Understanding and deterring tobacco use among adolescents

[Study of nicotine dependence among 342 adolescent smokers]

OBJECTIVE

This research evaluated nicotine dependence in adolescent smokers, their motivation to smoke and/or stop smoking, and their knowledge of how to stop smoking as well as the potential difficulties involved.

METHOD

Three hundred forty-two high school students completed questionnaires using two measures of dependence (the Fagerstrom tolerance test and a visual-analog self-evaluation scale), a test to measure motivation to smoke (the Horn test), and a questionnaire exploring motivations to stop smoking, methods used to stop smoking, and the anticipated difficulties.

RESULTS

On the Fagerstrom tolerance test, 14.6% of the students indicated strong dependence, whereas 32.3% indicated intermediate dependence. The Fagestrom score was strongly correlated to the self-evaluation test (r = 0.54, P < 0.001) and negatively correlated with the subjects' ages at the onset of smoking (r = -0.28, P < 0.001). The Horn test revealed that the main motivation to smoke is the search for relaxation and a decrease of negative emotions, indicating that cigarette smoking is primarily a means to manage stress and anxiety. Eighty-nine percent of the subjects stated that they would like to stop smoking, primarily because of the financial cost and health concerns. Among those subjects wishing to stop, 64.5% had previously tried to stop and had failed and 72% believed that it would be 'difficult' or 'very difficult' to stop. The main anticipated difficulties were an increase in stress and anxiety and, for the girls, weight gain. The anticipation of these difficulties was strongly correlated to dependence scores (r = 0.43, P < 0.001). Despite awareness of these difficulties, only 19.6% of the subjects wishing to stop smoking expected to seek medical assistance. For most of the measured variables, there was no difference between boys and girls.

CONCLUSION

This study confirms the seriousness of tobacco consumption in adolescence. The results suggest the need for early programs aimed at preventing or delaying onset of use as well as the need to develop programs to aid high school students to stop smoking.

Public knowledge, awareness, and perceptions of the association between skin aging and smoking

BACKGROUND

Although the tobacco industry promotes images of glamour, 2 decades of epidemiologic research have concluded the opposite: smokers have enhanced facial aging and skin wrinkling compared with nonsmokers.

OBJECTIVE

The purpose of this study was to obtain information on the public's awareness of the association between cigarette smoking and skin aging.

METHODS

In the spring of 1994, the Maine-wide Cooperative Telephone Survey conducted telephone interviews in 678 randomly selected, nonseasonal dwelling units in Maine. From each dwelling unit, one randomly selected adult resident was interviewed to assess awareness of the association of skin aging with smoking.

RESULTS

Fifty-eight percent of those persons interviewed had smoked at least 100 cigarettes, and among them, 24% were current smokers (28% men, 21% women). After adjusting for sex, age, and education, current smokers remained less likely to be aware of this association compared with former (prevalence ratio, 0.78; 95% confidence interval, 0.64-0.95) and never smokers (prevalence ratio, 0.87; 95% confidence interval, 0.70-1.07). However, nearly one fourth of smokers in this study believed that most or some smokers would consider this information in their decision to quit, with slightly higher findings in young smokers.

CONCLUSION

These findings are of public health importance. While strategies for framing messages about the association between smoking and facial aging await further study, this association deserves to be considered in all tobacco control and counter-advertising campaigns.

Risky behavior and risk in adolescents with IDDM

PURPOSE

To determine: (1) the frequency of risky behaviors (alcohol and other drug use, smoking cigarettes, smokeless tobacco use, and unprotected intercourse); (2) the perception of general risks and diabetes-related risks from risky behaviors; (3) if perception of risk is related to engaging in risky behaviors; and (4) if perception of general risks and diabetes-related risks are influenced by age, gender, or race in adolescents with insulin dependent diabetes mellitus (IDDM). Decreasing risky behaviors in youth with IDDM is important because of their increased vulnerability to specific disease related physiologic and pathologic changes.

METHODS

A descriptive, cross-sectional design was used. Data on risky behavior and perception of risk were obtained by self-report during a regularly scheduled clinic visit. One hundred and fifty-five adolescents between ages of 10-20 years participated. Correlational and student's t-test analyses were used to test relationships and group differences (age, race, gender).

RESULTS

Thirty-nine percent of the sample reported alcohol use, 34% reported smoking cigarettes, 8% reported smokeless tobacco use, 10% reported drug use, and 29% reported unprotected intercourse. Perception of risk to peers from these behaviors was significantly higher (t = 8.1, df 153; p < .001) than risk to self. Females reported significantly lower (t = 3.08, df 52; p < .002) risk to self than males. There was no difference in perception of risk between youth who reported participating in risky behaviors (N = 38%) and those who did not (62%). Not surprisingly, the frequency of risky behavior increased with age (F = 15.46; p < .001).

CONCLUSIONS

Compared to community samples of middle school children, our sample had lower rates for most risky behaviors. As with community samples, the physical risks were known and perceived to be higher for peers than self. Perception of risk was not related to self-reports of risky behaviors. The lower rate of risky behaviors might reflect the success of educational efforts directed toward diabetes management or may be due to later initiation of behaviors, especially if personal social development is delayed. Additional research is indicated in order to understand the timing and trajectory of risky behavior and whether or not perception of risk deters youth with IDDM from engaging in risky behavior.

