Impacts of early smoking initiation: long-term trends of lung cancer mortality and smoking initiation from repeated cross-sectional surveys in Great Britain

Support for incentive-sensitization theory in adolescent ad libitum smokers using ecological momentary assessment

The incentive-sensitization theory (IST) has emerged as a potentially useful theory in explaining substance addiction. IST postulates that the prolonged use of a substance can alter neural systems that are often involved in incentive motivation and reward processes, leading to an increased "sensitization" to the substance and associated stimuli. However, this increased sensitization is thought to mediate only the individual's craving of the substance (e.g., their "wanting"), not their enjoyment of the substance (e.g., their "liking"), a process that may involve unconscious implicit changes in cognitive networks linked to specific substances. Consequently, IST may better explain the real-world dissonance reported for individuals who want to accomplish long-term substance cessation but fail to do so, a phenomenon that is common in adolescent smokers. Thus, the present study aimed to examine the principles of IST in a sample of 154 adolescent ad libitum smokers (Mage = 16.57, SDage = 1.12, 61.14% male) utilizing ecological momentary assessment. Data were analyzed utilizing a multilevel structural equation model examining changes in positive affect (PA), negative affect (NA), and stress from Time 1 (T1) and Time 2 (T2) as a function of smoking and tested the influence of implicit cognition (specifically, implicit attitudes about smoking [Implicit Association Test (IAT)]) on these associations. Consistent with the principles of IST, results found a modest significant negative association between smoking status at T1 and PA at T2 (B = -0.11, p = .047). This association was further moderated by IAT (B = -0.19, p = .029) and was particularly potentiated at high levels of IAT (B = -0.44, p < .001), compared to low (B = -0.05, p = .663) or mean levels of IAT (B = -0.25, p = .004). Findings from this study provide additional support to the principles underlying IST and indicate that, in adolescents, smoking may result in thwarted PA indicative of a transition from "liking" toward "wanting," and this is especially pronounced among those with stronger implicit smoking cognitions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence of health risk behaviours related to non-communicable diseases amongst South African university students: a systematic review

BACKGROUND

Engagement in risk behaviours adopted during university continues after graduation, increasing the risk of non-communicable diseases (NCDs). This systematic review aimed to investigate the prevalence of NCD risk behaviours amongst South African university students.

METHODS

PubMed and Scopus databases were searched (January 1990-April 2022) for studies investigating alcohol consumption, cigarette smoking, inadequate consumption of fruits and vegetables and physical inactivity. Study qualities were assessed with the Joanna Briggs Institute critical appraisal and levels of evidence checklists. An overall prevalence percentage was obtained for each risk behaviour.

RESULTS

A total of 50 studies (n = 26 624 students) were included. A range of 44.8-75.0% of students consumed inadequate servings of fruits and vegetables. Just over 54% consumed alcohol (95% confidence intervals [95%CI]:54.0-55.5%). A significantly higher percentage of males (44.2%) than females (25.8%) drank heavily (P < 0.001). Approximately one-third (34.8%, 95%CI:33.4-36.3%) were sedentary and 39.0% (95%CI:37.5-40.4%) were insufficiently active. Almost one-fifth (17.9%, 95%CI:17.3-18.5%) smoked cigarettes, being significantly more prevalent amongst males (21.8%) than females (13.5%) (P < 0.001). A total of 10% smoked 1-10 cigarettes/day and 1.2% smoked >10 cigarettes/day.

CONCLUSION

High percentages of South African students eat inadequate servings of fruits and vegetables, consume alcohol are physically inactive and smoke cigarettes. South African universities should implement screening measures and health campaigns.

Association of the age at smoking initiation and cessation on all-cause and cause-specific mortality: The Japan Collaborative Cohort Study

