Factors Associated With Smoking Onset: 3-Year Cohort Study of Schoolchildren

The relationship between secondhand smoke exposure, pro-tobacco social influences, and smoking susceptibility among nonsmoking Zambian adolescents

BACKGROUND

We tested the hypothesis that the extent of secondhand smoke (SHS) exposure among nonsmoking adolescents would be associated with their overall exposure to pro-tobacco social influences.

METHODS

Data were analyzed using descriptive and multivariate methods from the 2011 Zambia Global Youth Tobacco Survey.

RESULTS

The odds of SHS exposure increased with increasing exposure to pro-tobacco advertisements. About 39.5% of the gap in SHS exposure between nonsmokers with low versus high smoking susceptibility was attributable to differences in parental or peer smoking.

CONCLUSIONS

Sustained efforts are needed to denormalize tobacco use in order to reduce youth susceptibility to tobacco use.

Effectiveness of a complex intervention in reducing the prevalence of smoking among adolescents: study design of a cluster-randomized controlled trial

Background

The likelihood of an adolescent taking up smoking may be influenced by his or her society, school and family. Thus, changes in the immediate environment may alter a young person’s perception of smoking.

Methods/Design

The proposed multi-center, cluster-randomized controlled trial will be stratified by the baseline prevalence of smoking in schools. Municipalities with fewer than 100,000 inhabitants will be randomly assigned to a control or intervention group. One secondary school will be randomly selected from each municipality. These schools will be randomized to two groups: the students of one will receive any existing educational course regarding smoking, while those of the other school will receive a four-year, class-based curriculum intervention (22 classroom lessons) aimed at reinforcing a smoke-free school policy and encouraging smoking cessation in parents, pupils, and teachers. The intervention will also include annual meetings with parents and efforts to empower adolescents to change the smoking-related attitudes and behaviors in their homes, classrooms and communities.

We will enroll children aged 12-13 years as they enter secondary school during two consecutive school years (to obtain sufficient enrolled subjects). We will follow them for five years, until two years after they leave secondary school. All external evaluators and analysts will be blinded to school allocation.

The aim of this study is to analyze the effectiveness of a complex intervention in reducing the prevalence of smoking in the third year of compulsory secondary education (ESO) and two years after secondary school, when the participants are 14-15 and 17-18 years old, respectively.

Discussion

Most interventions aimed at preventing smoking among adolescents yield little to no positive long-term effects. This clinical trial will analyze the effectiveness of a complex intervention aimed at reducing the incidence and prevalence of smoking in this vulnerable age group.

Trial registration

Current Controlled Trials: NCT01602796.

Why do Romanian junior high school students start to smoke?

BACKGROUND

Adolescence is a crucial period in the development of smoking behaviour. To develop efficient prevention programmes for teenagers, it is essential to understand why adolescents start to smoke. The objective of this study was to assess the predictors of smoking onset among Romanian junior high school students aged 13-14.

METHODS

The data were obtained from a two-wave, 9-month longitudinal study carried out among 504 junior high school non-smokers from Cluj-Napoca, Romania. Questionnaires assessed smoking behaviour, attitudes, social influence, self-efficacy and intention regarding smoking (motivational variables), as well as different sociodemographic features.

RESULTS

The results from the logistic regression analysis revealed that baseline lower self-efficacy in refraining from smoking in several social situations, baseline pressures from peers to smoke and baseline intentions to smoke significantly increased the risk of non-smokers to become smokers at follow-up 9 months later.

CONCLUSIONS

These findings underline that reinforcing social self-efficacy to refuse smoking, resisting peer pressures and maintaining negative intentions regarding smoking are essential ingredients for smoking prevention programmes among Romanian junior high school students.

Factors associated with commencing smoking in 12-year-old students in Catalonia (Spain): a cross-sectional population-based study

Background

Over the last decade notable progress has been made in developed countries on monitoring smoking although experimenting with cigarettes and smoking in young people remains a serious public health problem. This paper reports a cross-sectional study at the beginning of the 3-year follow-up community study TA_BES. The aim was to study the prevalence of smoking in addition to determining predictive factors for when smoking commences in a representative population of 12-year-old first year compulsory secondary education students.

Methods

Twenty-nine secondary schools (N = 29) from an area of Catalonia participated in the study. In these schools 2245 students answered a questionnaire to study the attitudes, behaviors, and tobacco consumption in the subject's surrounding circle and family in relation to smoking; carbon monoxide measurements were taken by means of co-oximetry on 2 different occasions. A smoker was defined as a student who had smoked daily or occasionally in the last 30 days. For non-smokers the criteria of not considering was set up for those who answered that in the future they would not be smokers and considering those who answered that they did not rule out becoming a smoker in the future.

Results

Among the total 2245 students included in the analysis 157(7%) were classified as smokers. Among non-smokers we differentiated between those not considering smoking 1757 (78.3%) and those considering smoking 288 (12.8%).

