A six-year follow-up study of determinants of heavy cigarette smoking among high-school seniors

Adolescent smoking patterns: Associations with sociodemographic factors, cyberbullying, and psychiatric diagnoses in an outpatient clinical sample

There is a scarcity of research on smoking in adolescents within a clinical (outpatient) sample, and there is no existing knowledge on the relationship between cyberbullying and smoking in this population. The primary aim of this study is to determine the prevalence of smoking among adolescents in a clinical sample. Additionally, it aims to examine the potential associations between smoking status and factors such as socioeconomic characteristics, psychiatric diagnoses, and cyberbullying levels. A cross-sectional study was performed on 200 adolescents who visited a tertiary child and adolescent psychiatry outpatient clinic. Participants were assessed using the DSM-5 based psychiatric evaluation, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM-5 Turkish Adaptation (K-SADS-PL-DSM-5-T), the Revised Cyber Bullying Inventory-II, and the Fagerström Test for Nicotine Dependence. The study found that 21% of the sample consisted of regular smokers, with a higher prevalence observed among older adolescents. The prevalence of depression and disruptive behavior disorders was significantly greater in the smoking group compared to other groups (p:0.043, p < 0.001, respectively). There was a significant difference in the scores for the cyberbullying bully subdimension among smokers (p = 0.013). The results of the multinomial logistic regression analysis indicated significant associations between smoking and age, maternal smoking status, friends smoking status, and a diagnosis of disruptive behavior disorder (p < 0.05 for all variables). This study reveals a significant prevalence of adolescent smoking in an outpatient clinic. These findings highlight the necessity of implementing focused smoking cessation interventions for this specific population.

Evidence for a Causal Relationship Between Academic Achievement and Cigarette Smoking

INTRODUCTION

Academic achievement (AA) is associated with smoking rates. Can we determine the degree to which this relationship is likely a causal one?

METHODS

We predict smoking in male conscripts (mean age 18.2) assessed from 1984 to 1991 (N = 233 248) and pregnant females (mean age 27.7) receiving prenatal care 1972-1990 (N = 494 995) from AA assessed in all students at 16. Instrumental variable (IV) analyses used the instrument month-of-birth as in each school year, older children have high AA. Co-relative analyses used AA-smoking associations in the population, cousins and siblings to predict the AA-smoking relationship in MZ twins, thereby controlling for familial confounding.

RESULTS

In males, higher AA was associated with a substantial decrease in risk for smoking (odds ratio [OR] [95% confidence intervals [CIs]] per standard deviation [SD] = 0.41 [0.40-0.41]) while the parallel figures obtain from our IV and co-relative analyses were 0.47 (0.39-0.57) and 0.51 (0.43-0.60), respectively. In females, these figures for pre-pregnancy smoking were, respectively, 0.39 (0.39-0.39), 0.50 (0.46-0.54) and 0.54 (0.51-0.58). Results for heavy versus light smoking suggested a causal effect but were inconsistent across methods. However, among females smoking prior to pregnancy, AA predicted a reduced risk for continued smoking with ORs for uncontrolled, IV, and co-relative analyses equaling, respectively, were 0.54 (0.53-0.55) 0.68 (0.56-0.82) and 0.78 (0.66-0.91), respectively.

CONCLUSIONS

Two different methods produced consistent evidence that higher AA has a causal effect on reducing smoking rates and increasing cessation rates in smoking pregnant females. Improving AA may result in meaningful gains in population health through reduced smoking.

IMPLICATIONS

This study provides consistent evidence across two different methods that high AA is causally related to reduced rates of smoking and increasing rates of smoking cessation among pregnant women. Our results suggest that interventions that improve educational achievement in adolescence would reduce tobacco consumption, thereby improving public health.

Social Marketing Campaign in Tobacco Control (A Comparative Analysis of Indonesia and Taiwan)

BACKGROUND: Concern about the introduction of young adult smoking is increasing, perhaps because young adults have become a major tobacco marketing target. To solve this issue, both Bali and Taiwan have imposed local regulations on smoke-free areas. Concern about the legalization of young adult smoking is increasing, possibly because young adults have become a major marketing target for tobacco. Both Bali and Taiwan have placed local restrictions on smoke-free areas to solve this issue. AIM: This study will analyze the social marketing strategies used to impact young adults in Indonesia and Taiwan focusing specifically on aspects of the social marketing strategy, including channel analysis, market segmentation and consumer analysis, product, price, location and promotion considerations, as well as the implementation and evaluation. METHODS: This research employed a qualitative approach. Qualitative inquiry is a way of analysis by understanding the meaning of individuals or groups in social problems or human problems. The process comprises questions and procedures. Data collection was conducted by face-to-face interviews. The basic data for this paper came from face-to-face interviews with local government officials, local community leaders and members of the NGO community. RESULTS: The study found that 4P (Product, Price, Place, and Promotions) with the additional +2P (Partnership and Policy) elements of social marketing are employed by social marketing in Bali and Taiwan. The product refers to the principle of a safe life, in which it is easier to avoid than to cure. Price relates to the shift in behavior and the avoidance of early smokers, from smoking to stopping. The distribution networks used in Bali concentrate more on support for families and neighborhoods. CONCLUSION: The social marketing strategy using 4P (Product, Price, Place, and Promotion) and additional +2P (Partnership and Policy) elements is an effective model both in Taiwan and Bali. The commodity on the market is the concept of a safe life, where prevention is better than cure. The price is the shift in action, from smoking to stopping, and the prevention of early smoking. The two countries also include other parties, such as schools and community groups, to collaborate.

Individual intelligence and brain neural correlates associated with outcome expectancies for risk behaviors in adults

Although adults have matured developments of general intelligence, brain structure and brain function, many people continue to be risk takers, despite the harm that can result. The neural basis underlying risk-taking behaviors has been studied extensively in adolescents, but less so in adults. Outcome expectancies are important factors influencing individuals' risk behaviors, which comprise the expected risks (ER) and expected benefits (EB) associated with risk behaviors. In the current study, we systematically investigated inter-individual differences in adults' outcome expectancies for risk behaviors, considering the general intelligence, brain function, and brain structure. At the intelligence level, individuals with higher intelligence scores showed lower ER but higher EB associated with risk behaviors. At the brain function level, resting-state functional connectivity (FC) between regions within the default mode network is negatively correlated with ER but positively correlated with EB associated with risk behaviors, while FC between the insula and motor cortex is negatively correlated with EB associated with the risk behaviors. At the brain structure level, gray matter volume in posterior cingulate cortex (PCC) and bilateral parahippocampus were negatively correlated with the ER associated with risk behaviors. Furthermore, the relationship between the outcome expectancy associated with risk behaviors and the FC between anterior cingulate cortex and PCC is partially mediated by the general intelligence. The current study provides new insight that furthers our understanding of how individual differences in adults' risk attitudes and behaviors are modulated by general intelligence and reflected in resting-state FC and brain structures related to self-reference and inhibitory control processing.