We estimated the association between the age at smoking initiation and cessation and all-cause and cause-specific mortality among Japanese men (n = 41,711; age 40-79 years) by analyzing data from the Japan Collaborative Cohort Study for the Evaluation of Cancer Risks. From 1988 and 1990 to 2009, 13,429 all-cause deaths (cancers, n = 4999; cardiovascular diseases, n = 3682) occurred in this cohort. Fitted Cox proportional hazard models, with never smokers as the reference group, were created. Former smokers demonstrated a lower risk for all-cause and cause-specific mortality than current smokers, with a dose-dependent reduction in the risk based on smoking-initiation age. Among former smokers who quit smoking aged 50 years or more, the highest hazard ratios were detected for those who started smoking at <20 years of age (all-cause, cancer, and cardiovascular disease mortality, hazard ratio [95% confidence interval] 1.51 [1.29-1.77], 1.68 [1.27-2.23], and 1.48 [1.12-1.96], respectively). Former smokers who quit smoking at <50 years of age had negligible all-cause or cardiovascular disease mortality regardless of the smoking-initiation age, whereas the cancer mortality risk remained significantly high among those who quit smoking at 40-49 years of age. Thus, smoking cessation significantly reduces the all-cause mortality risk; however, early initiation and later cessation do not provide a huge benefit, which earlier cessation does. Therefore, all smokers should be encouraged to quit smoking earlier in life regardless of their age at smoking initiation.

Panoramic smoking burden and genetic susceptibility in relation to all-cause and cause-specific mortality: a prospective study in UK Biobank

BACKGROUND AND AIMS

Various smoking behaviors, including smoking initiation, age of initiation, heaviness of smoking and smoking cessation, have been individually related to the risk of mortality; however, no study has assessed these smoking behaviors jointly in relation to mortality. Our study aimed to measure prospectively the association of panoramic smoking burden (PSB), generated from the four aforementioned smoking behaviors, with all-cause and cause-specific mortality, and measure whether such associations are modified by genetic variations.

DESIGN

Prospective cohort study.

SETTING

UK Biobank.

PARTICIPANTS

A total of 360 937 participants aged between 37 and 73 years were enrolled in 2006-10 and -followed-up to 2018.

MEASUREMENTS

The exposure was PSB, constructed based on four smoking behaviors including smoking initiation, age of initiation, heaviness of smoking and smoking cessation in a weighted method. A genetically determined PSB was also constructed with smoking-associated single nucleotide polymorphisms (SNPs) and categorized into tertiles. The primary outcomes were all-cause and cause-specific mortality.

FINDINGS

We identified 15 968 deaths [9022 from cancer and 5092 from cardiovascular disease (CVD)] over a median of 11.36 years' follow-up. For all-cause mortality, compared with participants with the PSB of zero, the hazard ratios of participants who had a PSB of one, two, three and four were 1.23 [95% confidence intervals (CI) = 1.18-1.29), 1.66 (95% CI = 1.59-1.75), 3.33 (95% CI = 3.17-3.51) and 5.76 (95% CI = 4.66-7.13), respectively. Among participants within each genetic risk category, low and intermediate PSB were associated with 45-58% reduced risk of all-cause death compared with high PSB. Analysis of population-attributable risk percentage indicated that 21.9, 19.1 and 24.7% of all-cause-, cancer- and CVD-specific death could have been avoided if all ever smokers initiated smoking after age 18 years, smoked < 20 cigarettes/day and quit smoking.

CONCLUSIONS

The panoramic smoking burden, based on smoking initiation, age of initiation, heaviness of smoking and smoking cessation, appears to be associated with all-cause and cause-specific mortality in a gradient manner with increasing panoramic smoking burden independent of other traditional and genetic risk factors.

Association Between Initiation, Intensity, and Cessation of Smoking and Mortality Risk in Patients With Cardiovascular Disease: A Cohort Study

Objectives: To examine the effect of smoking status, smoking intensity, duration of smoking cessation and age of smoking initiation on the risk of all-cause and cause-specific mortality among cardiovascular disease (CVD) patients.

Design: A population-based prospective cohort study.

Setting: The National Health Interview Survey (NHIS) in the U.S. that were linked to the National Death Index (NDI).

Participants: 66,190 CVD participants ≥ 18 years of age who were interviewed between 1997 and 2013 in the NHIS linked to the NDI through December 31, 2015.

Outcome Measures: The primary outcome was all-cause mortality and the secondary outcome was cause-specific mortality including CVD mortality and cancer mortality.

