Natural course of smoking cessation and predictors of quitting in young adulthood

Background

Young adulthood is characterized by major life changes that can promote or inhibit cigarette smoking. Gaps in knowledge on the natural course of, and factors associated with quitting impede progress in designing effective cessation interventions targeting this age group. We describe the natural course of cessation among students who smoked cigarettes in their last year of high school and we identify predictors of quit status at age 30.

Methods

Data were drawn from an ongoing investigation of 1294 grade 7 students age 12-13 recruited in 1999-2000 in 10 high schools in Montreal, Canada. Using data collected at ages 17, 20, 24 and 30, grade 11 cigarette smokers were categorized as quitters or current smokers at age 30.

Results

Among 245 grade 11 smokers, 48% (55% of females; 33% of males) had quit by age 30. Among 106 quitters with complete data, 27% were consistently abstinent during young adulthood, 33% were intermittently abstinent and 40% were abstinent at age 30 only. Smokers at age 30 had higher impulsivity scores in grade 11 than quitters and were more likely to report nicotine dependence symptoms and have family members who smoked. Quitters rated self-control and social influences as more important reasons to quit than smokers. Although 85% of smokers wanted to quit, only 45% had used a cessation strategy in the past year.

Conclusions

Adolescents likely to be smokers at age 30 are identifiable in high school. Cessation assistance must be offered early in high school to provide adolescents with opportunities to quit before smoking becomes intractable.

Key messages

Among grade 11 smokers, 27% were consistently abstinent in young adulthood, 33% were intermittently abstinent, and 40% were abstinent at age 30 only. Cessation programs are needed early in high school to prevent intractable smoking.

Psychometric properties of the Autonomy over Tobacco Scale in German

BACKGROUND/AIMS

We investigated the psychometric properties of a German translation of the 12-item Autonomy over Tobacco Scale (AUTOS) among 1,195 eighth-grade students.

METHODS

Data for this study were collected as part of the fourth wave of data collection of the Smokefree Class Competition intervention in the Saxony-Anhalt region of Germany. Students from the control arm of the Smokefree Class Competition study who indicated that they had ever smoked 'at least a few puffs' on a cigarette were classified as ever-smokers. They self-completed questionnaires distributed by teachers.

RESULTS

AUTOS scores ranged from 0 to 36 with a distribution highly skewed toward lower-response categories. Inter-item correlations ranged from 0.65 to 0.89 (mean = 0.79, SD = 0.06). Composite reliability for the AUTOS was high (Ω = 0.96) and 3 lower-order factors were also reliable (withdrawal: 0.89, psychological dependence: 0.91, cue-induced cravings: 0.87). Concurrent validity was supported by strong relationships between the AUTOS and both lifetime cigarette consumption and current smoking frequency. Youths were 18 times more likely to be current smokers (95% CI = 11.9-27.2, p < 0.001) if they endorsed any AUTOS item.

CONCLUSION

The German AUTOS is reliable and valid, and the results are consistent with the English AUTOS for use with adolescents.

Short term patterns of early smoking acquisition

OBJECTIVE

To describe short term patterns of smoking acquisition exhibited by adolescent smokers.

DESIGN

Interview records from the prospective development and assessment of nicotine dependence in youth study were examined retrospectively. Interviews were conducted three times per year over 30 months.

SUBJECTS

164 students in grades 7-9 (ages 12-15 years, 86 girls, 78 boys) who had used cigarettes at least twice.

MAIN OUTCOME MEASURES

A continuous timeline of smoking activity, beginning with the subject's first use of tobacco and continuing through follow up, was translated into six patterns--abstinent, sporadic, occasional, daily, escalating, and intermittent. Outcome measures were the proportion of subjects starting/ending in each pattern, and the number of transitions per subject between patterns.

RESULTS

There was a general but discontinuous progression from infrequent to more frequent use, with many interspersed periods of not smoking. Escalation to daily smoking was common after the development of dependence symptoms, but was rare among those who did not have symptoms. After the appearance of symptoms, both transitions to heavier daily smoking and attempts at cessation increased.

CONCLUSIONS

Movement to heavier, more frequent smoking is generally unidirectional, although many youths attempt to quit one or more times. The appearance of any symptom of dependence altered the subsequent pattern of smoking behaviour. Future investigators might consider using more frequent data points and a continuous timeline to track smoking behaviour.

Sex differences in peer responsiveness to suicide ideation

Two surveys assessing attitudes toward and beliefs about suicide were conducted with undergraduates. There were 473 participants in Survey I and 692 participants in Survey II. Sex differences were found in participants' receptivity to suicidal individuals, beliefs about the behavior of suicidal peers, attitudes concerning the worth of suicidal people, incidence of adolescent suicide, and morality of suicide. There was no sex difference in participants' own frequency or seriousness of suicide ideation or suicide attempts. Results are discussed in terms of hypotheses concerning traditional socialization of males and females, resulting in sex-role differentiation that may influence attitudes toward and beliefs about suicide.