Risk and Protective Factors for Cigarette Use in Young Adolescents in a School Setting: What Could Be Done Better?

Machine Learning Helps in Prediction of Tobacco Smoking in Adolescents

Background

Considering the increasing prevalence of adolescent smoking in recent years, this study proposes a machine learning (ML) approach for distinguishing adolescents who are prone to start smoking and those who do not directly confess to smoking.

Methods

We used two repeated measures cross-sectional studies, including data from 7940 individuals as distinct training and test datasets. Utilizing the randomized least absolute shrinkage and selector operator (LASSO), the most influential factors were selected. We then investigated the performance of different ML approaches for the automatic classification of students into smoker/nonsmoker and low-risk/high-risk categories.

Results

Randomized LASSO feature selection prioritized 15 factors, including peer influence, risky behaviors, attitude and school policy toward smoking, family factors, depression, and sex as the most influential factors in smoking. Applying different ML approaches to the three study plans yielded an AUC of up to 0.92, sensitivity of up to 0.88, PPV of up to 0.72, specificity of up to 0.98, and NPV of up to 0.99.

Conclusions

The results showed the capability of our ML approach to distinguish between classes of smokers and nonsmokers. This model can be used as a brief screening tool for automated prediction of individuals susceptible to smoking for more precise preventive intervention plans focusing on adolescents.

E-Cigarette Users' Profiles and Their Association with Identified Impacts of COVID-19 on Vaping among Young Adults in Malaysia

Electronic cigarettes (ECs) users' profiles and behaviors during the COVID-19 pandemic remain unclear. This cross-sectional study aimed to explore Malaysian EC users' profiles and their associations with related behaviors during the pandemic. The EC users (N = 351) were recruited from an official national vape entity. Respondents were predominantly of Malay ethnicity (90.6%), aged 31 to 35 years (27.6%), males (97.7%), married (68.7%), from Malaysia's west region states (63.5%) and tertiary educated (69.2%). The majority (80.3%) were non-dual users, and most purchased their vaping products online (77.2%), liked that they can vape while working at home (83.8%) and vaped more because of boredom (55.3%), had low and moderate nicotine addiction levels (94.9%), had low motivation level to quit EC use (92.6%) and were more likely to perceive that vaping did not increase the chances of complications from COVID-19. Respondents with moderate to high addiction levels had twice the odds of checking on their current EC supplies, whilst respondents with low motivation to quit had higher odds of using their tank/pod until the last drop and distancing from others when vaping. EC users should be encouraged to quit EC use, especially during the COVID-19 pandemic.

Do School-Level Factors Affect the Health Behaviors of High School Students in Korea?

We conducted a multilevel analysis to identify the individual- and school-level factors that affect Korean high school students' tooth brushing, soda intake, smoking, and high-intensity physical activity. We sampled 27,919 high school students from the 15th Korea Youth Risk Behavior Web-Based Survey. The individual-level variables included demographic, socioeconomic, and health-related factors. The school-level variables included school system and school type. Regarding the individual-level factors, economic level and academic performance had a significant effect on health behavior when the demographic variables were adjusted. In the final model, the school-level factors had a significant effect on health behavior. The odds ratio (OR) of brushing less than twice a day in vocational schools compared to general schools was 1.63 (p < 0.001), and the OR of soda intake more than three times a week in vocational schools was 1.33 (p < 0.001). In addition, the OR of smoking in vocational schools was 2.89 (p < 0.001), and the OR of high-intensity physical activity in vocational schools was 0.80 (p < 0.001). Therefore, both individual- and school-level factors affect Korean students' health behaviors. A school-based comprehensive health promotion strategy should be developed that considers schools' characteristics to equip all students with health awareness, regardless of socioeconomic status.

Effect of Peer Promoters on Changes in Adolescent Smoking Knowledge and Attitudes: A School-based Intervention Study

