Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

Self-efficacy and unwanted sexual intercourse: ‘Reproductive health education programme for high-school students in Vojvodina’

Introduction

Studies have shown the importance of self-efficacy in the domain of risky sexual behaviour. The aim of this study was to examine the association of unwanted sexual intercourse among secondary-school students with socio-demographic factors and perceived self-efficacy, and to assess the effectiveness of the programme on reproductive health.

Methods

The study involved 5,026 second-grade students in 72 high schools in the Province of Vojvodina, Serbia (APV). They were surveyed before and after the implementation of the extracurricular ‘Reproductive health education programme for secondary-school students in APV’. A questionnaire consisting of 57 questions (socio-demographic characteristics, knowledge, attitudes, and behaviour of students regarding reproductive health, and a general self-efficacy scale) was used as the research instrument.

Results

One quarter of students had engaged in unwanted sexual intercourse on one or more occasions. Students with poor material status were twice as likely to engage in unwanted sexual intercourse (ОR=2.01; 95%CI=1.07–3.75) as students with average or good material status. Students who did not engage in unwanted sexual intercourse had a higher self-efficacy score than students who who did (t=2.903; p<0.01). After the programme was completed, there was an increase in general self-efficacy.

Conclusion

Poor material status is a predictor of unwanted sexual intercourse. Students who have a higher level of self-efficacy engaged to a lesser degree in unwanted sexual intercourse. The programme is effective in terms of increasing general self-efficacy, and can be applied to encourage responsible sexual behaviour.

Social cohesion, psycho-physical well-being and self-efficacy of school-aged children in Lombardy: Results from HBSC study

Within the literature on health inequalities and social determinants of health, there is a growing interest in studying how the context of residence is able to influence health conditions and health-related outcomes, over and above individual characteristics. Life context affects people's well-being in a material way, through the availability of services and resources, but also through social, cultural and relational resources, to the extent to which people within the same context share norms, values and behaviours affecting their health conditions. In this study, we analysed the association between social cohesion in the context of residence and two health-related outcomes, psycho-physical well-being and self-efficacy, in school-aged children in Lombardy, using data from the Health Behaviour in School-aged Children (HBSC) study for 2014. The results show a positive association between the variables, indicating that social cohesion matters for young people's health and well-being and suggesting new areas of intervention in policies aiming at promoting health and reducing inequalities.

The effect of parental smoking on preadolescents' implicit and explicit perceptions of smoking-related cues

Children of smokers are significantly more likely to experiment with cigarettes and become habitual smokers than children of nonsmokers. The current study examined the effect of parental smoking on children's implicit and explicit responses toward smoking behavior and smoking-related cues with the goal of identifying potential mechanisms for this relationship. A sample of 8-12-year-old children of smokers (n = 57) and children of nonsmokers (n = 86) completed a dot probe task to assess implicit attentional bias toward smoking cues and the Affect Misattribution Procedure (AMP) to assess implicit affective responses to smoking cues. In addition, children indicated their explicit perceptions of smokers and smoking behavior. Results demonstrated that children of smokers showed more sustained implicit attentional bias toward pictures of smoking stimuli presented alone than children of nonsmokers. Overall, participants showed negative implicit affective responses to smoking stimuli regardless of parental smoking. Children of smokers indicated that smokers would experience fewer negative consequences than children of nonsmokers; these relationships were moderated by age. Together, our findings suggest that parental smoking affects the ways that preadolescent children implicitly process smoking cues and their perceptions about smoking and its consequences. These findings help us understand the environmental mechanisms associated with smoking behavior in this vulnerable population. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Gender differences in risk factors for cigarette smoking initiation in childhood

INTRODUCTION

We investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender.

METHODS

In spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005-2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys.

RESULTS

101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade.

CONCLUSIONS

Risk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use.

