Adolescent smoking behaviour and cigarette brand preference in Japan

Evaluating the public health impact of partial and full tobacco flavour bans: A simulation study

Background

Methods

Findings

Interpretations

Funding

Acute Myocardial Infarction in a 17-year-old High-school Girl

We report an unusual case of acute myocardial infarction in a high school girl. The patient was 17 years of age and had multiple coronary risk factors, including marked obesity with a body mass index (BMI) of 42.7 kg/m², dyslipidemia and glucose intolerance. She had been an on and off smoker since she was 13 years of age. Due to the recent Westernization of the lifestyle, the prevalence of metabolic syndrome in the young generation has been increasing in Japan. Cardiovascular disease based on lifestyle-related diseases may become more common in young people.

Relationships of coping styles and sleep quality with anxiety symptoms among Chinese adolescents: A cross-sectional study

BACKGROUND

Limited published research has examined the relationships of coping styles and sleep quality with anxiety symptoms in Chinese school adolescents. We aimed to explore the effect of coping styles and sleep quality on anxiety symptoms. Furthermore, we investigated the interactions of coping styles and sleep quality with anxiety symptoms.

METHODS

The survey was conducted in Jiangxi Province, China. The Simplified Coping Style Questionnaire, Pittsburgh Sleep Quality Index and Chinese Secondary School Students Anxiety Scale were utilized to assess sleep quality, coping styles and anxiety symptoms, respectively. Multiple logistic regression analysis was applied to explore the relationships of coping styles and sleep quality with anxiety symptoms.

RESULTS

A total of 3081 students participated in this study, 50.8% of whom were boys; the number of participants in grades 1, 2 and 3 were 979, 1085 and 1017, respectively. The prevalence of anxiety symptoms was 27.3%. Individuals with poor sleep quality were 3.558 (95% CI = 2.716-4.660) times as likely to have anxiety symptoms than those with good sleep quality. Higher negative coping style scores increased the prevalence of anxiety symptoms (OR = 2.101, 95% CI = 1.894-2.332), whereas higher positive coping style scores were related to reduced odds of anxiety symptoms (OR = 0.892, 95% CI = 0.800-0.995). Interactions of coping styles and sleep quality with anxiety symptoms were not found (all p > 0.05). The association between negative coping style and anxiety symptoms was mediated by sleep quality.

LIMITATIONS

This study was cross-sectional and limited to Ganzhou City.

CONCLUSIONS

The results of our study showed a higher prevalence of anxiety symptoms compared with the result of a previous study in Chinese school adolescents. Negative coping style and poor sleep quality were associated with an increased prevalence of anxiety symptoms, whereas positive coping style was related to a decreased prevalence of anxiety symptoms. Sleep quality was a mediating factor between negative coping style and anxiety symptoms.

Challenges and opportunities for greater tobacco control in Japan

Japan is a high tobacco burden country with over 20 million smokers in 2017. Tobacco control measures in Japan has been criticised as largely inadequate and ineffective despite ratifying the World Health Organization's Framework Convention on Tobacco Control in 2004. Numerous factors such as pro-tobacco legislators, regulatory oversight of the primary Japanese tobacco company from the Ministry of Finance and industry interference on the policy-making process in Japan have prevented aggressive tobacco control efforts. Given the intricate challenges in Japan, it is important to develop feasible and effective smoking cessation strategies. In this paper, we have analysed the trends in tobacco prices, sale and smoking prevalence, major tobacco/smoking policies and some of the industry-related challenges that have prevented the development of effective tobacco control measures in Japan. We have emphasised the need for stronger implementation of the World Health Organization's Framework Convention on Tobacco Control and its MPOWER policy package and to separate the tobacco industry from the tobacco control policymaking process to promote cessation and abstinence from smoking and better sensitisation against exposure to second-hand smoke.

Determinants of High-School Dropout: A Longitudinal Study in a Deprived Area of Japan

Background

Our objective in this study was to find determinants of high-school dropout in a deprived area of Japan using longitudinal data, including socio-demographic and junior high school-period information.

Methods

We followed 695 students who graduated the junior high school located in a deprived area of Japan between 2002 and 2010 for 3 years after graduation (614 students: follow-up rate, 88.3%). Multivariable log-binomial regression models were used to calculate the prevalence ratios (PRs) for high-school dropout, using multiple imputation (MI) to account for non-response at follow-up.

