Cigarette smoking and adolescents: messages they see and hear

Rural disparities in adolescent smoking prevalence

INTRODUCTION

Rural residence is a well-established risk factor for risk behaviors and subsequent morbidity and mortality in the United States. Smoking is the primary cause of preventable death and is more prevalent in rural America. As chronic smoking habits typically develop during adolescence, the discrepancy in smoking rates between rural and urban youth likely contributes to a significant geographic disparity in the long-term health of adults.

METHODS

Data were extracted from 12th-grader surveys of the US Monitoring the Future study from 1998 to 2018. The historic trends of smoking initiation, ever-regular and current-regular smoking rates of rural and urban adolescents were estimated with intercept-only time-varying effect models. Differences in prevalence between rural and urban youth were calculated for each smoking behavior.

RESULTS

Though overall smoking prevalence continues to decline, this trend is significantly attenuated among rural adolescents compared to urban youth. The absolute difference in lifetime smoking prevalence between rural and urban youth has markedly increased from 6.9% in 1998 to 13.5% in 2018, which is among the highest in the past 20 years and is a potentially alarming upward trend. However, the absolute differences in ever-regular and current-regular smoking prevalence have shown an overall net decline, decreasing from 6.4 to 4.8%, and from 5.5 to 3.0%, respectively.

CONCLUSIONS

This geographic disparity between rural and urban adolescents represents a potentially modifiable cause of increased morbidity and mortality in rural areas. Interventions and regulatory efforts should be tailored for rural adolescents to reduce the narrowing but persistent disparity in regular smoking.

An examination of portrayals of smoking in graphic novels/comic books: A picture is worth a thousand words

INTRODUCTION

Smoking continues to extract an unacceptably high toll in Ireland in terms of both mortality and morbidity. Therefore, attention needs to focus on examining pro-smoking influences on teenagers and young adults, as most smokers start smoking before the age of 21 years. Given that this critical period is one of identity formation and assertion of adulthood, it is useful to look at media representation of smoking. One form of increasingly pervasive media that may require further examination is that of the portrayal of smoking in graphic novels. The broad appeal of graphic novels has been well noted, particularly to those aged under 35 years.

METHODS

This research examined a random selection of ten graphic novels chosen from the main library in a provincial Irish City. The novels were examined on a panel-by-panel basis for images of smokers. Smokers were coded by gender.

RESULTS

Analysis identified a total of 526 panels depicting smoking. Substantial variation was noted in the number of smoking images between novels, varying from 0 to 267. A dramatic difference in the number of male to female smokers was observed, the ratio being approximately 17:1.

CONCLUSIONS

Graphic novels must be considered as a potentially significant source of portrayals of smoking to adolescent and young adult readers of this form of literature.

Behavioral Health Risk Factors: the Interaction of Personal and Country Effects

PURPOSE

This study investigated the relationship between the individual's self-assessed health status (SAHS) and health-risk factors (smoking, alcohol consumption and obesity), in 16 European countries. The associations were studied for the individual and for the country measures-and in particular, for the unexplored aspect of interaction between individual and country levels of the three risk factors.

METHOD

Data for 47,114 adults, who participated in the Survey of Health Aging and Retirement Europe (SHARE), were analyzed using Multilevel Regression Analysis. The individual data were complemented by OECD data that provided country-specific risk measures: percentage of daily smokers, annual per-capita consumption of alcohol (liters), and percentage of obese individuals.

RESULTS

We found that the individual's SAHS is negatively associated with smoking and with weight-risk factors and is positively associated with her/his alcohol consumption. The most pronounced associations relate to the weight variables, albeit they are attenuated in countries with higher percentages of obese individuals. Significant differences across countries were evidenced in the association between SAHS and smoking and between SAHS and alcohol consumption.

CONCLUSION

Individual health levels are associated with individual risk factors and also with the behaviors in the country. Significant interactions might indicate that psychological factors are at work.

Smoke-free homes, smoking susceptibility and familial smoking among never-smoking high school students: a cross-sectional analysis

BACKGROUND

Research has shown that living in a smoke-free home has a positive effect on adolescents' perceived acceptance of smoking. However, the relationship between smoke-free homes and adolescent smoking behaviours remains unclear. The aim of this study was to examine the association between smoke-free homes and smoking susceptibility among high school students, and to determine whether these associations persist when analyses are stratified by familial smoking status.