The influence of peer behavior as a function of social and cultural closeness: A meta-analysis of normative influence on adolescent smoking initiation and continuation

Although the influence of peers on adolescent smoking should vary depending on social dynamics, there is a lack of understanding of which elements are most crucial and how this dynamic unfolds for smoking initiation and continuation across areas of the world. The present meta-analysis included 75 studies yielding 237 effect sizes that examined associations between peers' smoking and adolescents' smoking initiation and continuation with longitudinal designs across 16 countries. Mixed-effects models with robust variance estimates were used to calculate weighted-mean Odds ratios. This work showed that having peers who smoke is associated with about twice the odds of adolescents beginning (OR ¯ = 1.96, 95% confidence interval [CI] [1.76, 2.19]) and continuing to smoke (OR ¯ = 1.78, 95% CI [1.55, 2.05]). Moderator analyses revealed that (a) smoking initiation was more positively correlated with peers' smoking when the interpersonal closeness between adolescents and their peers was higher (vs. lower); and (b) both smoking initiation and continuation were more positively correlated with peers' smoking when samples were from collectivistic (vs. individualistic) cultures. Thus, both individual as well as population level dynamics play a critical role in the strength of peer influence. Accounting for cultural variables may be especially important given effects on both initiation and continuation. Implications for theory, research, and antismoking intervention strategies are discussed. (PsycINFO Database Record

Predictors of the Onset of Cigarette Smoking: A Systematic Review of Longitudinal Population-Based Studies in Youth

CONTEXT

The onset of cigarette smoking typically occurs during childhood or early adolescence. Nicotine dependence symptoms can manifest soon after onset, contributing to sustained, long-term smoking. Previous reviews have not clarified the determinants of onset.

EVIDENCE ACQUISITION

In 2015, a systematic review of the literature in PubMed and EMBASE was undertaken to identify peer-reviewed prospective longitudinal studies published between January 1984 and August 2015 that investigated predictors of cigarette smoking onset among youth aged <18 years who had never smoked.

EVIDENCE SYNTHESIS

Ninety-eight conceptually different potential predictors were identified in 53 studies. An increased risk of smoking onset was consistently (i.e., in four or more studies) associated with increased age/grade, lower SES, poor academic performance, sensation seeking or rebelliousness, intention to smoke in the future, receptivity to tobacco promotion efforts, susceptibility to smoking, family members' smoking, having friends who smoke, and exposure to films, whereas higher self-esteem and high parental monitoring/supervision of the child appeared to protect against smoking onset. Methodologic weaknesses were identified in numerous studies, including failure to account for attrition or for clustering in samples, and misidentification of potential confounders, which may have led to biased estimates of associations.

CONCLUSIONS

Predictors of smoking onset for which there is robust evidence should be considered in the design of interventions to prevent first puff in order to optimize their effectiveness. Future research should seek to define onset clearly as the transition from never use to first use (e.g., first few puffs).

Precocious Initiation into Smoking, Alcohol Use, and Gambling among Children with Conduct Problems

OBJECTIVE

Adolescent participation in risky and addictive behaviours, such as smoking, substance use, and gambling has the potential to lead to many serious problems. The presence of conduct problems (CPs) and early initiation into risky and addictive behaviours have been independently shown to be associated with adolescent and young adult smoking, drinking, and gambling. Nevertheless, the relation between early initiation into risky and addictive behaviours and CPs remains to be explored among pre-adolescents. Our study aims to examine the prospective relation between CPs in early primary school and pre-adolescent initiation into smoking, alcohol use, and gambling.

METHOD

Our study used data from participants in an ongoing prospective, longitudinal study at the Université de Sherbrooke to examine cigarette, alcohol, and gambling initiation among primary school-aged boys and girls with CPs. Children were recruited between the ages of 6 and 9 years from several low socioeconomic status public schools in diverse geographical regions of Quebec. Initiation into cigarettes, alcohol, and gambling was measured 1 year later.

RESULTS

Children with CPs were found to be at greater risk for early initiation into smoking, alcohol, and gambling. These effects remained even once other known risk factors, such as poor parental supervision and child effortful control, were controlled for.

CONCLUSIONS

These results suggest that CPs present in early elementary school can predict early initiation in to potentially addictive behaviours among boys and girls. Implications for targeted preventive intervention are discussed.