Results: During the mean follow-up of 8.1 years, we documented 22,518 deaths (including 6,473 CVD deaths and 4,050 cancer deaths). In the overall CVD population, former and current smokers had higher risk of all-cause (Former smokers: hazard ratios (HRs), 1.26; 95% confidence interval (CI), 1.21–1.31, P < 0.001; Current smokers: HRs, 1.96; 95%CI, 1.86–2.07, P < 0.001), CVD (Former smokers: HRs, 1.12; 95%CI, 1.05–1.21, P = 0.001; Current smokers: HRs, 1.80; 95%CI, 1.64–1.97, P < 0.001) and cancer mortality (Former smokers: HRs, 1.49; 95%CI, 1.35–1.64, P < 0.001; Current smokers: HRs, 2.78; 95%CI, 2.49–3.09, P < 0.001) than never smokers. Furthermore, similar results were observed when the study subjects were stratified according to the type of CVD. Among current smokers, the risk for cancer mortality increased as the daily number of cigarettes increased, regardless of the specific type of CVD. However, the association of the risk for all-cause and CVD mortality with smoking intensity did not present a dose-response relationship. In participants with angina pectoris or stroke, smoking intensity was inversely associated with deaths from CVD. In addition, the risk for all-cause, CVD and cancer mortality declined as years of smoking cessation increased. Finally, the relative risk of all-cause mortality was not significantly different in individuals with a younger age of smoking initiation.

Conclusions: CVD patients who are smokers have an increased risk of all-cause, CVD and cancer mortality, and the risk decreases significantly after quitting smoking. These data further provide strong evidence that supports the recommendation to quit smoking for the prevention of premature deaths among individuals with CVD.

Age at the onset of tobacco smoking in South Africa: a discrete-time survival analysis of the prognostic factors

Background

While knowledge of onset of smoking tobacco, and associated risk factors can aid the formulation of evidence-based policy and interventions, such information is scarce in South Africa. We assessed age at onset of tobacco smoking in South Africa and identified its risk factors.

Methods

We analysed data of 15,316 respondents aged 15–98 years from the 2012 South African National Health and Nutrition Examination Survey. Descriptive statistics and survival analysis techniques were used alongside weighted percentages.

Results

Overall lifetime prevalence of smoking was 20.5%. Among the 3360 ever-smoked respondents, the overall median age at smoking onset was 18 years (Inter-quartile range (IQR) =5) with 2% starting before age 10 while 60% had smoked before age 20. Likelihood of tobacco smoking was higher among adolescents (<=20 years) and those aged 20–29 years than those aged > = 60 years, thrice higher among males, 29% higher among urban dwellers and thrice higher in Western Cape and Free State than in North West Province. The onset of tobacco smoking was earlier among males, wealthier and “coloured” people from Northern and Eastern Capes.

Conclusion

The onset of tobacco smoking peaked at 15–22 years and varied by province, sex, location, race and other characteristics. The age restrictions on smoking in South Africa has changed over time, coupled with the recent open and electronic advertisement of tobacco, and social media could have influenced the earlier onset of tobacco smoking in South Africa. Stricter regulations on tobacco-related advertisement and sales should be implemented.

Dose-response effect of smoking status on quality-adjusted life years among U.S. adults aged 65 years and older

Background

To estimate the impact of smoking on quality-adjusted life years (QALY) for US adults aged 65 years and older.

Methods

Using the 2003-08 National Health and Nutrition Examination Survey Linked Mortality File, we estimated the mean QALY throughout the remaining lifetime by participants' smoking status as well as smoking intensity and time since cessation.

Results

Never, former and current smokers had a mean QALY of 16.1, 12.7 and 7.3 years, respectively. Among current smokers, those who started smoking before age 18 had fewer QALYs than those who started at or after age 18 (6.0 and 8.5 years, respectively) and those smoking ≥20 cigarettes per day had fewer QALYs than those smoking <20 cigarettes per day (6.6 and 8.1 years, respectively). QALYs also declined with a longer duration of smoking and a shorter time since cessation. The potential gains if a person quit smoking would be 5.4 QALYs, and the gains would increase with a longer time since quitting as well as quitting at a younger age.

Conclusions

This study demonstrated the dose-response effect of smoking status on QALY. The results indicate the health benefits of tobacco cessation at any age and sizeable losses for former or current smokers.