Smoking cessation in pregnancy: a continuing challenge in the United States

Despite significant population level declines, smoking during pregnancy remains a major public health issue in the United States (US). Approximately 360,000-500,000 smoke-exposed infants are born yearly, and prenatal smoking remains a leading modifiable cause of poor birth outcomes (e.g. birth < 37 gestational weeks, low birth weight, perinatal mortality). Women who smoke during pregnancy are more likely to be younger and from disadvantaged socioeconomic and racial and ethnic groups, with some US geographic regions reporting increased prenatal smoking rates since 2000. Such disparities in maternal prenatal smoking suggests some pregnant women face unique barriers to cessation. This paper reviews the current state and future direction of smoking cessation in pregnancy in the US. We briefly discuss the etiology of smoking addiction among women, the pathophysiology and effects of tobacco smoke exposure on pregnant women and their offspring, and the emerging issue of electronic nicotine delivery systems. Current population-based and individual smoking cessation interventions are reviewed in the context of pregnancy and barriers to cessation among US women. Finally, we consider interventions that are on the horizon and areas in need of further investigation.

Identifying demographic and psychosocial factors related to the escalation of smoking behavior among Mexican American adolescents

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health. N=1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age=11.8 (SD=0.8), and 26.0% were born in Mexico. By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR=1.30; CI=1.07-1.57), male (OR=1.88, CI=1.40-2.53), having higher levels of anxiety (OR=1.03, CI=1.02-1.05), intending to smoke (OR=1.70, CI=1.18-2.46), having friends who smoke (OR=1.73, CI=1.12-2.70) and having parents' friends who smoke (OR=1.38, CI=1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR=0.91, CI=0.83-0.99) were protective against smoking escalation. Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation.

Effects of acute and chronic caffeine on risk-taking behavior in children and adolescents

Consumption of caffeinated beverages is associated with increased risk-taking behavior. The purpose of this study was to determine if acute caffeine administration influences risk-taking behavior in a dose-dependent manner. Participants were pre- (ages 8-9) and post-pubertal (ages 15-17) children who visited the laboratory three times and consumed a beverage containing 0, 1, or 2 mg/kg of caffeine. Thirty minutes later, participants completed the balloon analogue risk task (BART), the Iowa gambling task (IGT), and a delay discounting task. The number of balloons exploded on the BART task was significantly increased after 2 mg/kg of caffeine in moderate caffeine consumers, but was decreased after 2 mg/kg of caffeine in high caffeine consumers. There were no main effects of caffeine dose on the delay discounting task or on the IGT. Post-pubertal participants showed reduced delay discounting compared with pre-pubertal participants. Finally, average daily caffeine use was significantly, positively correlated with scores on a risk-taking questionnaire. These data suggest that caffeine dose-dependently influences decision making and risk taking. More research is needed to determine the mechanism of this difference as well as the extent to which sex and pubertal phase influence these relationships.

Influences of Personal, Injunctive, and Descriptive Norms on Early Adolescent Substance use

Social norms play an important role in adolescent substance use. Norm focus theory (Cialdini, Reno, & Kallgren, 1990) distinguishes three types of norms: injunctive, descriptive, and personal. This study examines the relative influences of these three norms, as well as the moderating effects of gender and ethnicity, on the concurrent substance use of 2,245 Mexican or Mexican-American students, 676 students of other Latino or multiethnic Latino origin, 756 non-Hispanic White students, and 353 African- American students. Personal norms appear to be the strongest significant predictor of substance use. Descriptive, parental injunctive, and friend injunctive norms also demonstrate significant, though weaker influences. Controlling for intentions reduces the predictive ability of each type of norm, especially personal norms. Gender moderates the relationship between norms and substance use with the relationships generally stronger for males. Personal norms act as stronger predictors of some types of substance use for Mexican/Mexican Americans.

Psychosocial Correlates of Smoking Trajectories Among Urban African American Adolescents

Little is known of smoking trajectories or of the correlates of smoking trajectories among African American youth. Ninth-grade African American adolescents (n = 566) were interviewed in Year 1 and then were subsequently interviewed annually for 3 additional years. Five trajectories of cigarette smokers were identified: abstainers, experimenters/consistent light smokers, consistent regular smokers, accelerators, and quitters. Psychological well-being at Year 1 was lower among consistent regular smokers and accelerators as compared to abstainers. Variance in other problem behaviors mirrored the smoker trajectories. At Year 4,the abstainers and experimenters/consistent light smokers reported greater participation in sports activities as compared to the quitters, whereas the abstainers reported greater participation in other school activities as compared to the consistent regular smokers.

Adolescents Discriminate between Types of Smokers and Related Risks

Many studies concerning cigarette smoking and smoking-related outcomes among adolescents use categories such as “casual” or “regular” smoker to define different types of smokers. It is not clear whether adolescents themselves differentiate between different types of smokers. The present study sought to examine whether and how adolescents discriminate between categories of smokers and how these discriminations engender different perceptions of risk attributable to smoking. Five hundred and fifty ninth graders (mean age 14) who reported never smoking tobacco completed a self-administered survey concerning smoking attitudes and beliefs. Adolescents discriminated significantly between nonsmokers, casual smokers, smokers, and addicted smokers, based on both frequency of smoking and the number of cigarettes smoked. Addicted smokers were perceived as having the greatest chance of experiencing negative outcomes, followed by the smoker, the casual smoker, and last, the nonsmoker. Finally, adolescents ascribed a far greater chance of quitting smoking to casual smokers than they did to either regular or addicted smokers. Understanding how adolescents define and discriminate between types of smokers has important implications for smoking-related interventions, especially concerning how we communicate about risks of smoking.