METHODS

We conducted a random cross-sectional survey (2012/2013 Youth Smoking Survey) of primary, junior and high school students in Canada (n = 47 203). Multivariable logistic regression analyses were used to examine the associations between smoke-free homes and susceptibility to smoking among never-smoking high school students, with and without stratification by familial smoking.

RESULTS

Analyses showed that adolescents living in a smoke-free home had reduced odds of being susceptible to smoking (odds ratio [OR] 0.582, 95% confidence interval [CI] 0.428-0.791) compared with their peers living in households where smoking was permitted. When adolescents had other family members who were smokers, having a smoke-free home was not significantly associated with reduced smoking susceptibility (OR 0.878, 95% CI 0.721-1.071).

INTERPRETATION

Our results suggest that smoke-free homes may influence future smoking initiation. Optimal success in preventing youth smoking uptake necessitates having a coherent antismoking message between the home smoking environment and familial smoking behaviour.

Understanding the sources of normative influence on behavior: the example of tobacco

Despite extensive research on social norms, the sources of norm formation are not well understood. Social exposure to a behavior (defined as the composite of ways through which people see that behavior in their social, physical, and symbolic environments) can serve as a source of normative influence. Using tobacco as a case study, we propose that research should move beyond categories of individuals as sources of norms and focus on a broader range of sources of normative influences. An understanding of social exposure as a source for norms may be important to better understand and intervene in environments to promote public health. We make policy recommendations arising from the explication of social exposure and propose directions for future research.

Home smoking bans may increase the risk of smoking onset in children when both parents smoke

INTRODUCTION

Our objective was to determine if there is effect modification by home smoking bans in the association between parental smoking and cigarette smoking onset in children.

METHODS

Data on smoking onset, number of parents who smoke, and home smoking rules were collected from children who had never smoked in self-report questionnaires in grades 5, 7, 9, and 11. The association between number of parents who smoke and smoking onset in children was tested in pooled logistic regression in 2 groups defined by the presence or absence of a complete home smoking ban.

RESULTS

In homes without a complete ban and relative to participants with no parents who smoke, the odds ratio (95% confidence interval [OR (95% CI]) for smoking onset was 1.5 (1.1-1.9) when one parent smoked and 1.4 (1.0-2.1) when both parents smoked. In homes with a complete ban, the OR (95% CI) was 1.6 (1.1-2.3) if one parent smoked, but 4.9 (2.4-9.9) if both parents smoked.

CONCLUSION

The association between number of parents who smoke and smoking onset in children was modified by the presence of a complete home smoking ban. In homes with a complete smoking ban in which both parents smoke, it may be prudent those parents communicate clearly with their children about their reasons for implementing the ban as well as about their reasons for continuing to smoke.

Gender differences in risk behaviors among high school youth

The US Centers for Disease Control and Prevention's (CDC) Youth Risk Behavior Surveillance System (YRBSS) demonstrates that American youth engage in a wide variety of risky behaviors.¹ The frequency and type of these behaviors often differ by a number of factors, such as socioeconomic status, race, and ethnicity. For example, results of the 2011 YRBSS revealed that white high school students were most likely to have texted or e-mailed while driving or been bullied on school property, while black high school students were most likely to have engaged in risky sexual behaviors, to have been physically inactive, and to be obese.¹ Conversely, Hispanic high school students were most likely to have ridden with a driver who had been drinking alcohol; to have ever used cocaine, inhalants, or ecstasy; and to have failed to use protection to prevent pregnancy during last sexual intercourse.¹ However, it is difficult to discern whether differences in risk-taking behaviors between and among ethnic groups can actually be attributed to differences in group norms, socioeconomic status, or cultural beliefs regarding acceptance or rejection of such behaviors,¹ suggesting a need for more comprehensive regional investigations.

Targeted smoking cessation messages for adolescents

PURPOSE

To develop and to conduct a preliminary evaluation of smoking cessation messages targeted for adolescents.

METHOD

We (a) conducted a formative evaluation to identify the optimal content and presentation approach for adolescent-targeted smoking cessation messages, (b) developed two smoking cessation videos catering to adolescent smokers' message preferences, and (c) copy tested the videos to determine the optimal message frame (gain vs. loss) using a quasi-experimental crossover design.