Early smoking-onset age and risk of cardiovascular disease and mortality

Early smoking onset age (SOA) is a public health concern with scant empirical evidence of its role in health outcomes. The study had two aims: i) to assess whether an early SOA was associated with the risk of fatal and non-fatal CVD and all-cause and CVD mortality and ii) to explore the linear and non-linear association between SOA and the outcomes of interest. Data from 4499 current or former smokers, recruited from 1995 to 2005, aged 25 to 79 years, and with a median 7.02 years of follow-up, were obtained from the REGICOR population-based cohort. In the present analysis, performed in 2018, the independent variable was SOA and the dependent variables were CVD events, CVD mortality, and all-cause mortality. Penalized smoothing spline methods were used to assess the linear and non-linear association. During follow-up, 361 deaths and 210 CVD events were recorded. A significant non-linear component was identified in the association between SOA and CVD outcomes with a cut-off point at 12 years: In the group aged ≤12 years, each year of delay in SOA was inversely associated with CVD risk (HR = 0.71; 95%CI = 0.53-0.96) and CVD mortality (HR = 0.58; 95%CI = 0.37-0.90). No association was observed in the older SOA group. A linear association was observed between SOA and all-cause mortality, and each year of delay was associated with 4% lower risk of mortality (HR = 0.96; 95%CI = 0.93-0.98). The associations were adjusted for lifelong exposure to tobacco and cardiovascular risk factors. These results reinforce the value of preventing tobacco use among teenagers and adolescents.

Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014-2016

INTRODUCTION

Tobacco use mostly begins in adolescence and young adulthood. Earlier age of initiation of cigarette smoking is associated with greater nicotine dependence and sustained tobacco use. However, data are limited on the age of initiation of non-cigarette tobacco products, and the association between using these products and nicotine dependence and progression to established use.

METHODS

Combined 2014-2016 National Youth Tobacco Survey data, a nationally representative cross-sectional survey of US students in grades 6-12 yielded 19 580 respondents who reported ever using any of five tobacco products: electronic cigarettes, cigarettes, cigars, smokeless tobacco and hookah. Analyses assessed age of reported first use of each product among ever-users, overall and by sex and race/ethnicity. Current daily use, past 30-day use, feelings of craving tobacco and time to first tobacco use after waking were assessed by age of first use.

RESULTS

Among ever-users, weighted median age for first use was 12.6 years for cigarettes, 13.8 years for cigars, 13.4 years for smokeless tobacco, 14.1 years for hookah and 14.1 years for e-cigarettes. First trying these tobacco products at age ≤13 years was associated with greater current use of the respective product and nicotine dependence compared with initiating use at age >13 years.

CONCLUSIONS

First tobacco use at age ≤13 years is associated with current daily and past 30-day use of non-cigarette tobacco products, and with the development of nicotine dependence among youth ever-users. Proven tobacco prevention interventions that reach early adolescents are important to reduce overall youth tobacco use.

Divergent trends in lung cancer incidence by gender, age and histological type in Estonia: a nationwide population-based study

Background

Lung cancer (LC) is the leading cause of cancer deaths in men and the second most frequent cause of cancer deaths in women in Estonia. The study aimed to analyze time trends in LC incidence and mortality in Estonia over the 30-year period, which included major social, economic and health care transition. The results are discussed in the context of changes in tobacco control and smoking prevalence. Long-term predictions of incidence and mortality are provided.

Methods

Data for calculating the incidence and mortality rates in 1985–2014 were obtained from the nationwide population-based Estonian Cancer Registry and the Causes of Death Registry. Joinpoint regression was used to analyze trends and estimate annual percentage change (APC) with 95% confidence interval (CI). Nordpred model was used to project future incidence and mortality trends for 2015–2034.

Results

Incidence peaked among men in 1991 and decreased thereafter (APC: -1.5, 95% CI: -1.8; −1.3). A decline was seen for all age groups, except age ≥ 75 years, and for all histological types, except adenocarcinoma and large cell carcinoma. Incidence among women increased overall (APC: 1.6, 95% CI: 1.1; 2.0) and in all age groups and histological types, except small cell carcinoma. Age-standardized incidence rate (world) per 100,000 was 54.2 in men and 12.9 in women in 2014. Changes in mortality closely followed those in incidence. According to our predictions, the age-standardized incidence and mortality rates will continue to decrease in men and reach a plateau in women.