A pilot study of what African American maternal caregivers and their adolescent daughters talk about when asked to discuss tobacco together

Parents play a critical role in shaping their children's substance use behaviors, yet few studies have examined the messages that caregivers give their adolescents about tobacco. In this study, we identify tobacco-related messages discussed by African American maternal caregivers and their adolescent daughters. Twenty-five African American maternal caregivers and their adolescent daughters participated in a video-taped discussion about tobacco. Discussions were transcribed and coded thematically. Seven themes emerged, which were grouped into tobacco-messages and communication strategies. Messages included health risks, non-health-related reasons to stop smoking, reasons people smoke, and tobacco products and marijuana. Strategies caregivers used to communicate their tobacco-related messages included sharing personal or their families' experience with smoking, using humor, and role-playing. Finally, embedded within all of the themes, participants expressed their disapproval of tobacco use, whether it was directed at their own use, their adolescents' use, a family members' use, or peers' use. African American maternal caregivers and their daughters openly talk about a variety of tobacco-related topics, and caregivers are open to sharing their own and their families' experience with substance use. Findings also suggest that having caregivers and their adolescents participate in discussions tasks could be potentially beneficial in facilitating discussions and could identify areas in which caregivers could use help in discussing sensitive topics.

Smoking Initiation Among Mexican Heritage Youth and the Roles of Family Cohesion and Conflict

PURPOSE

High levels of family conflict increase the risk for early smoking initiation and smoking escalation among adolescents, whereas high levels of warmth and cohesion in the family are protective against smoking initiation. However, little is known about the associations between changes in family function during adolescence on subsequent smoking initiation among Mexican heritage adolescents.

METHODS

In 2005-2006, 1,328 Mexican heritage adolescents aged 11-14 years enrolled in a cohort study to examine nongenetic and genetic factors associated with cigarette experimentation. In 2008-2009, 1,154 participants completed a follow-up. Multivariate logistic regression models were computed to prospectively examine associations between smoking behavior assessed in 2008-2009 and changes in family cohesion and family conflict assessed in both 2005-2006 and 2008-2009, controlling for gender, age, and linguistic acculturation, positive outcome expectations associated with smoking, as well as friends and family smoking behavior.

RESULTS

Overall 21% had tried cigarettes by 2008-2009. Consistently low levels of family cohesion (odds ratio [OR] = 3.06; 95% confidence interval [CI], 1.38-6.73) and decreases in family cohesion (OR = 2.36; 95% CI, 1.37-4.07), as well as consistently high levels of family conflict (OR = 1.74; 95% CI, 1.08-2.79) and increases in conflict (OR = 1.87; 95% CI, 1.19-2.94) were independent risk factors for smoking initiation among Mexican heritage youth.

CONCLUSIONS

Our findings suggest that family cohesion protects against adolescent smoking, whereas family conflict increases the risk for smoking. Therefore, intervention programs for adolescents and parents could focus on enhancing family bonding and closeness, which is protective against smoking initiation.

Parent and child cigarette use: a longitudinal, multigenerational study

OBJECTIVES

Using longitudinal data from the multigenerational Youth Development Study (YDS), this article documents how parents' long-term smoking trajectories are associated with adolescent children's likelihood of smoking. Prospective data from the parents (from age 14-38 years) enable unique comparisons of the parents' and children's smoking behavior, as well as that of siblings.

METHODS

Smoking trajectories are constructed using latent class analysis for the original YDS cohort (n = 1010). Multigenerational longitudinal data from 214 parents and 314 offspring ages 11 years and older are then analyzed by using logistic regression with cluster-corrected SEs.

RESULTS

Four latent smoking trajectories emerged among the original cohort: stable nonsmokers (54%), early-onset light smokers who quit/reduce (16%), late-onset persistent smokers (14%), and early-onset persistent heavy smokers (16%). Although 8% of children of stable nonsmokers smoked in the last year, the other groups' children had much higher percentages, ranging from 23% to 29%. Multivariate logistic regression models confirm that these significant differences were robust to the inclusion of myriad child- and parent-level measures (for which child age and grade point average [GPA] are significant predictors). Older sibling smoking, however, mediated the link between parental heavy smoking and child smoking.

CONCLUSIONS

Even in an era of declining rates of teenage cigarette use in the United States, children of current and former smokers face an elevated risk of smoking. Prevention efforts to weaken intergenerational associations should consider parents' long-term cigarette use, as well as the smoking behavior of older siblings in the household.

Exploring alternate processes contributing to the association between maternal smoking and the smoking behavior among young adult offspring

INTRODUCTION

Maternal smoking during pregnancy (MSP) is a known risk factor for regular smoking in young adulthood and may pose a risk independently of mother's lifetime smoking. The processes through which MSP exerts this influence are unknown but may occur through greater smoking quantity and frequency following initiation early in adolescence or increased sensitivity to nicotine dependence (ND) at low levels of smoking.

METHODS

This study used path analysis to investigate adolescent smoking quantity, smoking frequency, and ND as potential simultaneous mediating pathways through which MSP and mother's lifetime smoking (whether she has ever smoked) increase the risk of smoking in young adulthood among experimenters (at baseline, <100 cigarettes/lifetime) and current smokers (>100 cigarettes/lifetime).

RESULTS

For experimenters, MSP was directly associated with more frequent young adult smoking and was not mediated by adolescent smoking behavior or ND. Independently of MSP, the effect of mother's lifetime smoking was fully mediated through frequent smoking and was heightened ND during adolescence. Controlling for MSP eliminated a previously observed direct association between mother's lifetime smoking and future smoking among experimenters. For current smokers, only prior smoking behavior was associated with future smoking frequency.

CONCLUSIONS

These results seem to rule out sensitivity to ND and increased smoking behavior as contributing pathways of MSP. Further, the impact of MSP on young adult smoking extends beyond that of having an ever-smoking mother. Future work should test other possible mediators; for example, MSP-related epigenetic changes or gene variants influencing the brain's nicotine response.

Do health and education agencies in the United States share responsibility for academic achievement and health? A review of 25 years of evidence about the relationship of adolescents' academic achievement and health behaviors

PURPOSE

The United States Centers for Disease Control and Prevention monitors health-risk behaviors of adolescents in United States, which include (1) violence; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors contributing to unintended pregnancy and sexually transmitted diseases; (5) inadequate physical activity; and (6) unhealthy dietary behaviors. We reviewed original research published in peer-reviewed journals between 1985 and 2010 to synthesize evidence about the association of adolescent health-risk behaviors and academic achievement.