Age is among the factors related to commencing smoking. The risk of becoming a smoker increases 2.27 times/year. The influence of the group of friends with a very high risk for boys OR 149.5 and lower, albeit high, in girls OR 38.1. Tobacco consumption of parents produces different effects in young people. A smoking father does not produce alterations in the smoking behavior of young people. However having a smoking mother or former smoking is a risk factor for boys and a protective factor for girls.

We detected a gradual risk of becoming a smoker by means of the co-oximetry test. A boy/girl with a test between 6 p.p.m and 10 p.p.m increased the probability of smoking by 2.29 and co-oximetry values > 10 p.p.m multiplied the risk 4 times over.

Conclusions

Results indicate that the age of commencing smoking is maintained in spite of prevalence having decreased in the last few years. The risk factors identified should be used to involve families and the educational community by offering them tobacco weaning programmes.

Smoking risk factors and gender differences among Spanish high school students

The objectives of the present study were to analyze the pattern of tobacco use among Spanish adolescents, as well as to determine gender differences in specific risk factors of cigarette use. The study sample was made up of 1,483 boys and 1,358 girls, aged 12-16 (M = 14). Participants were asked to answer an ad-hoc instrument to evaluate the pattern of use, perceived availability, risk of harm, family- and peer-use, engagement in leisure activities, drive for thinness, and self-esteem. Results showed no gender differences in the pattern of use. With regard to risk and protector factors, a predictive analysis showed that peer-related variables were the most determinant for tobacco use both for boys and girls. Some gender differences were also detected: Playing sports was protective for boys only, and listening to music for girls only. Drive for thinness and self-esteem were not related to tobacco use for either boys or girls. These findings help increase our understanding of smoking risk factors in adolescence and to pay special attention to the group of friends when planning prevention programs to reduce risk factors.

The impact of social influence on adolescent intention to smoke: combining types and referents of influence

OBJECTIVES

Theory and research suggest that the intention to smoke is the main determinant of smoking initiation and emphasizes the role of cognitive and social factors on the prediction of the intention to smoke. However, extended models such as the I-Change and results from published studies reveal inconsistencies regarding the impact of social influence on the intention to smoke. Possible explanations for this may be the definition and measurement of the constructs that have been used.

DESIGN AND METHODS

The current study was designed with two main goals: (i) to test a measurement model for social influence, combining different types of social influence (subjective norms, perceived behaviour, and direct pressure) with various referents of influence (parents, siblings, peers, and teachers); (ii) to investigate the impact of social influence on adolescent intention to smoke, controlling for smoking behaviour. LISREL was used to test these models. The sample includes 3,064 Portuguese adolescents, with a mean age of 13.5 years, at the beginning of the seventh school grade.

RESULTS

The hypothesized measurement model of social influence was supported by results and explained 29% of the variance of the intention to smoke. A more extended model, including attitude and self-efficacy, explained 55% of the variance of the intention to smoke. Perceived behaviour of peers, parental norms, and perceived behaviour of parents were the social influence factors with impact on adolescent intention to smoke.

CONCLUSIONS

Results suggest that different referents exert their influence through distinct types of social influence and recommend further work on the definition and measurement of social influence.

Longitudinal effects of the European smoking prevention framework approach (ESFA) project in Spanish adolescents

BACKGROUND

To describe the effects of a Spanish smoking prevention programme in the context of an European project on regular smoking, in a sample of Barcelona adolescents.

METHOD

A quasi-experimental design was conducted. An experimental group (EG) (1080 pupils) was exposed to programme and compared with a control group (CG) (872 students). The intervention included a school-based programme (16 sessions in 3 years), reinforcement of a smoke-free school policy, smoking cessation for teachers, brochures for parents and other community-based activities involving youth clubs and tobacco sales.

RESULTS

At 12 months, 4.5% of boys and 5.6% of girls were new smokers in the EG versus 6.7% and 11.7% in the CG (P < 0.001). At 36 months, 18.6% of boys and 31.2% of girls in the EG were regular smokers versus 21.6% of boys and 38.3% of girls in the CG (P < 0.001). The main factors associated with progression to regular smoking at 36 months were to be girl, to attend to a public school and to belong to the CG.

CONCLUSION

These results endorse the effectiveness of multi-modal smoking prevention programmes, which include strategies with adults who influence adolescents.

[Variability in smoking experimentation and risk factors in 4 secondary schools in Murcia (Spain)]

OBJECTIVE

To identify patterns of tobacco experimentation and consumption in 4 geographically close groups of students in the first year of secondary education, as well as attitudes and consumption in their social environments. To identify the factors associated with tobacco experimentation and consumption in each of the student groups.

MATERIAL AND METHOD

An observational, descriptive, cross-sectional, multicenter study was conducted in 4 secondary schools in the region of Murcia (Spain). The study population consisted of first graders in secondary education, recruited in January 2005. The study variables were collected using a modified version of the FRISC questionnaire.