Vaping as a Catalyst for Smoking? An Initial Model on the Initiation of Electronic Cigarette Use and the Transition to Tobacco Smoking Among Adolescents

INTRODUCTION

The popularity of electronic cigarettes (e-cigarettes) among adolescents is growing worldwide. A more accurate model than the much discussed but inadequate Gateway Hypothesis is needed to explain some adolescents' initial preference for e-cigarettes over tobacco cigarettes, as well as any transition from e-cigarettes to tobacco smoking. Our aim was to summarize the diffuse fear that adolescents will be indirectly encouraged to begin smoking tobacco via the use of e-cigarettes and to systematize the disparate causal hypotheses used thus far in relevant literature.

METHODS

We summarized the vague and fragmented hypotheses formulated thus far in literature on both trajectories from abstinence to e-cigarette use and from there to tobacco smoking into a set of empirically testable hypotheses and organized them into a comprehensive model.

RESULTS

Our results indicate that the perceived health risks, specific product characteristics (such as taste, price and inconspicuous use), and higher levels of acceptance among peers and others potentially make e-cigarettes initially more attractive to adolescents than tobacco cigarettes. Later, increasing familiarity with nicotine could lead to the reevaluation of both electronic and tobacco cigarettes and subsequently to a potential transition to tobacco smoking. The suggested "catalyst model" takes variations in the nicotine content of e-cigarettes as well as the dual use of different substances into account.

CONCLUSION

Our model provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking which, after being tested in empirical studies, could lead to the formulation of concrete recommendations for healthcare intervention and prevention measures.

IMPLICATIONS

We developed a model that provides causal hypotheses for the initiation of e-cigarette use and for the potential transition to tobacco smoking.

Influence of family and friend smoking on intentions to smoke and smoking-related attitudes and refusal self-efficacy among 9-10 year old children from deprived neighbourhoods: a cross-sectional study

Background

Smoking often starts in early adolescence and addiction can occur rapidly. For effective smoking prevention there is a need to identify at risk groups of preadolescent children and whether gender-specific intervention components are necessary. This study aimed to examine associations between mother, father, sibling and friend smoking and cognitive vulnerability to smoking among preadolescent children living in deprived neighbourhoods.

Methods

Cross-sectional data was collected from 9–10 year old children (n =1143; 50.7% girls; 85.6% White British) from 43 primary schools in Merseyside, England. Children completed a questionnaire that assessed their smoking-related behaviour, intentions, attitudes, and refusal self-efficacy, as well as parent, sibling and friend smoking. Data for boys and girls were analysed separately using multilevel linear and logistic regression models, adjusting for individual cognitions and school and deprivation level.

Results

Compared to girls, boys had lower non-smoking intentions (P = 0.02), refusal self-efficacy (P = 0.04) and were less likely to agree that smoking is ‘definitely’ bad for health (P < 0.01). Friend smoking was negatively associated with non-smoking intentions in girls (P < 0.01) and boys (P < 0.01), and with refusal self-efficacy in girls (P < 0.01). Sibling smoking was negatively associated with non-smoking intentions in girls (P < 0.01) but a positive association was found in boys (P = 0.02). Boys who had a smoking friend were less likely to ‘definitely’ believe that the smoke from other people’s cigarettes is harmful (OR 0.57, 95% CI: 0.35 to 0.91, P = 0.02). Further, boys with a smoking friend (OR 0.38, 95% CI: 0.21 to 0.69, P < 0.01) or a smoking sibling (OR 0.45, 95% CI: 0.21 to 0.98) were less likely to ‘definitely’ believe that smoking is bad for health.

Conclusion

This study indicates that sibling and friend smoking may represent important influences on 9–10 year old children’s cognitive vulnerability toward smoking. Whilst some differential findings by gender were observed, these may not be sufficient to warrant separate prevention interventions. However, further research is needed.

Family characteristics and health behaviour as antecedents of school nurses' concerns about adolescents' health and development: a path model approach

BACKGROUND

Family socio-economic factors and parents' health behaviours have been shown to have an impact on the health and well-being of children and adolescents. Family characteristics have also been associated with school nurses' concerns, which arose during health examinations, about children's and adolescents' physical health and psychosocial development. Parental smoking has also been associated with smoking in adolescents.