Results

The MI model estimated that 18.7% of students dropped out of high school in approximately 3 years. In the covariates-adjusted model, three factors were significantly associated with high-school dropout: ≥10 days of tardy arrival in junior high school (PR 6.44; 95% confidence interval [CI], 1.69–24.6 for “10–29 days of tardy arrival” and PR 8.01; 95% CI, 2.05–31.3 for “≥30 days of tardy arrival” compared with “0 day of tardy arrival”), daily smoking (PR 2.01; 95% CI, 1.41–2.86) and severe problems, such as abuse and neglect (PR 1.66; 95% CI, 1.16–2.39). Among students with ≥30 days of tardy arrival in addition to daily smoking or experience of severe problems, ≥50% high-school dropout rates were observed.

Conclusions

Three determinants of high-school dropout were found: smoking, tardy arrival, and experience of severe problems. These factors were correlated and should be treated as warning signs of complex behavioral and academic problems. Parents, educators, and policy makers should work together to implement effective strategies to prevent school dropout.

Association between Possibility of Purchasing Cigarettes and E-cigarette Experience among Korean Adolescent Smokers

BACKGROUND

To aim of this study was to examine the association between perceived possibility of purchasing cigarettes and e-cigarette experience among adolescents who currently smoke cigarettes.

METHODS

Data were derived from the Korea Youth Risk Behavior Web-Based Survey; a total of 29,169 current smokers participated. The dependent variable was e-cigarette experience in the previous month. Analyses included χ2 test and survey logistic regression.

RESULTS

A perceived easy possibility of purchasing cigarettes increased the odds of e-cigarette experience (odds ratio, 1.19; 95% confidence interval, 1.07-1.33) compared to when it was perceived as impossible. An easy possibility of purchasing cigarettes increased the odds of e-cigarettes experience among males aged 12-15 or 17 years compared to when it was impossible to purchase cigarettes.

CONCLUSION

A perceived easy possibility of purchasing cigarettes was more likely to increase e-cigarette experience among adolescents. Laws restricting adolescents' access to e-cigarettes must be strengthened.

Menthol cigarettes and the public health standard: a systematic review

Background

Although menthol was not banned under the Tobacco Control Act, the law made it clear that this did not prevent the Food and Drug Administration from issuing a product standard to ban menthol to protect public health. The purpose of this review was to update the evidence synthesis regarding the role of menthol in initiation, dependence and cessation.

Methods

A systematic review of the peer-reviewed literature on menthol cigarettes via a PubMed search through May 9, 2017. The National Cancer Institute’s Bibliography of Literature on Menthol and Tobacco and the FDA’s 2011 report and 2013 addendum were reviewed for additional publications. Included articles addressing initiation, dependence, and cessation were synthesized based on study design and quality, consistency of evidence across populations and over time, coherence of findings across studies, and plausibility of the findings.

Results

Eighty-two studies on menthol cigarette initiation (n = 46), dependence (n = 14), and cessation (n = 34) were included. Large, representative studies show an association between menthol and youth smoking that is consistent in magnitude and direction. One longitudinal and eight cross-sectional studies demonstrate that menthol smokers report increased nicotine dependence compared to non-menthol smokers. Ten studies support the temporal relationship between menthol and reduced smoking cessation, as they measure cessation success at follow-up.

Conclusions

The strength and consistency of the associations in these studies support that the removal of menthol from cigarettes is likely to reduce youth smoking initiation, improve smoking cessation outcomes in adult smokers, and in turn, benefit public health.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4987-z) contains supplementary material, which is available to authorized users.

Challenges in breast and cervical cancer control in Japan

Since the mid-1990s, there has been an increasing incidence of, and mortality from, cervical and breast cancers in Japan. Such an increase has raised concerns over the efficiency of Japan's screening programmes for these cancers. Although citizens benefit from universal health coverage, the Japanese health insurance system mostly focuses on tertiary prevention and disease treatment, while secondary prevention (screening) is low priority. Citizens have multiple opportunities to be screened for cancer-either through programmes organised by municipalities, or individual or collective, opportunistic and comprehensive health check-ups on a voluntary basis. Despite this, however, participation is as low as 35% of the target population for both cancers. In this Policy Review, we discuss the challenges in the prevention of breast and cervical cancers in Japan, particularly focusing on the structure of the National Health Insurance system and the National Cancer Control Plan, reasons for low participation as a result of social and political attitudes, as well as providing recommendations to overcome these challenges. Japanese women would benefit from new measures to increase participation, a national data surveillance programme to monitor screening activities, and the implementation of a quality assurance system among all providers.