Background: Smoking is currently a trend among youths, with the public emergence of new smokers shifting to this group. Aim:This study aims at analyzing the effect of peer promoters as communicators on the knowledge and smoking attitudes of junior high school adolescents. Methods:The quasi-experimental and non-equivalent control group designs were used. Furthermore, the respondents included 1062 students from two junior high schools in Makassar City, Indonesia, with 473 and 589 males and females, respectively. A total of 801 respondents had paired data (pre and post-test) consisting of 334 in the intervention and 467 in the control school.Paired t-test was used to measure the difference in the pretest and post-test scores of intervention and control schools. Independent t-test was used to determine  mean difference between the pretest and post-test scores between intervention and the control schools. Results:The results showed that 18.4% (n = 1062) had smoked, with subtleties of 39.4% male and 1.5% female understudies. the knowledge score increase of 0.82 (p = 0.000) and 0.22 (p = 0.004) was observed in the intervention and control schools, respectively (n = 801). The attitude score also increased by 2.23 (p = 0.080) in the intervention and 2.51 (p = 0.000) in the control school (n = 801).  Differences in the knowledge and attitude scores between both schools obtained a value of p = 0.004 and 0.766, respectively. Conclusion: education by peer promoters increase knowledge and change adolescent smoking attitudes indicated the promotion of school-based smoking behavior prevention efforts with intensive peer approach

Prevalence and Determinants of Tobacco Smoking Among Low-Income Urban Adolescents

Background: Tobacco-smoking in children is one of the most crucial public health concerns, which could be highly prevalent in underprivileged populations. Methods: A cross sectional, random sampling survey was conducted to determine the prevalence of current tobacco-smoking and related risk factors among adolescents living in a low-income area of Santiago de Chile. Results: Of the 2,747 adolescents participating in the study, 24.0% [95% confidence interval (CI) 22.3-25.5] were current smokers, with no significant difference between girls and boys. Factors associated with current smoking were as follows: positive attitude to smoking cigarettes offered by peers [odds ratio (OR) 8.0; 95% CI 5.7-11.3, P < 0.001], having smoking best friends (OR 4.0; 95% CI 2.6-6.0, P < 0.001), and passive smoking in the house (OR 1.9; 95% CI 1.2-3.1, P = 0.008). A total of 16.8% (95% CI 11.4-18.2) of children had smoked an entire cigarette at the age of ≤12, and 62.3% (95% CI, 60.5-64.1) were passive smokers at home. Regarding nonsmoking children, 52.4% (95% CI 49.74-55.06) were exposed to tobacco smoke at home. Conclusion: The prevalence of current tobacco-smoking in adolescents is high and increasing compared to previous studies undertaken in the selected low-resourced area. Two-thirds of children who started smoking before the age of 12 years were current smokers at the time of the survey, highlighting the prevalence of the powerful addiction generated and the need for better preventive strategies against tobacco-smoking for children living in low-resource communities.

Personal and Family Factors Associated With High-risk Behaviours Among Adolescents in Malaysia

PURPOSE

The objective of this study was to investigate the relationships between high-risk behaviours and personal and family factors among adolescents in Malaysia.

METHODS

A nationwide data set was examined for this secondary data analysis. The dependent variable was the degree of risk, which was measured based on the number of high-risk behaviours in which adolescents participated. Age, gender, ethnicity, self-rated academic performance, family size, parental marital status and parental academic attainment were included as independent variables. Analyses stratified by educational level were conducted. Odds ratios (ORs) were calculated using ordered logit.

RESULTS

The most common high-risk behaviour among Malaysian adolescents was physical inactivity (35.97%), followed by smoking (13.27%) and alcohol consumption (4.45%). The majority of adolescents had low risks (52.93%), while only a small proportion had high risks (6.08%). Older age was associated with increased odds of having high risks (OR: 1.26). Male adolescents had higher odds of being in a high-risk category compared to female adolescents (OR: 1.28). Compared to Malays, Chinese adolescents had higher odds of being in a high-risk category (OR: 1.71), whereas Indian adolescents had lower odds (OR: 0.65). Excellent academic performance was associated with reduced odds of participating in high-risk behaviours (OR: 0.41).

CONCLUSION

Personal factors are important determinants of high-risk behaviours. This study provides a better understanding of those adolescent groups that are at greater risk.

PRACTICAL IMPLICATIONS

An intervention directed towards reducing participation in high-risk behaviours among adolescents who have both poor academic performance and less-educated parents may yield promising outcomes.

Effectiveness of School-Based Smoking Prevention Education Program (SPEP) Among Nonsmoking Adolescents: A Quasi-Experimental Study

Preventing smoking among adolescents is critical. This study evaluated the effectiveness of the Smoking Prevention Education Program among nonsmoking adolescents. A quasi-experimental study design was used. Data were collected from Year 5 students ( n = 140) from four government primary schools in the Kuantan and Pahang districts of Malaysia. The participating schools were randomly assigned into the intervention and control groups. Questionnaires and exhaled carbon monoxide (CO) levels were used to collect data at the baseline and at 3 months postintervention. At 3 months postintervention, the percentage of nonsmokers remained 100% in the intervention group, while 2.9% of the participants in the control group reported to have smoked in past 7 days. Comparatively, the mean scores of attitudes, subjective norms, and nonsmoking intentions of the intervention group improved significantly. The intervention was effective in preventing smoking initiations among Malaysian adolescents; however, further evaluation of this intervention is needed among varied populations.