OBJECTIVES

The aim of this study was to determine to what extent school nurses' concerns about adolescents' physical health and psychosocial development related to family characteristics are mediated through parents' and adolescents' own health behaviours (smoking).

DESIGN

A path model approach using cross-sectional data was used.

SETTINGS

In 2008-2009, information about health and well-being of adolescents was gathered at health examinations of the Children's Health Monitoring Study.

PARTICIPANTS

Altogether 1006 eighth and ninth grade pupils in Finland participated in the study.

METHODS

The associations between family characteristics, smoking among parents and adolescents and school nurses' concerns about adolescents' physical health and psychosocial development were examined using a structural equation model.

RESULTS

Paternal education had a direct, and, through fathers' and boys' smoking, an indirect association with school nurses' concerns about the physical health of boys. Paternal labour market status and family income were only indirectly associated with concerns about the physical health of boys by having an effect on boys' smoking through paternal smoking, and a further indirect effect on concerns about boys' health. In girls, only having a single mother was strongly associated with school nurses' concerns about psychosocial development through maternal and adolescent girl smoking.

CONCLUSIONS

Socio-economic family characteristics and parental smoking influence adolescent smoking and are associated with school nurses' concerns about adolescents' physical health and psychosocial development. The findings underline the importance of comprehensively taking into account adolescents' and parents' health behaviours and the family situation in health-care contacts when providing health counselling.

Prolonged pacifier use during infancy and smoking initiation in adolescence: evidence from a historical cohort study

AIM

To investigate the association between prolonged pacifier use during childhood and smoking in adolescence and early adulthood.

METHODS

A historical cohort study including patients from a dental private office was designed. Dental records were used, which contained complete data about sucking habits from 314 children (2-10 years of age) who had attended a private dental office from 1988 to 1994 in Ibiá, Brazil. Then, we collected data about the smoking habits from 261 subjects who were successfully contacted again from 2004 to 2006. Our outcome variable was smoking, and subjects who had smoked more than 100 cigarettes during their lifetime were classified as smokers. Poisson regression analysis matched the association between oral habits and smoking. Incidence rate ratios (IRR) and 95% confidence intervals (95% CI) were calculated. The level of significance was set at 5%.

RESULTS

We observed a statistically significant association between prolonged pacifier use (more than 24 months) and smoking (IRR = 4.48; 95% CI 2.32-8.65). Breastfeeding, in contrast, was a protective factor (IRR = 0.64; 95% CI 0.42-0.96).

CONCLUSIONS

Prolonged pacifier use during childhood is positively associated with smoking initiation in adolescence and early adulthood.

The impact of smoking in the home on the health outcomes of non-smoker occupants in the UK

Smoking in the home remains a key source of exposure to secondhand smoke for non-smokers, particularly since the UK public smoking ban in 2007. A systematic literature review was conducted to identify all UK evidence on the impact of secondhand smoke exposure in the home on health and behavioural outcomes in non-smoker occupants. MEDLINE, EMBASE and the Cochrane Library were searched to identify all relevant UK empirical studies from 2000 to June 2011. A qualitative overview of the evidence is presented. Exposure to secondhand smoke in UK homes was found to be associated with serious negative health effects in non-smokers, including significantly increased risk of meningococcal carriage (p < 0.001) and disease (p = 0.05) in children and adolescents, cognitive impairment (p < 0.001) in adults, a higher rate of medically attended accidents in children with smoking mothers (p < 0.01), and for non-smoking women, a significant decrease in infant birth weight (p = 0.007). Living in a smoking household significantly increased the risk of future regular smoking in children (p < 0.001). In conclusion, this systematic review has identified strong evidence of an association between secondhand smoke exposure in the home and several serious health conditions. This finding highlights the importance of educating current smokers on the consequences of non-smoker exposure to smoking in the home.