Conclusions

The study revealed divergent LC trends by gender, age and histological type, which were generally consistent with main international findings. Growing public awareness and stricter tobacco control have stimulated overall favorable changes in men, but not yet in women. Large increase in incidence was observed for adenocarcinoma, which in men showed a trend opposite to the overall decline. LC will remain a serious public health issue in Estonia due to a high number of cases during the next decades, related to aging population, and previous and current smoking patterns. National tobacco control policy in Estonia should prioritize preventing smoking initiation and promoting smoking cessation, particularly among women.

Impact of Age at Smoking Initiation on Smoking-Related Morbidity and All-Cause Mortality

INTRODUCTION

Using a nationally representative sample of U.S. adults, the aims of this study were to examine the impact of early smoking initiation on the development of self-reported smoking-related morbidity and all-cause mortality.

METHODS

National Health Interview Survey data from 1997 through 2005 were linked to the National Death Index with follow-up to December 31, 2011. Two primary dependent variables were smoking-related morbidity and all-cause mortality; the primary independent variable was age of smoking initiation. The analyses included U.S. population of current and former smokers aged ≥30 years (N=90,278; population estimate, 73.4 million). The analysis relied on fitting logistic regression and Cox proportional hazards models.

RESULTS

Among the U.S. population of smokers, 7.3% started smoking before age 13 years, 11.0% at ages 13-14 years, 24.2% at ages 15-16 years, 24.5% at ages 17-18 years, 14.5% at ages 19-20 years, and 18.5% at ages ≥21 years. Early smoking initiation before age 13 years was associated with increased risks for cardiovascular/metabolic (OR=1.67) and pulmonary (OR=1.79) diseases as well as smoking-related cancers (OR=2.1) among current smokers; the risks among former smokers were cardiovascular/metabolic (OR=1.38); pulmonary (OR=1.89); and cancers (OR=1.44). Elevated mortality was also related to early smoking initiation among both current (hazard ratio, 1.18) and former smokers (hazard ratio, 1.19).

CONCLUSIONS

Early smoking initiation increases risks of experiencing smoking-related morbidities and all-cause mortality. These risks are independent of demographic characteristics, SES, health behaviors, and subsequent smoking intensity. Comprehensive tobacco control programs should be implemented to prevent smoking initiation and promote cessation among youth.

Nicotine produces long-term increases in cocaine reinforcement in adolescent but not adult rats

Studies have shown that many smokers begin using nicotine during adolescence, yet the influence of early nicotine use on the response to other drugs of abuse in adulthood is not fully understood. In the current study, nicotine was administered to adolescent and adult rats for seven days. Thirty days later, cocaine-induced locomotor activity and cocaine self-administration were examined when the rats pretreated as adolescents were adults. Rats exposed to nicotine during early adolescence were sensitized thirty days later to the locomotor-activating effects of cocaine and self-administered a greater number of cocaine infusions than adolescent rats pretreated with vehicle. As a result of this increased intake, the cocaine self-administration dose-response curve was shifted upward indicating an increase in cocaine reinforcement. Rats pretreated with nicotine as adults, however, did not show a difference in locomotor activity or cocaine self-administration thirty days later compared to adult rats pretreated with vehicle. These findings suggest that early exposure to nicotine has long-term consequences on cocaine use. These data further suggest that nicotine use may carry a greater risk during adolescence than adulthood and adolescents who smoke may be particularly vulnerable to stimulant use. This article is part of a Special Issue entitled SI: Adolescent plasticity.

Effect of a sport-for-health intervention (SmokeFree Sports) on smoking-related intentions and cognitions among 9-10 year old primary school children: a controlled trial

BACKGROUND

Preventing children from smoking is a public health priority. This study evaluated the effects of a sport-for-health smoking prevention programme (SmokeFree Sports) on smoking-related intentions and cognitions among primary school children from deprived communities.

METHODS

A non-randomised-controlled trial targeted 9-10 year old children from Merseyside, North-West England. 32 primary schools received a programme of sport-for-health activities over 7 months; 11 comparison schools followed usual routines. Data were collected pre-intervention (T0), and at 8 months (T1) and one year post-intervention (T2). Smoking-related intentions and cognitions were assessed using an online questionnaire. Intervention effects were analysed using multi-level modelling (school, student), adjusted for baseline values and potential confounders. Mixed-sex focus groups (n = 18) were conducted at T1.