RESULTS

In the formative evaluation, adolescent smokers preferred peer-delivered cessation messages that emphasized long-term health consequences and some social and short-term health consequences of smoking. The information from the formative evaluation was used to create a gain- (emphasized the benefits of quitting and joining a smoking cessation program) and a loss-framed video (emphasized the cost of continuing to smoke and consequences of failing to join a smoking cessation program). The copy test of the videos indicated that adolescents found the messages clear and appealing. The gain-framed message was considered more novel than the loss-framed message and was preferred by most participants. Nonetheless, the loss-framed version resulted in more positive attitudes toward quitting than the gain-framed version.

CONCLUSION

Little is known about how to construct effective smoking cessation messages tailored specifically for adolescent smokers. The study findings provide insight into adolescents' preferences for message content and presentation. Although considered less novel, providing loss-framed information may be most influential among adolescents. These findings have important implications for developing effective adolescent-targeted smoking cessation messages.

Smoking cross-culturally: risk perceptions among young adults in Denmark and the United States

Research examining smokers' understanding of their smoking risk reveals that smokers acknowledge some risk but often deny or minimize personal risk. We examined risk perceptions of lung cancer among smokers and non-smokers in a smoking-lenient (Denmark) and a smoking-prohibitive (the United States) culture. Participants were 275 Danish students attending trade schools (mean age 22.6 years) and 297 US students attending community colleges in Florida (mean age 23.6 years). Results revealed cross-cultural differences suggesting that Danish smokers showed greater risk minimization than US smokers. In addition, in both countries the risk of a typical smoker was rated as lower by smokers than non-smokers, and smokers rated their personal risk as lower than they rated the risk of the typical smoker. Cross-cultural differences in moralization of smoking might be one explanation for these findings.

[Tobacco and advertising. Systematic review of the articles published between 2000 and 2008]

OBJECTIVE

To evaluate the influence of tobacco advertising on consumer habits.

DESIGN

Systematic review.

DATA SOURCES

PubMed, Ovid, Scielo, Mediclatina, Elsevier-Doyma, Isooc (CSIC) (January 2000-September 2008)

METHODS

A total of 44 national and international articles, linking the consumption of tobacco with any promotional or advertising practice. Articles not focused on the impact of advertising and promotion of cigarettes and research on prevention, intervention, plans and laws were removed.

RESULTS

Advertising influences tobacco consumption. Publicity leads to starting smoking (5 articles) and maintaining the habit (3 articles). It uses the relationship between advertising and smoker's image and concept (5 articles) and different advertising strategies (22 articles).

CONCLUSIONS

The advertising developed by the tobacco industry uses different strategies of influence on the consumption of cigarettes in the population.

Acculturation matters: risk perceptions of smoking among Bosnian refugees living in the United States

The relationship between acculturation and health behavior change is complex. Little research has focused on acculturation and perceptions of health-related risks. This study investigated acculturation and risk perceptions of heart attack and lung cancer among a group of refugees. Questionnaires were distributed to a sample of Bosnian refugees living in the United States (N = 55). Results indicated that smokers thought they were less at risk than other smokers and no more at risk than non-smokers, whereas non-smokers did not think they were less at risk than other non-smokers. Greater acculturation was associated with greater perception of smokers' risk of heart attack and lung cancer. Smoking cessation interventions with refugees should incorporate culturally appropriate risk information.

Adolescents and tobacco use: systematic review of qualitative research methodologies and partial synthesis of findings

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute.

Antitobacco media awareness of rural youth compared to suburban and urban youth in Indiana

PURPOSE

This study examined the awareness and impact of antitobacco media messages among rural, suburban, and urban youth.

METHOD

Self-administered questionnaires were received from 1,622, 1,059, and 1,177 middle school (sixth, seventh, and eighth grade) students in rural, suburban, and urban locations, respectively. Logistic regression compared media awareness and impact among the groups, controlling for grade, gender, race, and smoking behavior.