Overestimation of peer smoking prevalence predicts smoking initiation among primary school students in Hong Kong

PURPOSE

To investigate the relationship between perceived prevalence of smoking and smoking initiation among Hong Kong primary second- to fourth-grade-students.

METHODS

A cohort of 2,171 students was surveyed in 2006 and again in 2008. Students who perceived ever-smoking prevalence in peers as "none" or "some" were considered as correct (reference group), whereas those who perceived it as "half" (overestimation) or "most/all" (gross overestimation) were considered as incorrect.

RESULTS

At baseline, overestimation was found to be cross-sectionally associated with ever-smoking (p < .01). At follow-up, 7.2% of never-smoking students with incorrect estimation at baseline had started smoking, which was 79% (95% confidence interval: 3%-213%), greater than that of 3.7% for those with correct estimation. Among the never-smoking students with incorrect estimation, subsequent correct estimation was associated with 70% (95% confidence interval: 47%-83%) lower risk of smoking initiation compared with persistent incorrect estimation.

CONCLUSION

Overestimation of the prevalence of peer smoking predicted smoking initiation among children. Interventions should be carried out to evaluate whether correcting children's overestimation of peer smoking could reduce smoking initiation.

A parallel process model of the development of positive smoking expectancies and smoking behavior during early adolescence in Caucasian and African American girls

This study examined the development of positive smoking expectancies and smoking behavior in an urban cohort of girls followed annually over ages 11-14. Longitudinal data from the oldest cohort of the Pittsburgh Girls Study (N = 566, 56% African American, 44% Caucasian) were used to estimate a parallel process growth model of positive smoking expectancies and smoking behavior. Average level of positive smoking expectancies was relatively stable over ages 11-14, although there was significant variability in initial level and rate of change in positive smoking expectancies. Ethnicity was associated with expectancy intercept and slope, such that African American, relative to Caucasian, girls initially had more positive expectancies, and less rapid change in positive expectancies. Ethnic differences in past year smoking prevalence emerged at age 14, with greater smoking prevalence among Caucasian (17%), compared to African American (8%), girls. Initial level of positive smoking expectancies and initial smoking behavior were positively associated, but positive expectancies did not predict growth in smoking behavior. Depression at age 11 was concurrently and positively associated with both positive expectancies and smoking. Study results suggest the potential utility of culturally tailored smoking prevention efforts, and the potential secondary benefit of depression treatment to prevent smoking among at-risk girls.

Smoking behaviours, access to cigarettes and relationships with alcohol in 15- and 16-year-old schoolchildren

BACKGROUND

Adolescent smoking is a significant public health concern in the UK and across Europe. This study examines smoking behaviours, methods of accessing cigarettes and use of non-commercial (fake, foreign and single) cigarettes across a sample of schoolchildren. Relationships with alcohol consumption, deprivation, personal income and extra-curricular activities are also explored.

METHODS

A cross-sectional survey of 9833 15- and 16-year-old schoolchildren in the North West of England.

RESULTS

Cigarettes were most commonly accessed from off-licences and newsagents, but pupils also reported non-commercial access through friends, family and street sellers/neighbours. A high percentage of smokers had bought foreign (57%), fake (28%) and single (54%) cigarettes. Frequent binge drinking, not participating in extra-curricular activities, receiving greater personal income, and having parents that smoked were significantly associated with being a regular and heavier smoker. Frequent binge drinking was also significantly associated with buying foreign/fake or single cigarettes. A higher percentage of those living in deprived areas were current smokers, although deprivation was not an independent predictor of cigarette use.

CONCLUSION

Strategies that restrict commercial access to cigarettes among adolescents may increase their reliance on social methods of access, and use of fake, foreign and single cigarettes. Interventions to reduce adolescent smoking must recognize the critical role of parents and communities in discouraging smoking and preventing social access to cigarettes in children. A joint approach to prevention is required that targets children at risk of smoking, heavy alcohol use and associated health-damaging behaviours.