METHODS

Using predetermined selection criteria, 122 articles were included that used at least one variable for health-risk behaviors and also for academic achievement.

RESULTS

For all six health-risk behaviors, 96.6% of the studies reported statistically significant inverse relationships between health-risk behaviors and academic achievement.

CONCLUSIONS

With this persuasive evidence about the interrelationship of health-risk behaviors and academic achievement, it is imperative that leaders in education and health act together to make wise investments in our nation's school-age youth that will benefit the entire population. A unified system that addresses both health behavior and academic achievement would have reciprocal and synergistic effects on the health and academic achievement not only of children and adolescents, but also of adults in the United States.

Adolescents' experiences of a strengths-based treatment program for substance abuse

Substance abuse is a growing issue among adolescents. While not every adolescent who struggles with this issue seeks treatment, those who do frequently fail to complete treatment or tend to relapse following treatment. To improve adolescent treatments for substance abuse issues it is important to understand adolescent experiences while in treatment, along with the factors that contribute to positive treatment outcomes. Qualitative methods were used to examine 52 post-treatment interviews conducted with adolescents following their completion of a five-week strengths-based residential program for substance use issues. The adolescent narratives were analyzed to answer three research questions: (1) what aspects of the treatment program were found to be most helpful by youth, (2) which specific strengths did youth identify to be the most helpful throughout the treatment process and in beginning to overcome their substance use issues, and (3) did youth begin to adopt strengths-based thinking strategies over the course of treatment? Results include descriptive answers to these questions based on common themes across participant responses. Implications for future research are discussed.

An examination of different smoking patterns among Canadian youth: new insight for tobacco control programming

Patterns of smoking can vary among youth smokers. The purpose of this study was to examine three different patterns of smoking among youth (daily smoking, smoking sporadically on weekdays and weekends, and smoking during weekdays only), and to examine the sociodemographic characteristics that are associated with each smoking pattern in a representative sample of Canadian youth smokers. Data were collected as part of the 2010/2011 Youth Smoking Survey (YSS) from 31,396 students in grades 9 to 12 from secondary schools in 9 Canadian provinces. Data from the YSS were used to assess smoking behaviors and sociodemographic factors that are associated with smoking patterns among youth. We used logistic regression models to examine factors associated with week day only and some day smoking patterns relative to daily smoking patterns. Results indicate that among current youth smokers, the majority are daily smokers (62.0%), followed by some day (23.5%) and week day only (13.5%) smokers. Students who smoke some days were more likely than daily smokers to share cigarettes with others; however, they were less likely than daily smokers to have a parent, step-parent or guardian who smokes cigarettes and less likely to have close friends who smoke cigarettes. Conversely, students who smoke week days only were less likely than daily smokers to have a sibling who smokes cigarettes. These data suggest that the school environment continues to play an important role in reducing youth smoking rates in Canada, especially among youth who only smoke week days. The high percentage of week day only smokers suggests that current school-level tobacco control initiatives may be insufficient for preventing youth smoking onset.

Peer influence and selection processes in adolescent smoking behavior: a comparative study

INTRODUCTION

Adolescent smoking studies find evidence of active peer influence and selection processes. However, studies have shown that these processes operate differently depending on context. This study uses SIENA to model coevolutionary processes between smoking and changes in friendship ties, comparing two high schools in which data were collected in identical fashion to explore influence and selection mechanisms with respect to current smoking, and smoking levels.

METHODS

This is a longitudinal survey with 2 waves of data. In-home surveys were conducted with students from 2 large high schools in the United States: a West Coast school, and a Midwestern school. Participants were consented students in 10th and 11th grades at the first wave of data collection. The primary measures were self-reported smoking behavior and friendship nominations.

RESULTS

There is evidence of influence and selection in both schools for adolescents' smoking status (1 = any smoking) and for level of smoking.

CONCLUSIONS

These models reflect great similarities in influence and selection processes across schools for different smoking behaviors. However, smoking prevalence may impact the exact mechanisms by which influence and selection operate. Researchers should consider smoking interventions with independent modules addressing different selection and influence processes, implemented based on contextual factors such as the prevalence of smoking.

Risk factors for adolescent smoking: parental smoking and the mediating role of nicotine dependence

BACKGROUND

Parental smoking and early-emerging nicotine dependence symptoms are well-documented risk factors for adolescent smoking. However, very little is known about the mediating pathways through which these risk factors may act, or whether parental smoking may cause or signal early-emerging nicotine dependence symptoms.

METHODS

Data were drawn from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study. Adolescents who had smoked under 100 cigarettes in their lifetime (n=594; low-exposure group) and adolescents who had smoked over 100 cigarettes, but fewer than 5 cigarettes per day (n=152) were included in the analyses. Path analysis was performed on longitudinal data to investigate the association between parental smoking and smoking frequency at the 48 months follow-up, both directly and through mediating variables of smoking frequency, smoking quantity, and nicotine dependence.

RESULTS

Father's smoking was associated with higher adolescent nicotine dependence scores at the baseline assessment wave. Structural equation modeling revealed that mother's smoking at baseline was associated with adolescent's smoking frequency at the 48-month follow-up, and its effect was partially mediated by both smoking frequency and nicotine dependence among low-exposure adolescent smokers.

CONCLUSIONS

Parental smoking is a risk factor for future smoking in low-exposure adolescent smokers, above and beyond the risks posed by smoking behavior and nicotine dependence. Moreover, parental smoking is associated with early-onset nicotine dependence in low-exposure adolescent smokers. As an easily measureable risk factor, parent smoking status can be used to identify and intervene with novice adolescent smokers who are at high risk for chronic smoking behavior.

Intergenerational relationships between the smoking patterns of a population-representative sample of US mothers and the smoking trajectories of their children

OBJECTIVES

We assessed intergenerational transmission of smoking in mother-child dyads.

METHODS

We identified classes of youth smoking trajectories using mixture latent trajectory analyses with data from the Children and Young Adults of the National Longitudinal Survey of Youth (n = 6349). We regressed class membership on prenatal and postnatal exposure to maternal smoking, including social and behavioral variables, to control for selection.