RESULTS

The study population was composed of 377 students (190 boys) with a mean age of 12.6 years (standard deviation [SD] = 0.6). Between 15.3% and 42.1% of the students had smoked at some time. Between 2% and 6.9% smoked regularly. These differences were related to socioeconomic characteristics ("living with the mother", p = 0.049; "living with the father", p = 0.015) and consumption in the environment ("mother", p = 0.013; "friends", p < 0.001; "teachers", p < 0.001). Multivariate analysis revealed an association between experimentation and receiving more than 6R per week pocket money, consumption among friends, experimenting with alcohol and not living in one of the towns studied.

CONCLUSIONS

Significant differences were found among the towns studied. Application of standard preventive programs may prove ineffective unless they are adapted to the characteristics of the specific school.

[Parental smoking and lung function in healthy children and adolescents]

OBJECTIVE

The debate continues on the effect of passive smoking on nonsmokers. The effect of parental smoking on the lung function of children varies considerably according to geographic area, source of passive smoking, and sex. The objective of this study was to evaluate the effect of parental smoking on the lung function of children.

POPULATION AND METHODS

A cross-sectional study was performed on a sample of the population of healthy children and adolescents between 6 and 18 years of age in Galicia. Subjects were selected by means of 2-stage cluster sampling grouped by sex and age.

RESULTS

Approximately 56% of the children were exposed to the tobacco smoke of one of their parents. Children whose fathers were smokers presented a 40% higher risk of reduced forced expiratory flow at 75% of forced vital capacity (FEF75%) and a 30% higher risk of reduced FEF25%-75%. Children whose mothers were smokers presented a 30% higher risk of reduced forced expiratory volume in the first second and a 40% higher risk of reduced FEF50%. There was a 60% increase in risk of reduced FEF75%. The fact that both parents smoked did not appear to increase the risk of reduced lung function.

CONCLUSIONS

Parental smoking has a considerable effect on the lung function of children and adolescents. Smoking by either the mother or the father has a decisive influence. The fact that this effect is independent of the growth of the child and that the obstructive effect is located principally in the distal airways appears to confirm the hypothesis that this effect is produced after birth.

The social factors implicated in cigarette smoking in a Jordanian community

Cigarette smoking is highly prevalent among scholars and university students in Jordan. The aim of this study is to discover the environmental factors and social influences that motivate Jordanian students to smoke and to recommend adequate programs in order to stop adolescents from smoking. A questionnaire of (28) items was designed to assess students and professor's attitudes towards smoking, the sample of the study consisted of(851) participants from different levels in a community nearby Al-Isra Private University. The study also attempted to examine the effects of the following factors: social status, age, gender, parental education and mode of spending free time, having parents, siblings, friends and teachers who smoke. The results show that the proportion of smokers to nonsmokers was of (33:67). The first cigarette smoked by 65% of the sample, was before the age of 18 years and 88.5% was before the age of 21 years. The environmental factors and social influences that motivate students to smoke were related to teachers and friends behavior. The major reasons to start smoking were to try something new and Spending free time with friends more than with family. Also Health disturbances suffered by smokers (fatigue, stress, frustration and depression) were as two times greater compared to nonsmokers. Desire to quit smoking among participants were very high and there was a positive correlation between nonsmokers and high level of education. Desire were greatly negative to have smoker mate = 93%, smoker children = 96% or smoker friends = 87%. In conclusion the increased rate of smoking before age of 18 years indicates that smoking prevention programs need to be started at an earlier age. The risk factors of smoking onset are subject to modification and families must be aware of the potential risks of certain ways of spending time and modifying attitudes.

Which sociodemographic factors are important on smoking behaviour of high school students? The contribution of classification and regression tree methodology in a broad epidemiological survey

BACKGROUND

The purpose of this study is to evaluate the most important sociodemographic factors on smoking status of high school students using a broad randomised epidemiological survey.

METHODS

Using in-class, self administered questionnaire about their sociodemographic variables and smoking behaviour, a representative sample of total 3304 students of preparatory, 9th, 10th, and 11th grades, from 22 randomly selected schools of Mersin, were evaluated and discriminative factors have been determined using appropriate statistics. In addition to binary logistic regression analysis, the study evaluated combined effects of these factors using classification and regression tree methodology, as a new statistical method.

RESULTS

The data showed that 38% of the students reported lifetime smoking and 16.9% of them reported current smoking with a male predominancy and increasing prevalence by age. Second hand smoking was reported at a 74.3% frequency with father predominance (56.6%). The significantly important factors that affect current smoking in these age groups were increased by household size, late birth rank, certain school types, low academic performance, increased second hand smoking, and stress (especially reported as separation from a close friend or because of violence at home). Classification and regression tree methodology showed the importance of some neglected sociodemographic factors with a good classification capacity.

CONCLUSIONS

It was concluded that, as closely related with sociocultural factors, smoking was a common problem in this young population, generating important academic and social burden in youth life and with increasing data about this behaviour and using new statistical methods, effective coping strategies could be composed.

[Smoking among adolescents: population study on parental and school influences]

OBJECTIVE

Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors.

SUBJECTS AND METHODS

The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home.

RESULTS

A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school.

CONCLUSIONS

Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school.