RESULTS

961 children completed all assessments and were included in the final analyses. There were no significant differences between the two study groups for non-smoking intentions (T1: β = 0.02, 95 % CI = -0.08-0.12; T2: β = 0.08, 95 % CI = -0.02-0.17) or for cigarette refusal self-efficacy (T1: β = 0.28, 95 % CI = -0.11-0.67; T2: β = 0.23, 95 % CI = -0.07-0.52). At T1 there was a positive intervention effect for cigarette refusal self-efficacy in girls (β = 0.72, 95 % CI = 0.21-1.23). Intervention participants were more likely to 'definitely' believe that: 'it is not safe to smoke for a year or two as long as you quit after that' (RR = 1.19, 95 % CI = 1.07-1.33), 'it is difficult to quit smoking once started' (RR = 1.56, 95 % CI = 1.38-1.76), 'smoke from other peoples' cigarettes is harmful' (RR = 1.19, 95 % CI = 1.20-2.08), 'smoking affects sports performance' (RR = 1.73, 95 % CI = 1.59-1.88) and 'smoking makes 'no difference' to weight' (RR = 2.13, 95 % CI = 1.86-2.44). At T2, significant between-group differences remained just for 'smoking affects sports performance' (RR = 1.57, 95 % CI = 1.43-1.72). Focus groups showed that SFS made children determined to remain smoke free and that the interactive activities aided children's understanding of smoking harms.

CONCLUSION

SFS demonstrated short-term positive effects on smoking attitudes among children, and cigarette refusal self-efficacy among girls. Although no effects were observed for non-smoking intentions, children said that SFS made them more determined not to smoke. Most children had strong intentions not to smoke; therefore, smoking prevention programmes should perhaps target early adolescents, who are closer to the age of smoking onset.

Smoking Cessation Failure Among Korean Adolescents

The aim of this study was to identify smoking cessation failure subgroups among Korean adolescents. Participants were 379 smoking adolescents who joined a smoking cessation program. A questionnaire and a cotinine urine test were administered before the program began. Three months after the program ended, the cotinine urine test was repeated. A decision-tree model identified seven subgroups with low or high smoking cessation rates. The predictors of smoking cessation were intention to stop smoking, initiation of smoking, amount of cigarette use, self-efficacy, and paternal smoking status. The subgroup with the lowest smoking cessation rate included adolescents who did not have any intention to stop smoking and who had started smoking after eighth grade, and none of the participants in this group stopped smoking. The results of this study provide crucial information for tailored smoking cessation programs.

Machines that Go 'Ping': Medical Technology and Health Expenditures in OECD Countries

Technology is believed to be a major determinant of increasing health spending. The main difficulty to quantify its effect is to find suitable proxies to measure medical technological innovation. This paper's main contribution is the use of data on approved medical devices and drugs to proxy for medical technology. The effects of these variables on total real per capita health spending are estimated using a panel model for 18 Organisation for Economic Co-operation and Development (OECD) countries covering the period 1981-2012. The results confirm the substantial cost-increasing effect of medical technology, which accounts for almost 50% of the explained historical growth of spending. Despite the overall net positive effect of technology, the effect of two subgroups of approvals on expenditure is significantly negative. These subgroups can be thought of as representing 'incremental medical innovation', whereas the positive effects are related to radically innovative pharmaceutical products and devices. A separate time series model was estimated for the USA because the FDA approval data in fact only apply to the USA, while they serve as proxies for the other OECD countries. Our empirical model includes an indicator of obesity, and estimations confirm the substantial contribution of this lifestyle variable to health spending growth in the countries studied.

Process evaluation of a sport-for-health intervention to prevent smoking amongst primary school children: SmokeFree Sports

Background

SmokeFree Sports (SFS) was a multi-component sport-for-health intervention aiming at preventing smoking among nine to ten year old primary school children from North West England. The purpose of this study was to evaluate the process and implementation of SFS, examining intervention reach, dose, fidelity, acceptability and sustainability, in order to understand the feasibility and challenges of delivering such interventions and inform interpretations of intervention effectiveness.

