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

A scoping review on the use of machine learning in research on social determinants of health: Trends and research prospects

Background

Machine learning (ML) has spread rapidly from computer science to several disciplines. Given the predictive capacity of ML, it offers new opportunities for health, behavioral, and social scientists. However, it remains unclear how and to what extent ML is being used in studies of social determinants of health (SDH).

Methods

Using four search engines, we conducted a scoping review of studies that used ML to study SDH (published before May 1, 2020). Two independent reviewers analyzed the relevant studies. For each study, we identified the research questions, Results, data, and algorithms. We synthesized our findings in a narrative report.

Results

Of the initial 8097 hits, we identified 82 relevant studies. The number of publications has risen during the past decade. More than half of the studies (n = 46) used US data. About 80% (n = 66) utilized surveys, and 70% (n = 57) employed ML for common prediction tasks. Although the number of studies in ML and SDH is growing rapidly, only a few studies used ML to improve causal inference, curate data, or identify social bias in predictions (i.e., algorithmic fairness).

Conclusions

While ML equips researchers with new ways to measure health outcomes and their determinants from non-conventional sources such as text, audio, and image data, most studies still rely on traditional surveys. Although there are no guarantees that ML will lead to better social epidemiological research, the potential for innovation in SDH research is evident as a result of harnessing the predictive power of ML for causality, data curation, or algorithmic fairness.

Predictors of current tobacco smoking by adolescents in Nigeria: Interaction between school location and socioeconomic status

INTRODUCTION

Tobacco smoking is the largest preventable cause of global mortality, with its prevalence increasing in Sub-Saharan Africa, particularly among adolescents. We sought to determine the factors associated with tobacco smoking among Nigerian school adolescents and investigate the interaction between school location and socioeconomic status (SES).

METHODS

Using a cross-sectional study design, 4332 eighth to tenth grade students in rural and urban secondary schools in Enugu State, Nigeria, were selected by stratified two-stage cluster sampling. We collected data using a modified Global Youth Tobacco Survey (GYTS) Core Questionnaire. Outcome measures were current smoking of cigarettes and other smoked tobacco. Multilevel mixed effects logistic regression models were used to determine factors associated with current tobacco smoking and were considered statistically significant at p<0.05.

RESULTS

Prevalences of current smoking of cigarettes and other smoked tobacco were 13.3% (95% CI: 11.3-15.7) and 5.8% (95% CI: 4.6-7.2), respectively. Possession of higher weekly allowance, exposure to secondhand smoke or tobacco advertisements, having smoking parents, friends or classmates who smoke, and sale of cigarettes near school, were positively associated with current smoking of tobacco. Female sex, having both parents employed and being exposed to tobacco teaching in school were negatively associated with current cigarette smoking while increasing age and high father's SES were negatively associated with current smoking of other tobacco products. There was an interaction between school location and father's SES in the association with cigarette smoking. The higher odds of smoking in rural versus urban schools were much higher for students with fathers of high SES compared to low SES. In rural schools, high SES was associated with higher odds of smoking, but in urban schools low SES was associated with higher odds of smoking. CONCLUSIONS Environmental factors are associated with adolescent tobacco smoking. Tobacco control programs should use targeted strategies that vary depending on the local context.

Exposure to Hookah and Cigarette Smoke in Children and Adolescents According to Their Socio-Economic Status: The CASPIAN-IV Study

Background

Exposure to smoking or passive smoking is one of serious health problems especially in the pediatric age group.

Objectives

To compare the prevalence and determinants of passive smoking in a nationally representative sample of Iranian children and adolescents according to their socioeconomic status (SES).

Materials and Methods

This nationwide study was conducted in 2011 - 2012 among 14880 students aged 6 - 18 years, living in 30 provinces in Iran. Exposure to the smoke of hookah or cigarette was documented by using validated questionnaires. Possible influencing factors were determined and the frequency of passive smoking was compared according to the regional and familial SES.

Results

Participants consisted of 13,486 children and adolescents including 49.2% girls and 75.6% urban inhabitants (90.6% participation rate). The mean age of participants was 12.47 ± 3.36 years. Overall, 43.87% of them (44.07% of boys and 43.66% of girls) were exposed to second hand smoke at home. Exposures to hookah or cigarette smoke at home were respectively reported in 21.46% and 34.49% of participants. The prevalence of passive smoking was lower in children of families with higher SES level, but higher in high SES regions of the country than in low SES ones, and ranged from 39.2% in the region with lowest SES to 49.05% in the highest SES region. Higher education levels of fathers and mothers were significantly associated with lower frequency of passive smoking.

Conclusions

Exposure to second hand smoke is a major problem among Iranian children and adolescents. Low family SES and low parental education increased the frequency of passive smoking. Appropriate public health education and legislation for smoke free home as well as family-centered counseling should be strengthened.

Determinants of Tobacco and Hookah Smoking in a Nationally Representative Sample of Iranian Children and Adolescents: The CASPIAN-IV Study

Background

The consumption of tobacco through a hookah is growing in popularity, especially among children and adolescents, but little is known about the determinants of hookah smoking.