RESULTS

Compared to rural youth, suburban youth were more likely to recall media messages about the dangerous health effects of tobacco use (odds ratio [OR] = 1.94) and have their personal choice to use tobacco affected by the messages (OR = 1.85). Suburban and urban youth more often recalled antitobacco messages (OR = 2.00 and 2.15), reported that the messages made them think about the dangers of tobacco use (OR = 2.02 and 1.47), believed that these ads prevent youth from initiating tobacco use (OR = 3.21 and 1.46) and stop youth from using tobacco (OR = 2.25 and 1.47), and recalled seeing specific campaign television ads (OR = 3.72 and 3.57). Urban youth were more likely to recall specific campaign messages on the radio (OR = 1.58). Neither suburban nor urban youth differed from the rural youth on whether the campaign-specific radio and television ads made them think about not using tobacco.

CONCLUSIONS

The results support the need for targeting antitobacco media announcements to youth, based on their residence.

Is there a relation between school smoking policies and youth cigarette smoking knowledge and behaviors?

To comply with workplace legislation, New Zealand schools are required to have policies regarding tobacco smoking. Many schools also have policies to prevent tobacco use by students, including education programmes, cessation support and punishment for students found smoking. This paper investigated the associations between school policies and the prevalence of students' cigarette smoking. Furthermore, we investigated the association between school policy and students' tobacco purchasing behavior, knowledge of health effects from tobacco use and likelihood of influencing others not to smoke. Data were obtained from a self-report survey administered to 2,658 New Zealand secondary school students and staff from 63 schools selected using a multi-stage sampling procedure. Components of school policy were not significantly associated with smoking outcomes, health knowledge or health behavior, and weakly related to a punishment emphasis and students advising others to not smoke. Similarly, weak associations were found between not advising others to not smoke and policies with a punishment emphasis as well as smoke-free environments. The results suggest that having a school tobacco policy was unrelated to the prevalence of tobacco use among students, tobacco purchasing behavior and knowledge of the negative health effects of tobacco.

A systematic review of school-based smoking prevention trials with long-term follow-up

BACKGROUND

Several systematic reviews of school-based smoking prevention trials have shown short-term decreases in smoking prevalence but have not examined long-term follow-up evaluation. The purpose of this study was to conduct a systematic review of rigorously evaluated interventions for school-based smoking prevention with long-term follow-up data.

METHODS

We searched online bibliographic databases and reference lists from review articles and selected studies. We included all school-based, randomized, controlled trials of smoking prevention with follow-up evaluation to age 18 or 12th grade and at least 1 year after intervention ended, and that had smoking prevalence as a primary outcome. The primary outcome was current smoking prevalence (defined as at least 1 cigarette in the past month).

RESULTS

The abstracts or full-text articles of 177 relevant studies were examined, of which 8 met the selection criteria. The 8 articles included studies differing in intervention intensity, presence of booster sessions, follow-up periods, and attrition rates. Only one study showed decreased smoking prevalence in the intervention group.

CONCLUSIONS

Few studies have evaluated the long-term impact of school-based smoking prevention programs rigorously. Among the 8 programs that have follow-up data to age 18 or 12th grade, we found little to no evidence of long-term effectiveness.

Responses to tobacco control policies among youth

OBJECTIVE

Explore adolescents' response to current and potential tobacco control policy issues.

DESIGN

The 13 site Tobacco Control Network (TCN), sponsored by the Centers for Disease Control and Prevention, conducted 129 sex and ethnic homogeneous focus groups.

PARTICIPANTS

785 white, African American, Asian American/Pacific Islander, American Indian, and Hispanic adolescents who were primarily smokers from rural, urban, and suburban locations across the USA.

MAIN OUTCOME MEASURES

Awareness, knowledge, opinions, and behaviour regarding laws and rules, prices, cigarette ingredients, and warning labels.

RESULTS

Teenagers were generally familiar with laws and rules about access and possession for minors, but believed them ineffective. They were knowledgeable about prices, and reported that a sharp and sudden increase could lead them to adjust their smoking patterns but could also have negative consequences. They found a list of chemical names of cigarette ingredients largely meaningless, but believed that disclosing and publicising their common uses could be an effective deterrent, especially for those who were not yet smoking. They were aware of current warning labels, but considered them uninformative and irrelevant.

CONCLUSIONS

Understanding teenagers' attitudes and behaviours before implementing policies that will affect them will likely increase their effectiveness. Disclosing and publicising the chemical contents of cigarettes, and increasing prices quickly and sharply, are potentially effective areas for policy change to impact adolescent tobacco use.