Area disparity in children's perceptions of access to tobacco and cigarette purchasing experiences in Taiwan

BACKGROUND

Adolescents who perceive easy access to tobacco are more likely to acquire cigarettes and experience smoking. This study assesses area disparities in perceptions of access to tobacco and cigarette purchasing experiences among schoolchildren.

METHODS

Data on children's tobacco-related variables were obtained from the Control of School-Aged Children Smoking Study Survey in Taiwan. A stratified random sample of 65 primary schools was included. Polytomous logistic regression analyzed factors associated with tobacco accessibility and purchasing experiences.

RESULTS

More than half of the children reported that tobacco retailers often or always sold cigarettes to them. Rural and mountainous children were more likely to have access to cigarettes (adjusted odds ratio [AOR] = 2.01 and 3.01, respectively) and have cigarette purchasing experiences (AOR = 3.06 and 13.76, respectively). Cigarette purchasing from retailers (AOR = 1.84) was significantly associated with children's perceptions of access to tobacco. The factors associated with cigarette purchasing experiences were families smoking (AOR = 8.90), peers smoking (AOR = 2.22), frequent exposure to entertainer smoking on TV and in films (AOR = 2.15), and perceived access to tobacco (AOR = 1.51).

CONCLUSIONS

The health department should strictly enforce laws regarding retailers selling tobacco to underage, particularly in remote areas. Schools can reinforce tobacco-use prevention messages.

Risk Factors for Smoking Behaviors Among Adolescents

Many students in Korea begin to use tobacco and develop a regular smoking habit before they reach adulthood. Yet, little is known about various signs contributing to the transition of the student smoking behaviors. This study used a national sample to explore and compare risk factors for smoking behaviors. Three types of smoking behaviors were defined: never smoking (in their lifetime), history of experimental smoking (ever tried but not within the last 30 days), and current smoking (at least 1 day during the last 30 days). Risk factors for experimentally starting and not continuing smoking were identified as gender, perceived health status, and friend-related stress. School type, academic performance, alcohol use, perception of harm of smoking, and close friends’ smoking increased the risk of progressing from never smoking to the history of experimental smoking and current smoking. Our findings may be valuable in school health care settings in planning cessation programs.

Analysis of Smoking by South Korean Middle School Students: Shifting Preferences in Brand Choice and Rising Popularity of Marlboro Cigarettes

South Korean Global Youth Tobacco Surveys (GYTS) conducted in 2005 and 2008 were analyzed to determine changes in smoking behavior, cigarette brand choices, perceptions of smoking, and exposure to cigarette promotion/marketing and anti-smoking media messages. Results showed an increase in smoking prevalence, media exposure to cigarette advertising, and the offering of free cigarettes from cigarette company representatives, and a decrease in seeing anti-smoking messages and the perception that quitting smoking is difficult. There was a dramatic rise in the popularity of Marlboro as a brand choice among youth smokers in 2005 (9.1%) to 2008 (49.9%). These unfavorable trends suggest a pervasive tobacco industry influence among South Korean youth. Despite the regulations on advertising in South Korea that have been enacted and other anti-smoking policies which have been implemented, it appears that Philip Morris is particularly adept at circumventing advertising and market restrictions while effectively promoting Marlboro brand identity in youth.

Unhealthy Lifestyle, Poor Mental Health, and Its Correlation Among Adolescents

Objectives. The objective was to study the relationship between mental health and lifestyles of adolescents using samples representative of Japanese adolescents nationwide. Method. The survey was conducted between December 2004 and January 2005 among students enrolled in randomly selected junior and senior high schools. Self-administered questionnaires addressed lifestyles, sleeping habits, and mental health status. Of 103 650 questionnaires collected, 85 158 were analyzed. Results. Population characteristics associated with poor mental health were being female, being a senior high school student, skipping breakfast, not participating in extracurricular activities, not consulting parents about personal matters, parental smoking, students’ smoking or alcohol use, poor subjective sleep assessment, and short or long sleeping duration. Conclusion. Smoking and anxiety disorders are associated with an elevation in acculturative stress in adolescents. Prepossessing adolescents are in subclinical depression. Results suggest that lifestyles approaches in preventions that target students can be effective in reaching high-risk populations.