Objectives

The current study aimed to assess the determinants of tobacco smoking and hookah smoking in a nationally representative sample of Iranian children and adolescents.

Patients and Methods

This study was conducted as part of the fourth cross-sectional survey of a national school-based program. Using a cluster random sampling method, a validated questionnaire was completed anonymously by 14,880 students who were aged 6 - 18 years and living in urban and rural areas of 30 provinces in Iran.

Results

The final study group consisted of 13,486 children and adolescents (participation rate of 90.6%), of whom 49.2% were girls and 75.6% were urban residents. The mean age was 12.47 ± 3.36 years. According to the self-reports of the students, 2.6% (3.5% of boys and 1.7% of girls) were current tobacco smokers, 5.9% (7.5% of boys and 4.2% of girls) were ever tobacco smokers, and 1.8% (2.49% of boys and 1.14% of girls) were current hookah smokers. Based on a multiple logistic regression (MLR) model, the following factors increased the risk of current smoking: age, number of days spent with friends per week, hookah smoking or cigarette smoking by the father, hookah smoking by siblings, hookah smoking by other members of the family, and screen time. The age, number of days spent with friends, hookah or cigarette smoking by the father, hookah smoking by siblings, and screen time increased the risk of hookah smoking. Female gender and living in rural areas decreased the risk of current tobacco and hookah smoking.

Conclusions

Preventive measures against tobacco use should be underscored for Iranian families. The preparation of strategies on the promotion of a healthy lifestyle should be considered a health priority.

Predicting Initiation of Smoking Cessation Treatment and Outcome Among Adolescents Using Stressful Life Events and Coping Style

BACKGROUND

Adolescent smoking is a major public health concern, and current treatments are only somewhat effective in promoting abstinence. One way to improve treatments is to identify psychosocial characteristics that impede cessation, allowing development of targeted treatments. This study examined the influence of 2 such characteristics, life event stressors and coping, on initiation of cessation treatment and end-of-treatment abstinence status.

METHODS

One hundred five adolescent smokers were eligible to participate in a validated contingency management (CM) and cognitive-behavioral (CBT) cessation treatment; of those, 72 completed at least 1 treatment session. Data included sociodemographic characteristics, questionnaires assessing past-year life events and coping behavior use, and abstinence status at the end of the 4-week treatment. Logistic regression was used to predict treatment initiation and abstinence status, with life event stressor number, coping, or their interaction as predictors.

RESULTS

Higher levels of cognitive and peer support coping predicted treatment initiation, whereas life events were unrelated. End-of-treatment abstinence was predicted by higher numbers of life events and greater use of avoidant coping. The interaction of helpless coping and life events also predicted abstinence, with greater increases in helpless coping as total life events rose in abstinent but not nonabstinent participants. Finally, greater use of behavioral coping predicted abstinence in participants exposed to only CM treatment, whereas lesser use of behavioral coping predicted abstinence in participants receiving combined CM/CBT treatment.

CONCLUSIONS

Exposure to life event stressors may promote cessation by forcing use of self-control resources prior to the quit attempt, which may strengthen such resources. Techniques that improve self-control resources may improve cessation outcome, and prevention programs may want to emphasize behavioral coping to improve rates of treatment initiation.

Trends in smoking among university students between 2005-2012 in Sakarya, Turkey

Turkey protects its entire population of 75 million people with all the MPOWER measures at the highest level. The aim of this study is to make a comparison of smoking and addiction data obtained from Sakarya University students in 2005-6 and 2012-13. A total of 4,200 (2,500 and 1,700 for each academic year) students at Sakarya University in Sakarya, Turkey, were randomly selected for sampling purposes. The selected participants represented Sakarya University students. Data were collected using a pretested anonymous and confidential, self-completed questionnaire which took 15-20 minutes to complete and Fagerstrom Test for nicotine dependence. Chi-squared, Spearman correlation, and binary logistic regression tests were used to define associations, if any. The level of significance was kept at alpha=0.05. Smoking prevalence dropped by 8.5% (from 26.9% to 18.5%). Male gender, older age, high family smoking index, low self-rated school success, and high peer smoker proportion were common variables that have correlation with smoking status. In the binary logistic regression test the highest contributor to "being a smoker" was found to be the rate of peer smokers. Having all friends smoking puts the student a a 47.5 and 58.0 times higher risk for smoking for males and females, respectively. Our results suggest an admirable diminution of smoking prevalence among Sakarya University students, which can be attributed to MPOWER protection.

The prevalence of smoking among karbala/iraq university students in iraq in 2005

BACKGROUND

Tobacco use is considered one of the largest public health threats facing the world. The estimated number of current smokers in the world exceeds 1.3 billion, which means that one third of the world’s population above 15 years are smokers. Smoking prevalence is increasing in the developing world but monitoring of this trend is poor in these countries. Studies on smoking in Iraq are scarce, with the current smoking prevalence rate reported to be 15–25% for males and 1–10% for females in surveys conducted in the past ten years.