Health risks information reaches secondary school smokers

This cross-sectional study aimed to assess smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 11-15 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. Multinomial logistic regression was used to assess whether lesson recall was associated with smoking status in a model adjusting for age, gender, ethnicity, family and best friend smoking status, socioeconomic status, and school. Quitters were more likely than smokers to report having changed their ideas about smoking as a result of a lesson (OR 5.78, 95% CI 2.44-13.72). The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of 'health' compared with 'social influence' (chi(2) (1) 124.0, P < 0.001) or 'other/non-health' (chi(2) (1) 63.16, P < 0.001) topics. Mouth cancer was the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention.

Risk factors for smoking among school adolescents in Greece

OBJECTIVE

We conducted this study among school adolescents to identify factors, which influence schoolchildren to smoke.

METHODS

We carried out a cross-sectional study in a sample of 924 students of all classes (ages 12-18 years old) in 15 public high schools in a semi-urban area in Crete, Greece, using a questionnaire. The questionnaire comprised of 46 questions covering children's lifestyle habits regarding daily activities and leisure time, frequency of risk-taking behaviour, knowledge about the hazards and long-term consequences of smoking.

RESULTS

23.9% of participants were experimental smokers and 18.6% were current smokers. 11.4% of the total population was daily smokers. There was a significant increase in the prevalence of experimental and current smokers with school grades, while peaks in last grades were observed. Boys started smoking earlier than girls, mean (standard error) age 13.4 (2.3) years vs. 14.1 (2.3) years, P = 0.01. Stepwise logistic regression analysis showed a positive relationship between current smoking and having brother or sister smoking [odds ratio (95% confidence interval) 2.7 (1.7-4.4) and 1.8 (1.1-3.3) respectively], having more than three friends who were smokers [2.6 (2-3.4)] and last school grade [1.4 (1.2-1.7)]. Students appeared to be informed about long-term smoking hazards and had negative views on children who smoke especially in the lower grades.

CONCLUSIONS

Prevention programmes should be imposed early in elementary schools while cessation policies should target at all grades, in particular at critical grades depending on population-specific characteristics.

Association between socio-economic status and sexual behavior of adolescents

Introduction: Numerous studies have emphasized the importance of contextual factors as determinants of sexual behavior of adolescents. It has been found that lower socioeconomic status is associated with risky sexual behavior. Sexual behavior is individual but develops under strong influence of cultural and other influences. Objective. The aim of this study was to investigate the association of family?s socioeconomic status and risky sexual behavior of adolescents in Belgrade. Method. Self-administered questionnaire was used in secondary schools in Belgrade, and 1,782 adolescents attending first grade filled the questionnaire. For the analyses of predictors of risky sexual behavior, multiple logistic regression was used. Results. Parents? occupations did not show significant association with any of analyzed behaviors. Adolescents who received weekly disposable money above average were 2.5 times more likely to ever have had sexual intercourse, and if sexually active were more likely to use contraception. Perceived family?s wealth was a significant predictor of ever having sex (OR=1.9; CI 1.2-2.8) and not using contraception (OR=4.3; CI 1.2-15.0). Conclusion. Socioeconomic status is associated with sexual behaviors of adolescents. Fifteen-year olds who perceive their families as wealthier are more likely to ever have had sex and not use any kind of contraception. Adolescents with higher weekly income are more likely to ever have had sex and use contraception than their counterpats with less weekly disposable money. .

Youth tobacco use: a global perspective for child health care clinicians

Tobacco dependence, responsible for approximately 4 million annual deaths worldwide, is considered to be a "pediatric disease." The smoking epidemic is spreading rapidly in developing countries. Factors contributing to youth smoking in developing countries include cultural traditions, tobacco's easy accessibility and moderate pricing, peer and family influences, and tobacco companies' advertisements and promotional activities. Secondhand tobacco smoke exposure is a substantial problem that causes increased rates of pneumonia, otitis media, asthma, and other short- and long-term pediatric conditions. Parental tobacco use results in children's deprivation of essential needs such as nutrition and education. In this article we review contemporary evidence with respect to the etiology of nicotine dependence among youth, the forms of youth tobacco products worldwide, global youth tobacco-control efforts to date, medical education efforts, and child health care clinicians' special role in youth tobacco-control strategies. In addition, we provide a review of currently available funding opportunities for development and implementation of youth tobacco-control programs.