Methods

Process measures included: booking logs, 18 focus groups with children (n = 95), semi-structured interviews with teachers (n = 20) and SFS coaches (n = 7), intervention evaluation questionnaires (completed by children, n = 1097; teachers, n = 50), as well direct observations (by researchers, n = 50 observations) and self-evaluations (completed by teachers, n = 125) of intervention delivery (e.g. length of sessions, implementation of activities as intended, children’s engagement and barriers). Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively.

Results

Overall, SFS reached 30.8% of eligible schools, with 1073 children participating in the intervention (across 32 schools). Thirty-one schools completed the intervention in full. Thirty-three teachers (55% female) and 11 SFS coaches (82% male) attended a bespoke SFS training workshop. Disparities in intervention duration (range = 126 to 201 days), uptake (only 25% of classes received optional intervention components in full), and the extent to which core (mean fidelity score of coaching sessions = 58%) and optional components (no adaptions made = 51% of sessions) were delivered as intended, were apparent. Barriers to intervention delivery included the school setting and children’s behaviour and knowledge. SFS was viewed positively (85% and 82% of children and teachers, respectively, rated SFS five out of five) and recommendations to increase school engagement were provided.

Conclusion

SFS was considered acceptable to children, teachers and coaches. Nevertheless, efforts to enhance intervention reach (at the school level), teachers’ engagement and sustainability must be considered. Variations in dose and fidelity likely reflect challenges associated with complex intervention delivery within school settings and thus a flexible design may be necessary. This study adds to the limited scientific evidence base surrounding sport-for-health interventions and their implementation, and suggests that such interventions offer a promising tool for engaging children in activities which promote their health.

Prevalence, patterns and correlates of cigarette smoking in male adolescents in northern Jordan, and the influence of waterpipe use and asthma diagnosis: a descriptive cross-sectional study

Our study investigates the prevalence, patterns and predictors of tobacco smoking among early adolescent males in Northern Jordan and whether asthma diagnosis affects smoking patterns. A descriptive cross sectional design was used. Males in grades 7 and 8 from four randomly selected high schools in the city of Irbid were enrolled. Data on waterpipe (WP) use and cigarette smoking patterns were obtained (n = 815) using a survey in Arabic language. The overall prevalence of ever having smoked a cigarette was 35.6%, with 86.2% of this group smoking currently. Almost half of the sample reported WP use. The most common age in which adolescents started to experiment with cigarettes was 11–12 years old (49.1%), although 10 years was also common (25.3%). Significant predictors of male cigarette smoking were WP use (OR = 4.15, 95% CI = 2.99–5.76), asthma diagnosis (OR = 2.35, 95% CI = 1.46–3.78), grade 8 (OR = 1.52, 95% CI = 1.10–2.11), and having a sibling who smokes (OR = 2.23, 95% CI = 1.53–3.24). However, this cross-sectional study cannot establish causality, thus longitudinal studies are needed. Public health programs and school-based anti-tobacco smoking interventions that target children in early years at high schools are warranted to prevent the uptake of tobacco use among this vulnerable age group. High school students with asthma should be specifically targeted.

Trends in smoking and lung cancer mortality in Japan, by birth cohort, 1949-2010

OBJECTIVE

To determine smoking trends in Japan in comparison with lung cancer mortality.

METHODS

Age-specific smoking prevalence among cohorts born between 1897 and 1985 were determined for the period 1949-2010. The percentages of the cohorts born between 1893 and 1979 who initiated smoking early (e.g. before the age of 20 years) were determined. The results were compared against lung cancer mortality rates in people aged 40-84 years belonging to cohorts born between 1868 and 1968.

FINDINGS

In males, smoking prevalence was generally high, particularly among those born before the late 1950s, and early initiation was fairly uncommon. Early initiation was most common among recent birth cohorts of males, who showed relatively low prevalences of smoking. In females, the prevalence of smoking was generally low and early initiation was very uncommon, particularly among those born in the late 1930s and before the late 1940s, respectively. Recent cohorts of females showed relatively high prevalences of smoking and relatively high percentages of early initiation. In both sexes, lung cancer mortality was generally low but increased over the study period.

CONCLUSION

Lung cancer mortality in Japanese males was relatively low given the high prevalence of smoking, perhaps because early initiation was fairly uncommon. Over the last four decades, however, early initiation of smoking has become more common in both sexes. The adverse effect this is likely to have on lung cancer mortality rates has probably not been observed because of the long time lag between smoking initiation and death from lung cancer.