Disruptiveness, peer experiences and adolescent smoking: a long-term longitudinal approach

Aims   This study examined links of peer experiences (i.e. social status and affiliation with disruptive peers) throughout childhood with respect to adolescent smoking trajectories, after controlling for childhood disruptiveness. Specifically, we tested four models regarding links of peer experiences and deviant behaviours.
Design   Prospective community sample.
Participants   A total of 312 children, aged 6.17 years at baseline.
Measurements   Growth parameters of own disruptive behaviour, disruptive behaviour of friends and social status measured at ages 7–12 years as predictors of smoking assessed at ages 13–15 years, while controlling for own disruptive behaviour at age 6 years.
Findings   We found three groups with distinct profiles of smoking. One group displayed hardly any or no smoking at all; a second group showed a trajectory of increased smoking; and a third group that showed high smoking rates initially and increased in smoking intensity over time. Results support the assumption of the selection model that the link between disruptive peers and smoking is spurious and due to shared variances with own early disruptiveness. Moreover, support was found for the popularity–socialization model supporting the assumption that age-related increases in social status are associated with smoking.
Conclusions   The findings emphasize that early disruptiveness is predictive of later smoking. In addition, it was shown that smoking becomes less deviant over time, in line with group norms. Future prevention programmes should emphasize the need to change these norms.     

Outcome of a smoking cessation programme run in a routine hospital setting

Abstract
Background : Although tobacco smoking remains the largest preventable cause of mortality in Australia, resources to assist with cessation remain scarce. Research studies have demonstrated improved cessation rates with interventions such as counselling and pharmacotherapy, but there is little information on success in routine clinical practice.
Aims : To determine the outcome of a smoking cessation programme run in a routine hospital outpatient setting.
Methods : A prospective audit of patients referred to an outpatient smoking cessation programme by hospital specialists or general practitioners. The programme consisted of fortnightly counselling sessions, with nicotine replacement therapy when clinically indicated. Self-reported abstinence rates were determined by contacting patients by letter or telephone at 3 and 12 months. Abstinence was confirmed, whenever possible, by measuring the expired carbon monoxide (CO) concentration.
Results : Over 12 months, 226 new patients were seen through the programme. There was a correlation between the number of cigarettes smoked and the baseline Fagerstrom score ( r = 0.49, P < 0.001). Approximately 40% of subjects could not be contacted for follow up. At 3 months the self-reported abstinence rate was 31%, falling to 19% by 12 months. Measurement of expired CO concentrations proved that self-reported abstinence was reliable.
Conclusions : The abstinence rates achieved by our programme compared well with those previously reported in the literature, demonstrating the effectiveness of a smoking cessation programme run in routine clinical practice. There was an increasing relapse rate during the period of follow up. (Intern Med J 2002; 32: 24–28)     

Financial stress, smoking cessation and relapse: results from a prospective study of an Australian national sample

AIMS: Our aim was to examine the association between financial stress and subsequent smoking cessation among smokers, and relapse among ex-smokers. DESIGN AND PARTICIPANTS: Data came from the first two waves of the Household Income and Labour Dynamics in Australia (HILDA) survey. The size of the subsample of smokers was 2076, and that of ex-smokers was 2717. Data collection was based on face-to-face interviews. MEASUREMENT: Eight questionnaire items (e.g. difficulty paying electricity, gas or telephone bills and going without meals due to shortage of money) were used to construct a nine-point financial stress index. FINDINGS: Smokers with more financial stress were less likely to quit, with the odds of quitting reducing by 13% (95% CI: 4-21%; P = 0.008) per unit of the financial stress index. Ex-smokers with more financial stress were more likely to relapse (P < 0.001). CONCLUSIONS: Special programmes may have to be implemented to counter the potentially adverse effects of tobacco price increases on smokers who have financial stress and fail to quit smoking.     

Four-year follow-up of smoke exposure,attitudes and smoking behaviour following enactment of Finland's national smoke-free work-place law