Epidemiology and etiology of adolescent smoking

PURPOSE OF REVIEW

Despite the socioeconomic and personal health costs directly attributed to smoking, over one-half of high school seniors have used cigarettes, and over 15% of seniors are daily smokers. This review summarizes the recent research concerning the psychosocial and physiologic risk and protective factors associated with adolescent smoking.

RECENT FINDINGS

Studies of the psychosocial risk factors have added to the evidence that stress, peers and family influences, ethnicity, and depression all serve as risk factors for the development and maintenance of smoking in adolescents. Protective factors include parental expectations and monitoring, religious activity, and sociopolitical factors, such as tobacco-related marketing bans and higher cigarette taxes. Adolescent smoking trajectories have been further defined and can be used to classify smokers in terms of dependence symptoms. Finally, neurobiological research has focused to a large extent on the concept of disinhibition as a risk factor for smoking in adolescents.

SUMMARY

While rates of smoking in adolescents have declined since 1997, millions of adolescents initiate or continue smoking each year, with deleterious health and psychosocial consequences. Research into the risk and protective factors for adolescent smoking, particularly that which ties psychosocial and neurobiological factors together, is necessary to inform the development of tailored and maximally efficacious treatments for this population.

Lies, damned lies and statistics? Reliability and personal accounts of smoking among young people

Smoking remains a major problem among young people in Europe. However, within the research community examining the issue, debate continues about the best way of assessing the extent of that problem. Questions have been raised about the extent to which existing techniques for generating statistical representations of patterns of youth smoking can address a range of problems connected with identifying, accounting for and correcting unreliable self-report smoking data. Using empirical data from the UK Liverpool Longitudinal Smoking Study (LLSS), this paper argues that self-report measures of smoking, treated in isolation from participants' personal accounts, can disguise problems with the reliability and validity of a given study. Using longitudinal qualitative and quantitative data in dialogue, two main factors contributing to unreliable data are discussed: (a) participants' access to and familiarity with frameworks of everyday cultural knowledge about the practice of smoking, and (b) participants' retrospective revision of events in line with their current goals, aspirations and self-understandings. The conclusion drawn is that research has to employ multiple methods, minimally incorporating some personal contribution from participants, to explore the complex character of the problem of smoking and to avoid the difficulties posed by the models of smoking behaviour embodied within stand-alone statistical research.

Smoking behaviour, cessation attempts and the influence of parental smoking in older adult women: a cross-sectional analysis from Italy

OBJECTIVES

To investigate the association between parental smoking during infancy/adolescence and smoking prevalence in older adult women, and to provide a description of smoking and smoking cessation patterns in this subset of the population.

STUDY DESIGN

Cross-sectional survey.

METHODS

Between 1999 and 2001, trained physicians in 11 health agencies throughout the Abruzzo Region, Italy, conducted semi-structured interviews on 9708 women aged 50-70 years attending mammographic screening (overall response rate 89%). Information was collected on sociodemographic characteristics, smoking habits, parental smoking during their infancy and/or adolescence, and exposure to environmental tobacco smoke (ETS) inside or outside the family.

RESULTS AND CONCLUSIONS

The overall prevalence of current smoking was 15.6% (n=1516), and that of former smoking was 13.2%. Women whose parent(s) smoked were more likely to be current smokers, especially if only the mother smoked (adjusted odds ratio 4.27; 95% confidence interval 2.24-8.12). Other factors significantly associated with current smoking in the multivariate analysis were younger age, lower body mass index, higher level of education, unmarried status, and exposure to ETS either inside or outside the family environment. Eighteen percent of all current smokers were non-inhalers, and more than 60% of ex-smokers quit smoking on their first attempt. Our findings expand the existing evidence suggesting that a strong effect of parental conduct on a daughter's smoking behaviour may persist throughout life. Although more research is needed, especially to clarify the role of genetic and environmental factors in determining the mother-child smoking association, our results suggest that intensifying smoking prevention efforts directed at women with children might considerably reduce the risk of ever smoking in future female generations.