RESULTS

Youth smoking trajectories entailed early-onset persistent smoking, early-onset experimental discontinued smoking, late-onset persistent smoking, and nonsmoking. The likelihood of early onset versus late onset and early onset versus nonsmoking were significantly higher among youths exposed prenatally and postnatally versus either postnatally alone or unexposed. Controlling for selection, the increased likelihood of early onset versus nonsmoking remained significant for each exposure group versus unexposed, as did early onset versus late onset and late onset versus nonsmoking for youths exposed prenatally and postnatally versus unexposed. Experimental smoking was notable among youths whose mothers smoked but quit before the child's birth.

CONCLUSIONS

Both physiological and social role-modeling mechanisms of intergenerational transmission are evident. Prioritization of tobacco control for pregnant women, mothers, and youths remains a critical, interrelated objective.

Socioeconomic Context and Emotional-Behavioral Achievement Links: Concurrent and Prospective Associations Among Low- and High-Income Youth

Temporal associations in the relationship between emotional-behavioral difficulty and academic achievement were explored in 2 samples followed from 6th through 8th grade. The first sample comprised 280 students entering an economically disadvantaged urban middle school and the second comprised 318 students entering an affluent suburban middle school. Among disadvantaged youth, emotional indices were concurrently associated with poorer achievement while prospective associations between substance use and achievement were evident. For privileged adolescents, only a significant concurrent relationship emerged between social anxiety and achievement, although nonsignificant trends in the data suggest other, albeit weak, associations. The findings are discussed in terms of similarities and differences in these temporal associations across 2 samples representing extremes of the socioeconomic continuum.

Parental influence on adolescent smoking cessation: is there a gender difference?

We examined the association of parental disapproval of adolescent smoking and parental smoking status, with past smoking quit behaviors among daily-smoking, high school-aged adolescents, and also tested whether these associations differ for boys and girls. Adolescent regular smokers (N=253) completed questions on smoking behaviors, past smoking cessation behaviors, parental disapproval of smoking, and parental smoking. Past smoking cessation behaviors were defined as "the number of quit attempts that lasted longer than 24 hours" and "the longest number of days of abstinence". Logistic regression analyses showed that for all adolescents, even having one smoking parent was associated with decreased odds of being abstinent for longer than 2 days. However, for girls, not having any smoking parents was associated with greater duration of abstinence (>2 weeks). Having both parents, compared with not having any parents disapprove of smoking, was associated with greater number of quit attempts in boys, but this effect was not found in girls. The results indicate that parents have a salient role in adolescent smoking cessation behaviors, and this association appears to be gender-specific. However, further research is needed to understand the mechanisms that explain gender differences in parental influence on adolescent smoking cessation behaviors.

Predicting students' intention to smoke by theory of planned behaviour variables and parental influences across school grade levels

Differences were examined in Theory of Planned Behaviour determinants of students' intention to smoke including parents' attitudes towards smoking and parents' current cigarette use among Greek students of different school grade levels. Students (N = 763) aged 10-18 years reported their attitudes towards smoking, subjective norms, perceived behavioural control, self-identity and intention to smoke while their parents (N = 525) reported their attitudes towards smoking and their current cigarette use. All the TPB variables increased from lower to higher school grade level. Multi-sample path analyses showed that parent's attitudes towards smoking positively predicted students' intention to smoke only for elementary school children. Parents' current cigarette use did not contribute significantly. Students' attitudes, perceived behavioural control and self-identity predicted systematically intention to smoke in contrast to the subjective norm that did not contribute at all. Perceived behavioural control contributed to a higher degree in intention to smoke for senior high school students compared to the junior high school and elementary students. Self-identity contributed to a higher degree in intention to smoke for elementary compared to the junior high school students. The results of this study suggests that the determinants of smoking vary between early and late adolescence.

Recent findings on peer group influences on adolescent smoking

This review addresses peer group influences on adolescent smoking with a particular focus on recently published longitudinal studies that have investigated the topic. Specifically, we examine the theoretical explanations for how social influence works with respect to adolescent smoking; discuss the association between peer and adolescent smoking; consider socialization and selection processes with respect to smoking; investigate the relative influence of best friends, close friends, and crowd affiliations; and examine parenting behaviors that could buffer the effects of peer influence. Our review indicates the following with respect to adolescent smoking: (a) substantial peer group homogeneity of smoking behavior; (b) support for both socialization and selection effects, although evidence is somewhat stronger for selection; (c) an interactive influence of best friends, peer groups, and crowd affiliation; and (d) an indirect protective effect of positive parenting practices against the uptake of adolescent smoking. We conclude with implications for research and prevention programs.

Does mother's smoking influence girls' smoking more than boys' smoking? A 20-year review of the literature using a sex- and gender-based analysis

A systematic literature review was conducted to examine whether mother's smoking influences girls' smoking more than boys' smoking. Fifty-seven studies, published between 1989 and 2009, were analyzed using a sex and gender lens. Results indicate that mother's prenatal and postnatal smoking influences girls' smoking more than boys' smoking. Despite evidence that sex and gender are important determinants of smoking among adolescents when examined in relation to mother's smoking, the theoretical understanding of why girls are more likely to smoke if prenatally and postnatally exposed to mother's smoking remains unclear. Implications for future research are discussed.

Racial/ethnic differences in perceived smoking prevalence: evidence from a national survey of teens

Prior studies show that perceived smoking prevalence is a significant predictor of smoking initiation. In this study, we examine racial/ethnic differences in perceived smoking prevalence and racial/ethnic differences in exposure to contextual factors associated with perceived smoking prevalence. We used cross-sectional time series data from the Legacy Media Tracking Surveys (LMTS), a national sample of 35,000 12- to 17-year-olds in the United States. Perceived smoking prevalence was the primary outcome variable, measured using an LMTS question: "Out of every 10 people your age, how many do you think smoke?" Multivariable models were estimated to assess the association between perceived smoking prevalence; race/ethnicity; and exposure to social contextual factors. Findings indicate that African American, Hispanic, and American Indian youth exhibit the highest rates of perceived smoking prevalence, while white and Asian youth exhibit the lowest. Minority youth are also disproportionately exposed to social contextual factors that are correlated with high perceived smoking prevalence. These findings suggest that disproportionate exposure to social contextual factors may partially explain why minority youth exhibit such high levels of perceived smoking prevalence.