Factors associated with different smoking statuses among Malaysian adolescent smokers: a cross-sectional study

BACKGROUND

This study focused on the associations between socioeconomic status (SES) and adolescent smoking among secondary school students (13 to 17 years) in the Federal Territory of Kuala Lumpur, Malaysia. Our objective was to evaluate the relationships between adolescent demographics, socioeconomic status and smoking status.

METHODS

The survey data were based on baseline findings from a cross-sectional study (N = 422 adolescents). Chi-square test was used to assess the relationship between demographic characteristics, socioeconomic status (household monthly income and daily allowance) and adolescent smoking status. Exhaled carbon monoxide (CO) reading and the Hooked on Nicotine Checklist (HONC) were used to evaluate adolescent smoking status. A Multivariate Multinomial Logistic Regression (MMLR) was employed to test selected demographic and socioeconomic predictors of smoking status.

RESULTS

Of the 422 adolescents (M age = 15.58, SD = 1.24), more than half of the participants initiated smoking between 13 to 17 years old (59.0%). A total of 308 (73.0%) were electronic cigarette users, with more than 50% comprising of single users. The mean CO reading was 2.14 ppm with 78.0% of adolescents scoring more than 0 on the Hooked on Nicotine Checklist (HONC). Males and participants aged 15 and 16 years were at increased risks of sole CC smoking. Meanwhile, males, those who are not hooked on smoking and with a non-smoker CO reading were at increased risks of sole EC smoking. Finally, Bumiputeras were at less risk of EC smoking.

CONCLUSIONS

Demographic variables such as age, gender and ethnicity predicted smoking status predicted smoking risk, but not socioeconomic factors. The findings allow policy makers to target specific high-risk demographic groups when designing smoking cessation programs for adolescents.

Positive outcome expectancy mediates the relationship between social influence and Internet addiction among senior high-school students

Background and aims Based on the foundations of Bandura's social cognitive theory and theory of triadic influence (TTI) theoretical framework, this study was designed to examine the mediating role of positive outcome expectancy of Internet use in the relationship between social influence and Internet addiction (IA) in a large representative sample of senior high-school students in Taiwan. Methods Using a cross-sectional design, 1,922 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling, and a comprehensive survey was administered. Results Structural equation modeling and bootstrap analyses results showed that IA severity was significantly and positively predicted by social influence, and fully mediated through positive outcome expectancy of Internet use. Discussion and conclusions The results not only support Bandura's social cognitive theory and TTI framework, but can also serve as a reference to help educational agencies and mental health organizations design programs and create policies that will help in the prevention of IA among adolescents.

Mediating effect of deviant peers on the relationship between sensation seeking and lifetime smoking among high school students

BACKGROUND

Despite the greater risk of lifetime smoking among high sensation seekers, it is difficult to change a sensation seeking tendency through interventions. Therefore, it is important to identify a modifiable factor mediating the link between these two conditions in order to weaken or disconnect the association.

OBJECTIVES

Based on the literature, deviant peers may play a pivotal role in explaining this association. Thus, we aimed to investigate the mediating effect of deviant peers on the association between sensation seeking and lifetime smoking among Korean adolescents.

METHODS

We analyzed secondary data obtained from 876 high school students. Approximately 51% of the participants were male. In order to investigate the mediating effect of deviant peers after controlling for 16 factors, we tested an indirect effect in a simple mediation model using the PROCESS macro, which is a regression-based approach.

RESULTS

We found a significant total effect of sensation seeking on lifetime smoking: greater risk of lifetime smoking among high sensation seekers. In addition, we found a significant mediating effect of deviant peers on the association between the two conditions. Specifically, higher sensation seeking successfully predicted a greater number of deviant peers, which, in turn, successfully predicted greater risk of lifetime smoking.

CONCLUSION

Given difficulties in directly changing levels of sensation seeking and the significant mediating effect of deviant peers on the association between the two conditions, prevention strategies focusing on peers may be advantageous for high sensation seekers in reducing their risk of lifetime smoking in adolescence.