Tobacco brand preference among Mexican adolescents

INTRODUCTION

Advertising plays a major role in smoking behavior and forming brand preferences. Additionally, the most advertised tobacco brands have also been the most preferred. Maintaining brand loyalty in Latin America remains a priority for the tobacco industry.

OBJECTIVE

The purpose of this study was to explore tobacco brand preference trends from 2003 to 2006, and explore marketing and advertising factors that might be associated with these trends.

STUDY GROUP

Data for this study came from Mexican adolescents residing in cities that participated in the Global Youth Tobacco Survey in both 2003 and 2006 and reported smoking either Marlboro or Camel cigarettes in the past 30 days.

METHODS

Respondents reported the brand name of their preferred cigarette during the past 30 days. Multivariate regression analysis was used to determine differences by brand preference and exposure to tobacco marketing and advertising, which was assessed using six items.

RESULTS

In 2003, most adolescents preferred Marlboro. By 2006, older boys preferred Camel cigarettes to Marlboro, while girls' preference for Camel was similar to their preference for Marlboro. Adolescents that preferred Camel cigarettes in 2003 also reported greater exposure to tobacco marketing and advertising.

CONCLUSION

Findings indicate that there are ongoing shifts in youth brand preference in Mexico, and that these shifts might be related to marketing and advertising practices. There is an ongoing need for monitoring marketing and advertising practices in an effort to protect adolescents from tobacco company exploits.

Differential effects of TRPV1 receptor ligands against nicotine-induced depression-like behaviors

BACKGROUND

The contributions of brain cannabinoid (CB) receptors, typically CB1 (CB type 1) receptors, to the behavioral effects of nicotine (NC) have been reported to involve brain transient receptor potential vanilloid 1 (TRPV1) receptors, and the activation of candidate endogenous TRPV1 ligands is expected to be therapeutically effective. In the present study, the effects of TRPV1 ligands with or without affinity for CB1 receptors were examined on NC-induced depression-like behavioral alterations in a mouse model in order to elucidate the "antidepressant-like" contributions of TRPV1 receptors against the NC-induced "depression" observed in various types of tobacco abuse.

RESULTS

Repeated subcutaneous NC treatments (NC group: 0.3 mg/kg, 4 days), like repeated immobilization stress (IM) (IM group: 10 min, 4 days), caused depression-like behavioral alterations in both the forced swimming (reduced swimming behaviors) and the tail suspension (increased immobility times) tests, at the 2 h time point after the last treatment. In both NC and IM groups, the TRPV1 agonists capsaicin (CP) and olvanil (OL) administered intraperitoneally provided significant antidepressant-like attenuation against these behavioral alterations, whereas the TRPV1 antagonist capsazepine (CZ) did not attenuate any depression-like behaviors. Furthermore, the endogenous TRPV1-agonistic CB1 agonists anandamide (AEA) and N-arachidonyldopamine (NADA) did not have any antidepressant-like effects. Nevertheless, a synthetic "hybrid" agonist of CB1 and TRPV1 receptors, arvanil (AR), caused significant antidepressant-like effects. The antidepressant-like effects of CP and OL were antagonized by the TRPV1 antagonist CZ. However, the antidepressant-like effects of AR were not antagonized by either CZ or the CB1 antagonist AM 251 (AM).

CONCLUSIONS

The antidepressant-like effects of TRPV1 agonists shown in the present study suggest a characteristic involvement of TRPV1 receptors in NC-induced depression-like behaviors, similar to those caused by IM. The strong antidepressant-like effects of the potent TRPV1 plus CB1 agonist AR, which has been reported to cause part of its TRPV1-mimetic and cannabimimetic effects presumably via non-TRPV1 or non-CB1 mechanisms support a contribution from other sites of action which may play a therapeutically important role in the treatment of NC abuse.