Co-occurring patterns of smoking and alcohol consumption among Korean adolescents

This study seeks to assess the transition probabilities between smoking and alcohol consumption trajectories for ages 13-17 using data from the Korea Youth Panel Survey (KYPS). Four smoking trajectories were identified-noninitiator, late-onsetter, experimenter, and escalator. Similarly, four alcohol consumption trajectories were identified-noninitiator, late-onsetter, experimenter, and chronic user. Those in the chronic group of alcohol consumption were most likely to be smokers. Those who fell into a particular group for use of one substance were most likely to fall into the corresponding group for use of the other substance. Implications for smoking and alcohol prevention are discussed.

Distress and academic achievement among adolescents of affluence: a study of externalizing and internalizing problem behaviors and school performance

The main objectives of this study were to prospectively examine the relationship between externalizing (substance use and delinquency) and internalizing (depression and anxiety) dimensions and academic achievement (grades and classroom adjustment), as well as continuity over time in these domains, within a sample of wealthy adolescents followed from 10th to 12th grades (n = 256). In both parts of the study, cluster analyses were used to group participants at 10th grade and then group differences were evaluated on adjustment outcomes over time. In Part 1, problem behavior clusters revealed differences on academic indices with the two marijuana using groups--marijuana users and multiproblem youth--exhibiting the worst academic outcomes at all three waves. For Part 2, the two lowest achieving groups reported the highest distress across all externalizing dimensions over time. Stability across the three waves was found for both personal and academic competence as well as the associations between these two domains. Results are discussed in relation to intervention efforts targeting wealthy students at risk.

The roles of parenting, church attendance, and depression in adolescent smoking

The aim of the present study was to identify contextual factors related to smoking among urban African-American and White adolescents. We administered a survey assessing demographic and psychosocial variables to 299 adolescents in an urban pediatric clinic in the Midwest. Results indicated that being female, older age, lower academic performance, depressive symptoms, less frequent church attendance, parental smoking, and parental attitudes toward smoking were related to adolescent smoking. After controlling for demographics, the multivariate model predicting adolescent smoking included depressive symptoms, less frequent church attendance, and parental disapproval of smoking. Given these findings, efforts to decrease adolescent smoking may be enhanced by attending to depressive symptoms demonstrated by adolescents as well as contextual factors including parental attitudes and church attendance.

Correlates and predictors of tobacco use among immigrant and refugee youth in a Western Canadian city

BACKGROUND

Tobacco control is a priority of the British Columbia Ministry of Health as illnesses associated with tobacco use are the leading cause of preventable death in the province. As a result of increased immigration, British Columbia's demographic profile is becoming more diverse and necessitates approaches to health promotion and disease prevention that are culturally relevant. In order to develop culturally relevant anti-smoking messages and resources for immigrant and refugee youth, surveys were administered to 194 youth to better understand their attitudes towards smoking and to explore predictors of tobacco use.

RESULTS

Twelve percent of respondents reported smoking all or part of a cigarette within the past 30 days. Male respondents were three times more likely to smoke than female respondents. Logistic regression analysis showed that immigrant and refugee youth were more likely to be non-smokers if they did not have a father who smokes, drank alcohol less frequently and had fewer close friends who smoke.

IMPLICATIONS

These findings support previous research studies that relate youth smoking to social influences and demonstrate a need to address gender differences, the confluence of smoking and drinking and the significance of family and peer pressure on smoking when designing culturally relevant anti-smoking resources.

Influencing the parents of children aged 9-13 years: findings from the VERB campaign

BACKGROUND

The CDC's VERB campaign was designed to increase physical activity among children aged 9-13 years (tweens). As part of the strategy to surround tweens with support to be physically active, VERB developed messages for parents, the secondary target audience, to encourage them to support their tween's physical activity.

DESIGN

Multiple regression analyses were conducted to determine whether parent awareness of VERB was a significant predictor of seven factors that related to parental attitudes, beliefs, and supportive behaviors for tweens' physical activity using the Youth Media Campaign Longitudinal Survey (YMCLS).

SETTING/PARTICIPANTS

Parents (N=1946) of U.S. children aged 9-13 years.

INTERVENTION

Advertising directed at tweens through paid television, radio, print, Internet, and schools was the primary VERB intervention; tween advertising could have been also seen by parents. Messages directed at parents encouraging their support of tweens' physical activity were delivered in English through mainly print and radio. In-language messages for Latino and Asian audiences were delivered through print, radio, television, and at events.

MAIN OUTCOME MEASURES

Parents' awareness of VERB; parents' attitudes, beliefs, and support for their tweens' physical activities.

RESULTS

Awareness increased each year of the campaign; more than 50% of parents were aware of VERB by the third year of the campaign. Parents reported that their main source of awareness was television, the main channel used to reach tweens. Awareness of VERB was predictive of positive attitudes about physical activity for all children, belief in the importance of physical activity for their own child, and the number of days parents were physically active with their child.

CONCLUSIONS

Parents' awareness of VERB was associated with positive attitudes, beliefs, and behavior. Parents' awareness probably resulted from a combination of messages directed to parents and tweens. To maximize audience reach, social marketers who are developing health messages should consider the potential value of parents and their children seeing or hearing the same messages, separately or together.

Adolescents' responses to peer smoking offers: the role of sensation seeking and self-esteem

This article deals with an important topic (youth smoking) and makes a contribution to the literature by validating existing research and extending our understanding of smoking resistance strategies. This study classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of refuse, explain, avoid, and leave (REAL) and explored how personality factors explain adolescents' use of cigarette refusal strategies. Participants were predominantly Hispanic junior high students (6th-8th grades) from schools in the Northeast United States who participated in a survey design (N = 260). The strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with a greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related to the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies. Implications and directions for future research are discussed.

Nicotine and alcohol use in adolescent psychiatric inpatients: associations with diagnoses, psychosocial factors, gender and age

The aim of the survey was to describe the proportion of smokers and alcohol users in a group of children and adolescents admitted to a German department of child and adolescent psychiatry and psychotherapy. In addition, the proportion of smokers in this group of patients was compared with the proportion in the general population of the same age. The sample was composed of all children and adolescent inpatients (n=432, 8-17 years old meeting inclusion criteria) admitted to a German department of child and adolescent psychiatry between May 2001 and June 2003. A shortened adaptation of the questionnaire on legal and illegal drug use, developed by the Swiss Professional Service for Alcohol Problems, Lausanne, was used. Initiation, frequency and quantity of drug use, and parental substance use were assessed. The results showed an association between conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) and an early initiation of nicotine and alcohol use. Girls and boys with CD and ADHD were significantly more likely to be involved in higher levels of nicotine use compared with the general population. Parental nicotine use was associated with smoking in girls, while maternal nicotine use was associated with smoking in boys. Furthermore, regular alcohol use in both girls and boys was associated with nicotine use. To conclude, early initiation and elevated rates of nicotine and alcohol use are a particular risk for adolescents with CD and ADHD.

Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents

BACKGROUND

A number of factors have been identified that protect adolescents or, alternatively, put them at risk for drug use and other high-risk behaviours. These factors concern different personal and environmental factors, e.g. the community, the school setting, family, peer group and individual characteristics. The aim of the present study was to examine the associations between risk and protective factors and adolescents' use of alcohol and drugs.

METHODS

In both May 2003 and 2004, random samples of 4800 adolescents (a total of 9600) in Sweden were contacted and asked to fill out a questionnaire. It concerned use of alcohol and illicit drugs and a large number of adolescent risk and protective factors. A total of 5445 (57%) adolescents agreed to participate.

RESULTS

About 44% of the adolescents in grade 9 (15-16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17-18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs.

CONCLUSIONS

This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.

Social influences, and attitudes and beliefs associated with smoking among border Latino youth

BACKGROUND

Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border.

METHODS

A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior.

RESULTS

The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups.

CONCLUSIONS

These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.

Childhood social disadvantage and smoking in adulthood: results of a 25-year longitudinal study

AIM

To examine the associations between exposure to socio-economic disadvantage in childhood and smoking in adulthood.

DESIGN

A 25-year longitudinal study of the health, development and adjustment of a birth cohort of 1265 New Zealand children.

MEASUREMENTS

Assessments of childhood socio-economic disadvantage, smoking in adulthood and potential mediating pathways, including: parental education, family socio-economic status, family living standards and family income; smoking frequency and nicotine dependence at age 25 years; child IQ, educational achievement by age 18 years, conduct problems ages 14-16 years, parental smoking 0-16 years and peer smoking at 16 years.

FINDINGS

Smoking at age 25 was correlated significantly (P < 0.0001) with increasing childhood socio-economic disadvantage. Further, indicators of childhood socio-economic disadvantage were correlated significantly (P < 0.0001) with the intervening variables of childhood intelligence, school achievement, conduct problems and exposure to parental and peer smoking; which in turn were correlated significantly (P < 0.0001) with measures of smoking at age 25. Structural equation modelling suggested that the linkages between the latent factor of childhood disadvantage and later smoking were explained largely by a series of pathways involving cognitive/educational factors, adolescent behavioural adjustment and exposure to parental and peer smoking.

CONCLUSIONS

The current study suggested that smoking in adulthood is influenced by childhood socio-economic disadvantage via the mediating pathways of cognitive/educational factors, adolescent behaviour and parental and peer smoking.

Child and adolescent psychiatrists' practices in assisting their adolescent patients who smoke to quit smoking

OBJECTIVE

This national study examined the practices and perceptions of smoking cessation activities among child and adolescent psychiatrists.

METHOD

A random sample of child and adolescent psychiatrists was identified from the membership list of the American Academy of Child and Adolescent Psychiatry and was mailed a valid and reliable 34-item questionnaire.

RESULTS

A total of 184 responses (47%) were received. A plurality (48%) of psychiatrists reported being self-taught in smoking cessation techniques. A majority (67%) of psychiatrists were in the maintenance stage for asking about smoking status. However, only 19% consistently made attempts to assess willingness to quit, and 30% consistently gave messages urging the smoker to quit. The perceived number of barriers for addressing smoking was negatively correlated with psychiatrists' levels of confidence (r = -0.35, p <.001) and preparedness (r = -0.39, p <.001) in addressing smoking cessation. Estimations by the psychiatrists of youths who smoked were 61% of those with conduct disorders, 46% of those with schizophrenia, and 40% of those with attention-deficit/hyperactivity disorder.

CONCLUSION

Considering the perceived high rate of patient smoking and the lack of formal training in smoking cessation, more postgraduate education is needed to adequately prepare child and adolescent psychiatrists for addressing tobacco cessation.

The influence of parity and smoking in the social environment on tobacco consumption among daily smoking women in Denmark

The aim of this paper isto determine factors associated with higher tobacco consumption in a large cohort of daily smoking Danish women 27-39 years of age with a main focus on the smoking habits of people in the women's social environment and parity. A cohort of 12,023 Danish women was examined in a cross-sectional study design with a mailed questionnaire. Among the 3,672 daily smokers, 2,365 (64.4%) smoked more than 15 cigarettes per day. Smokers in the childhood home, living alone or cohabiting with a smoking partner, friends smoking, and colleagues smoking were associated with higher tobacco consumption, while short duration of smoking was associated with lower tobacco consumption. Anti-smoking programs should focus on the social network of the women. Furthermore, there is a need to target mothers who smoke, especially less educated mothers.

Genetic correlations between smoking initiation and smoking behaviors in a twin sample

Early exposure to cigarettes is connected to increasing rate of regular use later in life. We examine genetic correlation between the age of first cigarette and later smoking related behaviors. The sample consisted of twin ages 25 to 75. Biometrical analysis was used to evaluate the heritabilities and a second analyses based on Cholesky decomposition determined the shared variance. The genetic variance ranged from 48% to 69%. Models comparing age of first cigarette to and smoking persistence, cessation, and number of cigarettes during year smoked most individually indicated a very small proportion of shared genetic variance (ranging from 0.004 to 0.056). These findings support separate genetic and unshared environmental processes for the age of first cigarette as compared to three other smoking related phenotypes. Research in substance abuse risk and prevention literature suggests that delaying initial exposure is a critical step reducing in the risk of later regular use. The interventional implications of the findings support the importance of a tailored approach to preventing smoking behavior and reducing harm in smokers.

Social influences and self-efficacy as predictors of youth smoking initiation and cessation: a 3-year longitudinal study of vocational high school students in Taiwan

AIMS

This 3-year longitudinal study examined changes in patterns of risk factors and protective factors of smoking initiation and cessation among vocational high school students in Taipei, Taiwan.

DESIGN AND SETTING

In 2000, a total of 2151 10th grade students from 16 vocational high schools were assessed and followed up in the 11th and 12th grades. Self-administered questionnaires were collected in each year to assess the pattern of changes in smoking behaviors, and risk and protective factors.