OBJECTIVES

This study aimed to find the prevalence of smoking among Karbala University students in Iraq and determine its associations with participants’ demographic and other related predictors, including other substance use behaviors, to help inform and develop future prevention and control programs.

MATERIAL AND METHODS

A categorical random sample included 2298 students at Karbala University in Iraq who answered a self-completed questionnaire. The questionnaire was based on the Drug Abuse Program questionnaire and was piloted before implementation. Descriptive and analytic statistical tools (SPSS-20) were used to assess significant associations at P < 0.001 to compensate for multiple comparisons.

RESULTS

The prevalence of current smoking among Karbala University students was 10.5%, shisha smoking 4.4% and previous smoking (having ceased smoking for more than 30 days) 1.0%. Approximately half of the smokers surveyed (45.7%) started smoking before the age of 18. Smoking was positively related to male gender, increasing age, being unmarried, college, drinking alcohol, having a positive attitude toward smoking and higher fathers’ educational level.

CONCLUSION

Lifetime smoking prevalence was found to be approximately two out of ten students. Significant positive association was found between smoking and other substance use behaviours. Additionally it was associated with positive attitudes toward substance use.

Significant predictors were determined. Further studies are needed to explore the prevalence of smoking among Iraqi youths to find trends and help to guide the implementation scientifically based control and prevention programs.

Do researcher-derived classifications of youths' smoking behavior correspond with youths' characterizations of their behavior?

AIMS

To describe the categories employed by researchers to describe adolescents' smoking behavior and to determine how these various categorizations compare with youths' self-defined smoking status.

STUDY SELECTION

A search of the PubMed and Science Direct databases, limited to articles in the English language, published between January 2002 and November 2007.

DATA EXTRACTION

Employing a mixed methods approach, several categories of youths' smoking status were obtained from a literature review and subsequently reproduced by using responses to detailed questionnaire items. Associations between the researcher-derived smoking categories (from the literature review) and the youths' self-reported smoking status, from survey data, were determined.

RESULTS

The categories of smoking status, from the literature review, varied in definition and in the number of categories. The associations between the literature-based categories and the youths' self-reported smoking status were modest.

CONCLUSIONS

Researcher-derived categories of youths' smoking status may not adequately encapsulate youths' perceptions of their own smoking behavior. There is a need to better describe adolescents' smoking behavior with special consideration of the ways in which adolescents characterize their own smoking behavior.

Smoking at school: views of Turkish university students

The recent interest in cigarette smoking among university students has brought attention to problems concerning opinions, attitudes, prevention, health education, policy formulation and implementation. This survey research tested five hypotheses on the views of college students about smoking in school hallways and cafeteria, compliance with anti smoking laws, considering cigarette smoking as an expression of freedom of choice, teachers' smoking in classrooms and in their offices, and school administration's policy on enforcing the law. Hypothesized differences between students' views on the issues according to gender, smoking status and years at school were investigated. Data were obtained from 3,659 students attending six universities in Ankara, Turkey. The study findings provided support for all the hypothesized differences (except a single issue). Males and females differed significantly on all the issues studied. The majority of nonsmoking students have anti-smoking views in regards of the studied issues as compared to regular and occasional smokers. Smokers and nonsmokers markedly disagree on banning cigarette smoking in the cafeteria and hallways. However, the majority of students are against teachers' smoking in classrooms and in their offices with the doors open. Although most students want a smoke free environment, there is no active-anti smoking policy on smoking by universities. Findings point out the need for campus-wide effective smoking prevention programs, as well as cessation programs and services for the students.

Application of a stage based motivational interviewing approach to adolescent smoking cessation: the Transtheoretical Model-based study

OBJECTIVE

To evaluate the results of stage-based motivational interviewing (MI) efforts to help adolescents quit smoking using the three constructs of Transtheoretical Models (TTM). The validity of Turkish translations of two key scales was also assessed.

METHODS

A methodological and single group pre-post test study design was utilized. 275 adolescent smokers from one high school were recruited for validation of the scales and 60 of them participated in MI intervention. Change in smoking stage, interpretation of pros and cons of smoking, temptations, and smoking status were measured prior to the intervention, and follow-up was conducted at 3 and 6 months after intervention.

RESULTS

The scales showed adequate reliability and validity for use in Turkish adolescent. Of the MI participants, 40% and 55% had made positive movements in stage at 3 and 6 months, respectively. The interpretations of the cons of smoking significantly increased and temptations dropped toward the action stage at 3 months, and pros of smoking and temptations decreased at 6 months consistently with TTM. The percentages of those who had quit smoking at 3 and 6 months were 18.3% and 33.3% respectively.

CONCLUSION

A modest, short-term benefit of the intervention was provided to students towards stopping smoking and positive movement in stages was apparent.

PRACTICAL IMPLICATIONS

Using the MI principles in specific stages based on TTM, health care providers can influence and empower adolescent smokers positively for quitting smoking.