Clarification of the factor structure of the 12-item General Health Questionnaire among Japanese adolescents and associated sleep status

If the factors affecting the mental health status of adolescents and their association with sleep status could be clarified, this information would be helpful for formulating lifestyle and healthcare guidance for the promotion of healthy growth and the prevention of mental problems in these individuals. The purpose of this study was to clarify (1) the factor structure of the 12-item General Health Questionnaire (GHQ-12), and (2) the associations between the factors extracted from this questionnaire and lifestyle, in particular sleep status, by using a representative sample population of Japanese adolescents. One hundred three thousand sixty hundred fifty self-administered questionnaires were collected from students enrolled in junior high and high schools in Japan. Of these questionnaires, 99,668 were analyzed. Sleep duration, subjective sleep assessment, bedtime, and insomnia symptoms of these students over the past month were studied to investigate sleep status. The factor analyses yielded two factors: depression/anxiety and loss of positive emotion. Sleep duration of less than 7h was found to be associated with both depression/anxiety and loss of positive emotion, whereas sleep duration of 8h or more was associated only with loss of positive emotion. Subjective sleep assessment and insomnia symptoms were associated with both depression/anxiety and loss of positive emotion. It was demonstrated that two underlying factors of mental health status were associated with differences in sleep status. In order to improve the mental health status of adolescents, it is important to provide guidance about sleep and lifestyle habits according to the mental health status of the individual.

Menthol preference among smokers: association with TRPA1 variants

INTRODUCTION

Preference for smoking menthol cigarettes differs from individual to individual and population to population in ways that may provide higher levels of nicotine intake and contribute to smoking's morbidity and mortality. Menthol acts at sites that include the transient receptor potential (TRP) A1 channel that is expressed by nociceptors in the lung and airways, suggesting that individual and population differences in TRPA1 sequences might contribute to observed differences in menthol preference among smokers.

METHODS

We have thus sought association between menthol preference and common variants in the TRPA1 gene in heavier and lighter European-American smokers. Smokers were recruited for studies of smoking cessation in North Carolina and of substance abuse genetics in Maryland.

RESULTS

A common TRPA1 haplotype is defined by 1 missense and 10 intronic single nucleotide polymorphisms that display significant (.006 < p < .05; χ(2)) association with preference for mentholated cigarettes in heavy smokers (odds ratio ca. 1.3). There are smaller trends in the same direction in lighter smokers.

CONCLUSIONS

This TRPA1 haplotype provides a novel biological basis for individual differences in menthol preference and possibly for actions of other agents that act at TRPA1.

Epidemiology of menthol cigarette use in the United States

Background

Approximately one-fourth of all cigarettes sold in the United States have the descriptor “menthol” on the cigarette pack. It is important to determine what socio-demographic factors are associated with smoking menthol cigarettes if indeed these types of cigarettes are related to smoking initiation, higher exposure to smoke constituents, nicotine dependence, or reduced smoking cessation.

Methods

The National Cancer Institute (NCI) conducted a review of the scientific literature on this topic which we completed by adding more recently published articles via PubMed. We also conducted further data analyses using the National Survey on Drug Use and Health, the National Youth Tobacco Survey, the Monitoring the Future Survey, and the National Health and Nutrition Examination Survey to provide up-to-date information on this topic.

Results

Menthol cigarettes are disproportionately smoked by adolescents, blacks/African Americans, adult females, those living in the Northeast of the United States and those with family incomes lower than $50,000. Based on self-reports of menthol cigarette use, menthol cigarette use among smokers have increased from 2004 to 2008. However, no increase was observed during these years for predominantly menthol brands like Newport™, Kool,™ and Salem™, however, this lack of significant trend may be due, at least in part, due to smaller numbers of smokers of specific brands or sub-brands, which provide estimates which are less precise.

Conclusion

Menthol cigarettes are disproportionately smoked by groups of U.S. cigarette smokers. It is likely that other disparities in menthol cigarette use exist that we have not covered or have not been studied yet.

The impact of menthol cigarettes on smoking initiation among non-smoking young females in Japan

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry’s actions—increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females.

Risk factor effects and total mortality in older Japanese men in Japan and Hawaii

PURPOSE

We sought to identify factors related to total mortality in older Japanese men in Japan and Hawaii.