FINDINGS

Of the 1654 non-smokers in the 10th grade, 227 students initiated smoking by the 12th grade. Higher risk factors such as peer smoking, peers offering cigarettes, alcohol use and lower protective factors, such as refusal self-efficacy, antismoking attitude and belief in the 10th grade predicted youth initiation by grade 12. Increases in risk factors and decreases in protective factors during the years from 10th to 12th grades were associated significantly with youth smoking initiation. Of the 494 smokers in the 10th grade, 76 students quit smoking by the 12th grade. Lower risk factors and higher protective factors in 10th grade smokers predict youth smoking cessation by grade 12. Decreases in risk factors and increases in protective factors were associated significantly with youth smoking cessation.

CONCLUSIONS

The risk factors (i.e. social influences) and protective factors (i.e. self-efficacy) examined in this study predict both youth smoking initiation and youth smoking cessation.

Close friends', parents', and older siblings' smoking: reevaluating their influence on children's smoking

A number of longitudinal studies have explored the role of friends', parents', and older siblings' smoking in children's smoking acquisition. A reasonable implication of this previous research is that intervention efforts could be beneficially directed toward countering the potential influence of friends' and possibly older siblings' smoking but not parents' smoking. However, methodological limitations of this previous research motivated our reevaluation of the role of friends', parents', and older siblings' smoking in children's smoking. Close friends' smoking status was assessed when children were in 5th grade, whereas parents' and older siblings' smoking status was assessed when children were in 3rd grade. The outcome, children's daily smoking status, was assessed in 12th grade. The setting was 40 Washington state school districts that participated in the long-term Hutchinson Smoking Prevention Project. Participants were the 4,576 families for whom close friends', parents', and older siblings' smoking status as well as children's smoking status were available. The probability that each close friend's smoking influenced the child to smoke daily was 9% (95% CI = 6%-12%), the probability that each parent's smoking influenced the child to smoke daily was 11% (95% CI = 9%-14%), and the probability that each older sibling's smoking influenced the child to smoke daily was 7% (95% CI = 1%-13%). These results suggest that close friends', parents', and siblings' smoking were similarly important influences on children's smoking. Family-focused interventions could be a valuable future direction of prevention research.

Family and peer influences on tobacco use among adolescents with psychiatric disorders

The purpose of this study was to examine family and peer influences on smoking behaviors among 239 (191 smokers; 48 nonsmokers) psychiatrically hospitalized adolescents. Participants were queried using scales to measure parental supervision and monitoring, parenting style, adolescent-parent communication, family conflict and relations with parents, and the importance placed on life goals. The results of this study are consistent with previous findings from general population studies. Psychiatrically hospitalized adolescents' smoking status were also correlated with their siblings', peers', and girlfriends'/boyfriends' smoking status. In addition, we found that parental monitoring, closeness to parents, and ambitious life goals were protective factors against smoking. As a result, peer and family influences strongly impact the initiation and maintenance of adolescent smoking and should be considered when designing smoking cessation interventions for adolescents with psychiatric disorders.

Nine-year prediction of adolescent smoking by number of smoking parents

For scientific and public health reasons, it is important to identify the role of family influences on child smoking acquisition. Using a well-followed (>90%) cohort of 3,012 children and their parents, this study prospectively investigated the influence of smoking by 0 vs. 1 vs. 2 parents when the children were young (3rd grade), on whether the children subsequently became daily smokers. It is the only study to investigate the prediction of child/adolescent smoking at the end of the smoking acquisition period (12th grade) by parental smoking at the start of the period (3rd grade). Logistic regression analyses revealed that having one parent who smokes substantially increases the risk that children will become daily smokers, relative to families where neither parent smokes (OR=1.90, p<.01). There is no evidence that the increased risk depends on parent or child gender. These results suggest the need for public health interventions that inform parents of young children that their own smoking behavior increases their children's risk for future smoking.

Influences affecting adolescent smoking behavior in China

This study examined multiple influences on the use of tobacco by adolescents in China. Using the theory of triadic influences as a guide, we selected interpersonal, attitudinal/cultural, and intrapersonal constructs from baseline data to predict adolescent smoking 1 year later. We used prospective data from middle and high school students (N = 11,583) and their parents from the China Seven Cities Study, a longitudinal study that is evaluating the effects of changing economic and social factors on health behaviors including tobacco use. A multilevel regression analysis provided some support that each of the influences in the theory of triadic influences affects adolescent smoking in China. After adjusting for important confounders including age, gender, socioeconomic status, and smoking behaviors (lifetime and past 30-day) at baseline, we found significant risk factors within each of the three categories, including interpersonal influences (parental monitoring, good friend smoking, and peer smoking), attitudinal/cultural influences (school academic ranking, initial liking of smoking, and the meaning of smoking), and intrapersonal influences (susceptibility to smoking, and low self-confidence to quit smoking). Results suggest that the etiology of smoking among adolescents in China might be similar to that observed in western countries and that some of the techniques used successfully in prevention programs in those countries might be useful guides when developing prevention programs in China.

Perceived smoking environment and smoking initiation among multi-ethnic urban girls

PURPOSE

To examine associations between the perceived smoking environment and smoking initiation among urban multi-ethnic adolescent girls in New York City.

METHODS

Self-report surveys completed in grades 7, 8, and 9 assessed girls' (n = 858) smoking initiation, and perceived smoking environment (family smoking, friends' smoking, smoking norms, and cigarette availability). Carbon monoxide breath samples were collected from girls using a variation of the bogus pipeline procedure.

RESULTS

Differences were found in smoking prevalence with white girls reporting the highest prevalence of smoking at baseline and greatest increase in smoking prevalence from seventh to eighth grade. Black girls reported an initial increase in smoking prevalence from seventh to eighth grade followed by a decrease from eighth to ninth grade. Family smoking, friends' smoking, smoking norms, and cigarette availability were all associated with smoking initiation at eighth grade but only friends' smoking was associated with smoking initiation at ninth grade. Few ethnic differences were found in risk factors at baseline and racial/ethnic group did not modify associations between risk and smoking initiation.

CONCLUSIONS

Urban adolescent girls of different racial/ethnic backgrounds had similar perceptions of the smoking environment. Despite the similarity of risk factors across racial/ethnic groups, urban white girls are at increased risk to initiate smoking. Preventive interventions that target girls' perceived smoking environment during early adolescence should be effective across ethnic groups.