cigarette Smoking by Adolescents: A Social Marketing-Based Qualitative Study, Shiraz, Iran

Background: Smoking is one of the greatest challenges for public health. It is estimated that 7% - 25% of adolescents have experienced smoking in Iran. Objectives: The present study aimed to investigate the viewpoints of high school male students, their parents, and teachers about smoking by adolescents based on four components of the social marketing mix. Methods: A qualitative study with a phenomenological approach was conducted via 12 focus group sessions in Persian language. To this end, 82 participants (30 students, 28 parents, and 24 teachers) were selected based on purposive sampling method in 2015.The data were analyzed through directed content analysis. Results: All the three studied groups viewed “looking older” as the major cause of adolescent smoking, other factors included getting others’ attention, looking smart person, calmness, decreasing pain, and attractive packaging of cigarette. Some differences were observed between the viewpoints of students, parents, and teachers about the complications of cigarette. The students focused on the social consequences of smoking, but the parents and teachers were more worried about its long term physical side effects and addictive properties. Unlike parents, the teachers and students considered imitating from parents and famous people as the main socio-environmental factor of smoking. All three groups believed that people’s negative social image and negative attention towards smokers should be included in smoking prevention educational programs. However, some differences were reported between their ideas in other educational subjects. Conclusions: Evaluating factors related to tobacco use from three different perspectives can provide a more comprehensive view of these factors and show the reason for the failure of many efforts to prevent student tobacco use and develop a more effective program to promote health.