Smoking patterns and cessation motivations during adolescence

With increased knowledge of effective prevention of adolescent smoking, there is a concomitant lack of research on effective adolescent smoking cessation. This study surveyed 77 adolescents (mean age 15.8 years) at a youth detention center in Seattle, Washington, about smoking patterns, cessation attempts, and motivations as well as withdrawal symptoms from nicotine. The results revealed that the majority of smokers had previously attempted smoking cessation (72%). The most common reasons for wanting to quit were for health concerns. Only 30.8% abstained for more than 1 month, and 35.9% abstained for less than 3 days. Nicotine craving was the most severe and most commonly reported withdrawal symptom.

Models for effective prevention

The social influence models do provide some optimism for primary prevention efforts. Prevention programs appear most effective when 1) the target behavior of the intervention has received increasing societal disapproval (such as cigarette smoking), 2) multiple years of behavioral health education are planned, and 3) community-wide involvement or mass media complement a school-based peer-led program (45,46). Short-term programs and those involving alcohol use have had less favorable outcomes. Future research in primary prevention should address concerns of high-risk groups and high-risk countries, such as lower income populations in the United States or countries that have large adolescent homeless populations. The utilization of adolescent leaders for program dissemination might be particularly critical in these settings. A second major and global concern should focus upon alcohol use and alcohol-related problems. In many communities adolescent alcohol use is normative and even adult supported. Thus, young people are getting quite inconsistent messages on alcohol from their schools, from TV, from peers, and from parents. This inconsistency may translate into many tragic and avoidable deaths for young people. Clearly, in the area of alcohol-related problems, community-wide involvement may be necessary. A third direction for prevention research should involve issues of norms, access, and enforcement including policy interventions, such as involve the availability of cigarette vending machines or the ease of under-age buying or levels of taxation. These methods affect adolescents more acutely since their financial resources, for the most part, are more limited. These policy level methods also signify to adolescents what adults consider appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Helping your patients who smoke quit for good. A quick and easy approach

Cigarette smoking is the single most important behavior contributing to illness, disability, and death in the United States. However, by using appropriate techniques, physicians can help patients quit smoking, even when office visits are limited. Physicians who adopt the "differential diagnosis approach" (which categorizes smokers into stages of smoking cessation and offers specific counseling techniques) have increased confidence in their ability to help their patients. They thus can have a significant impact on the large percentage of smokers who visit physicians' offices each year.

Passive smoking in childhood--tobacco smoke

Prevalence of cigarette smoking varies widely in different countries, ranging, at the age of 13, from 2% to 5% (Sweden, United States) to more than 30% (Australia, Uruguay). Even if the prevalence of smokers among male adolescents is decreasing in western countries, it is increasing among girls and, in developing countries, male adolescent smokers still reach 40% (and up to 70%-80%). The determination of saliva cotinine levels, a product of nicotine metabolism, is an useful indicator of exposure to passive or active smoking. In a study of 210 children aged 9-13 years, we found detectable levels of saliva cotinine in 13% of children who lived in nonsmoking families and denied being regular smokers and in only 60% of children living in families with heavy cigarette consumption. This wide variations of a marker of smoking exposure may explain the differences in reported consequences of tobacco smoke in investigations conducted in different places and on different target populations. We later studied the effects of environmental tobacco smoke (ETS) in a sample of 166 nine-year-old children. The relationship between parental smoking and degree of bronchial responsiveness in males was significant. Also, prick skin test reactivity to allergens was significantly increased in children of smoking parents. Many studies concerning the effects of ETS exposure seem to demonstrate that not only the lungs and not only children are affected even if the difficulty of the epidemiology in such a field must suggest caution in interpreting the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Cigarette smoking: the clinician's role in cessation, prevention, and public health

Cigarette smoking is the most important preventable cause of illness and death in the United States, responsible for 390,000, or one sixth, of all deaths. Although smoking prevalence has decreased among adults, from 40% in 1965 to 29% in 1987, 49 million Americans continue to smoke. Smoking rates have declined at a slower rate among blacks, women, young people, and the less educated, groups that must be targeted for tobacco use prevention interventions. The clinician is uniquely positioned to reduce the enormous health toll from cigarette smoking. As a first step, physicians are urged to assess tobacco use during every patient visit by making smoking status a new vital sign. Although 85% of all smokers quit on their own, physicians can greatly facilitate this process. A brief intervention for physicians to help their smoking patients quit, based on a program of the National Cancer Institute, is presented. This program includes asking about smoking status during every clinic visit, advising all smoking patients to quit, assisting smokers by setting a quit date and using nicotine gum, if appropriate, and arranging follow-up with smokers who try to quit. Cessation rates of 5% to 25%, sustained for at least 1 year, are consistent with a successful, physician-mediated intervention program. Physicians are also urged to prevent smoking initiation among adolescents, particularly young girls and those not aspiring to attend college. Physicians can also reduce the enormous toll of tobacco use by acting at the public health and public policy levels. Recording tobacco use as a contributing or the underlying cause on death certificates, if appropriate, will assist in public health surveillance. Also, clinicians are urged to work at the organizational, community, and governmental levels to promote tobacco-free environments.