Trends in cigarette smoking among children in a southern community, 1976-1994: the Bogalusa Heart Study

Trends in Cardiovascular Health Among US Adolescents Aged 12-19 Years Using the New "Life's Essential 8" Metrics, 2007-2018

PURPOSE

The American Heart Association recently issued a substantial update to the definition and scoring of cardiovascular health (CVH), now called "Life's Essential 8" (LE8). We aimed to assess the trends in overall and individual LE8 CVH metrics among adolescents in the United States.

METHODS

A total of 6,999 United States adolescents aged 12-19 years from six cycles of the National Health and Nutrition Examination Survey from 2007-2008 to 2017-2018 were included in this study. The individual LE8 metrics included diet, physical activity, nicotine exposure, sleep health, body mass index (BMI), blood lipids, blood glucose, and blood pressure (BP). A higher CVH score indicates better CVH health.

RESULTS

The mean score of overall CVH significantly increased from 72.8 (95% confidence interval: 71.2-74.3) in 2007-2008 to 77.3 (76.1-78.5) in 2017-2018 in US adolescents (p-trend < .001). From 2007-2008 to 2017-2018, the mean scores increased from 75.5 (72.0-79.1) to 90.0 (88.0-91.9) for nicotine exposure, from 65.2 (61.6-68.8) to 73.3 (69.9-76.8) for sleep health, from 69.9 (67.1-72.8) to 73.0 (69.1-76.9) for blood lipids, and from 94.4 (93.0-95.9) to 96.2 (95.2-97.3) for BP (all p-trend < .05). However, the mean scores for diet, physical activity, and blood glucose did not significantly change (all p-trend > .05), whereas the mean score decreased from 81.4 (78.9-84.0) to 78.6 (76.4-80.8) for BMI (p-trend = .023).

DISCUSSION

In United States adolescents, the overall CVH and four components (nicotine exposure, sleep health, blood lipids, and BP) significantly improved over time, diet, physical activity, and blood glucose remained unchanged, whereas BMI worsened.

Cardiovascular Health Promotion in Children: Challenges and Opportunities for 2020 and Beyond: A Scientific Statement From the American Heart Association

This document provides a pediatric-focused companion to "Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Association's Strategic Impact Goal Through 2020 and Beyond," focused on cardiovascular health promotion and disease reduction in adults and children. The principles detailed in the document reflect the American Heart Association's new dynamic and proactive goal to promote cardiovascular health throughout the life course. The primary focus is on adult cardiovascular health and disease prevention, but critical to achievement of this goal is maintenance of ideal cardiovascular health from birth through childhood to young adulthood and beyond. Emphasis is placed on the fundamental principles and metrics that define cardiovascular health in children for the clinical or research setting, and a balanced and critical appraisal of the strengths and weaknesses of the cardiovascular health construct in children and adolescents is provided. Specifically, this document discusses 2 important factors: the promotion of ideal cardiovascular health in all children and the improvement of cardiovascular health metric scores in children currently classified as having poor or intermediate cardiovascular health. Other topics include the current status of cardiovascular health in US children, opportunities for the refinement of health metrics, improvement of health metric scores, and possibilities for promoting ideal cardiovascular health. Importantly, concerns about the suitability of using single thresholds to identify elevated cardiovascular risk throughout the childhood years and the limits of our current knowledge are noted, and suggestions for future directions and research are provided.

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.

Fifth through eighth grade longitudinal predictors of tobacco use among a racially diverse cohort: CATCH

CATCH provides multiethnic cohort data from third to eighth grades from four US geographic regions. This study examined smoking behaviors and predictors from fifth and eighth grades by ethnicity, gender, and geographic location through self-report data obtained from the cohort (N = 3,654). Overall, eighth grade prevalence for ever smoked was about 44%, 30-day prevalence was about 20%, 7-day prevalence 13.3%, and daily prevalence 7.4%. Prevalence was similar for Caucasians (21.5%) and Latinos (21.6%) and lowest for African Americans (13.1%). The 30-day prevalence for smokeless tobacco was higher for boys than for girls (9.8% vs 5.1%). Tobacco use by parents, siblings, and friends, and easy accessibility in the home in fifth grade, were significant predictors for smoking in eighth grade. Results did not differ by race, gender, or geographic location. The strongest correlate of smoking in eighth grade was having a best friend who smoked. Intention not to smoke in fifth grade predicted nonsmoking in eighth grade. Predictor strength across ethnic groups in different geographic regions was impressive. The social environment of young people continues to be an important instigator of smoking onset. The connection between intention and behavior over time suggests students' intentions not to smoke reflect decision-making at an early age.

Anti-tobacco socialization in homes of African-American and white parents, and smoking and nonsmoking parents

PURPOSE

To examine parental perceptions and behaviors with regard to teen smoking, comparing African-American and white parents, and those who did and did not smoke.

METHODS

Focus groups consisting of African-American and white parents who smoked provided initial in-depth information. A computer-assisted telephone survey of a biracial sample of 311 parents of children ages 8 to 17 years provided more generalizable information regarding parental beliefs and behaviors.

RESULTS

Nearly 50% of households either allowed teen smoking, had no ground rules, or had set restrictive rules but never communicated them to the children. Compared to white parents, African-American parents felt more empowered to affect their children's behaviors and were more likely to actively participate in anti-tobacco socialization within the home (all p values < 0.01). Among the African-American parents, 98% reported 18 years or older to be an appropriate age for teens to make up their own minds about using tobacco, whereas 26% of white parents thought 16 years to be an appropriate age (p < 0.001). Parents who smoked reported more frequent rule-making than those who did not smoke (p = 0.02), but were more likely to believe that childhood tobacco use is inevitable (p = 0.01).

CONCLUSIONS

Many parents are not engaged in antitobacco socialization in the home. Differences in the degree of parental participation may contribute to the variance in smoking prevalence between African-American and white children.

Ten-year trends in cigarette smoking among young adults, 1986-1996: the CARDIA study. Coronary Artery Risk Development In Young Adults

PURPOSE

To calculate ten-year smoking trends in a longitudinal cohort of young adults, and to characterize trends by race, sex, education, and birth cohort.

METHODS

Data on cigarette smoking have been collected for ten years (1986-1996) from 5115 black and white men and women, aged 18-30 years, participating in the Coronary Artery Risk Development In Young Adults (CARDIA) study. Regression analysis adjusting for intra-person correlation over time and weighting for factors affecting follow-up was used to estimate change in smoking rates.

RESULTS

Overall, smoking rates declined in white women (-0.50%/year, p < 0.001) and white men (-0.24%/year, p = 0.03). Rates remained stable in black women and increased in black men (0.37%/year, p = 0.01). Declining rates were generally observed in white women of all educational levels and birth cohorts and in several subgroups of white men. Increasing rates among black men could be attributed primarily to increasing rates in the youngest birth cohort. Among black men and women, prevalence of smoking in 1986 was considerably lower in the youngest birth cohort compared to the oldest; however, the increasing rates of change in smoking rates observed among the youngest birth cohorts (and decreasing rates in the oldest) lessened the disparity in prevalence rates across birth cohorts by 1996. Smoking initiation rates were highest among black men; cessation rates were highest among white women.

CONCLUSIONS

These findings confirm that declines in smoking prevalence are not occurring across all groups, and reveal populations in special need of targeted interventions, particularly young black men.