METHODS

Baseline data were collected from 1980 to 1982 in 1379 men in Hawaii and 954 men in Japan. Ages ranged from 61 to 81 years, with mortality follow-up during a 19-year period.

RESULTS

Compared with Japan, men in Hawaii had a 2-fold excess of diabetes and a 4-fold excess of prevalent coronary heart disease (P < .001). Total cholesterol and body mass index were also greater in Hawaiian men (P < .001). In contrast, men in Japan had greater systolic blood pressure and were nearly 3 times more likely to smoke cigarettes (P < .001). Although each cohort had elements of a poor risk factor profile, there was a 1.4-fold excess in the risk of death in Japan (49.4 vs. 36.2/1,000 person-years, P < .001). Although mortality was similar after risk factor adjustment, only blood pressure and cigarette smoking accounted for the higher risk of death in Japan.

CONCLUSIONS

Cigarette smoking and hypertension explain much of the excess mortality in Japan versus Hawaii. In this comparison of genetically similar cohorts, evidence further suggests that Japanese in Japan are equally susceptible to develop the same adverse risk factor conditions that exist in Hawaii.

Decrease in the prevalence of smoking among Japanese adolescents and its possible causes: periodic nationwide cross-sectional surveys

OBJECTIVES

To assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey.

METHODS

Nationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions.

RESULTS

Cigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionnaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy.

CONCLUSIONS

Japan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors' access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.

Social correlates of cigarette smoking among Icelandic adolescents: a population-based cross-sectional study

BACKGROUND

Previous research has shown that between 80 and 90 percent of adult smokers report having started smoking before 18 years of age. Several studies have revealed that multiple social factors influence the likelihood of smoking during adolescence, the period during which the onset of smoking usually occurs. To better understand the social mechanisms that influence adolescent smoking, we analyzed the relationship and relative importance of a broad spectrum of social variables in adolescent smoking in Iceland, a Nordic country with high per-capita income.

METHODS

We used cross-sectional data from 7,430 14- to 16 year-old students (approximately 81% of all Icelanders in these age cohorts) in the 2006 Youth in Iceland study. The Youth in Iceland studies are designed to investigate the role of several cognitive, behavioral, and social factors in the lives of adolescents, and the data collected are used to inform the design, implementation, and evaluation of substance use prevention programs that are being developed by Icelandic social scientists, policy makers, and practitioners.

RESULTS

Our analysis revealed that friends' smoking behavior and attitude toward smoking were strongly associated with adolescent smoking and other tobacco use, as well as alcohol consumption during the previous 30 days. Main protective factors were parent's perceived attitude toward smoking, the quantity of time spent with parents, absence of serious verbal conflict between parents and adolescents, and participation in physical activity. Family structure was related to adolescent smoking to a small extent, but other background factors were not.

CONCLUSION

We conclude that multiple social factors are related to adolescent smoking. Parents and other primary preventive agents need to be informed about the complicated nature of the adolescent social world in order to maximize their impact.

The impacts of a school-wide no smoking strategy and classroom-based smoking prevention curriculum on the smoking behavior of junior high school students

BACKGROUND

This study aimed at exploring the impacts of a school-wide no smoking strategy and a classroom-based smoking prevention curriculum on smoking-related knowledge, attitude, behavior, and skill of junior high school students.

METHODS

Using a pre-post quasi-experimental design, 469 seventh-to ninth-grade students at four junior high schools in Taiwan, were selected and separated into three groups according to class unit. Experimental group A experienced a school-wide no smoking strategy and a six-session smoking prevention curriculum. Experimental group B experienced only the school-wide no smoking strategy. The control group experienced no intervention. The students were tested 1 week before intervention began and 1 week after it ended.

RESULTS

Experimental group A exhibited a better understanding than either experimental group B or the control group of the dangers of smoking and of techniques for refusing cigarettes; and in fact, group A indicated low smoking intention than experimental group B. Experimental group A also had a better attitudes towards resisting smoking than the control group. However, the intervention had no demonstrable effect on the smoking behavior and on the smoking substitution methods of students.

CONCLUSIONS

To reduce the smoking rates among junior high school students, diversified school-wide no smoking strategies and standardized, diversified instruments should be adopted so that outcomes of smoking prevention work may be assessed more objectively and effectively.