Aims This study evaluated the possible impact of national smoke‐free work‐place legislation on employee exposure to environmental tobacco smoke (ETS), employee smoking habits and attitudes on work‐place smoking regulations. Design Repeated cross‐sectional questionnaire surveys and indoor air nicotine measurements were carried out before, and 1 and 3 years after the law had come into effect. Setting Industrial, service sector and office work‐places from the Helsinki metropolitan area, Finland. Participants A total of 880, 940 and 659 employees (response rates 70%, 75% and 75%) in eight work‐places selected from a register kept by the Uusimaa Regional Institute of Occupational Health to represent various sectors of public and private work‐places. Measurements Reported exposure to ETS, smoking habits, attitudes on smoking at work and measurements of indoor air nicotine concentration. Findings Employee exposure to ETS for at least 1 hour daily decreased steadily during the 4‐year follow‐up, from 51% in 1994 to 17% in 1995 and 12% in 1998. Respondents’ daily smoking prevalence and tobacco consumption diminished 1 year after the enforcement of legislation from 30% to 25%, and remained at 25% in the last survey 3 years later. Long‐term reduction in smoking was confined to men. Both smokers’ and non‐smokers’ attitudes shifted gradually towards favouring a total ban on smoking at work. Median indoor airborne nicotine concentrations decreased from 0.9 µg/m³ in 1994–95 to 0.1 µg/m³ in 1995–96 and 1998. Conclusions This is the first follow‐up study on a nationally implemented smoke‐free work‐place law. We found that such legislation is associated with steadily reducing ETS exposure at work, particularly at work‐places, where the voluntary smoking regulations have failed to reduce exposure. The implementation of the law also seemed to encourage smokers to accept a non‐smoking work‐place as the norm.     

Smoking and smoking cessation in Latin America: a review of the current situation and available treatments

Tobacco smoking is a growing problem throughout Latin American countries, especially in underdeveloped countries where poverty and lack of education about the dangers of smoking may make people more susceptible to becoming smokers. Moreover, the economies of many Latin American countries have become dependent on the production of tobacco. Furthermore, because of the associated promotion of tobacco, smoking has integrated into many Latin American cultures. Nevertheless, the harmful health effects of tobacco use are well documented, including greatly increased risks of developing chronic obstructive pulmonary disease, cardiovascular disease, and many forms of cancer. The medical costs associated with treating these diseases far outweigh the economic benefits of producing and selling this deadly crop. To control the tobacco pandemic in Latin American countries, nicotine addiction must be recognized and treated as a disease. Governments, both national and local, need to be more involved in enacting anti-smoking policies such as higher tobacco taxation, control of illegal tobacco smuggling, and reimbursement of medical smoking cessation interventions. The training of health professions in the area of nicotine addiction must also be improved, so that they may better assist smokers in their quit attempts and advise patients on, and prescribe, effective smoking cessation pharmacotherapies.     

Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample

Aims To evaluate non‐causal and causal patterns of smokeless tobacco (SLT) and cigarette use; to assess the prevalence of ‘non‐gateway’ and possible ‘gateway’ patterns of SLT use. Design and setting Data from the Cancer Control Supplement to the 1987 National Health Interview Survey, a representative survey of non‐institutionalized adults in the United States. From reported age at first use, participants were categorized by type and sequence of tobacco product use. SUDAAN 8.0.1 was used for statistical analyses. Participants Males aged 18–34 (n = 3454), weighted to provide estimates of the US population. A subsample of males aged 23–34 (n = 2614) was analyzed to minimize the possibility of future product switching. Measurements Smoking status, smokeless tobacco (snuff, chewing tobacco, both) use status, age at regular use of cigarettes, age at first use of smokeless tobacco. Findings Of those 23–34‐year‐olds who had ever used SLT with or without cigarettes, 77.2% (95% CI: 71.3, 83.3) were classifiable as non‐gateway users in that 35.0% (95% CI: 29.9, 40.1) had only used SLT and 42.2% (95% CI: 36.8, 47.7) had used cigarettes first. Cigarette use in younger cohorts was less common, despite increased SLT use. Those who used cigarettes before moist snuff were 2.1 times more likely to have quit smoking (95% CI 1.21,6.39) than cigarette‐only users. Conclusions The large majority of SLT users are non‐gateway users. Causal gateway effects should be of minor concern for policy. SLT may be more likely to prevent smoking than cause it.     

The role of genes in tobacco smoking during adolescence and young adulthood: a multivariate behaviour genetic investigation

Aims To incorporate a psychosocial model of tobacco smoking into a behaviour genetic design to examine genetic and environmental influences on variation in smoking involvement. Design Longitudinal twin study. Setting and participants Twins initially aged between 13 and 18 years and registered with the Australian Twin Registry were surveyed three times between 1988 and 1996. A total of 414 pairs of identical and same‐sex fraternal twin pairs participated in all three surveys, aged between 20 and 25 at wave 3. Biometric modelling estimated the influence of genetic and environmental factors in determining variation in smoking at each wave, both before and after adjusting for perceived smoking behaviours of peers and parents. Measurements Twins answered a questionnaire on their own smoking status and reported on the use of tobacco by parents and friends as they perceived it, at each survey wave. Findings At all three surveys, current smokers were more likely to have parents who smoked and to have smokers among their peers. Genes and environmental factors, both common and unique, contributed to variation in smoking behaviours. However, after controlling for the smoking behaviours of peers and parents, the role of genes in determining variation in smoking involvement was reduced by 100% at wave 1 and by 30% at wave 2. Friends’ smoking reduced the magnitude of the common environment variance by 11%, 30% and 40% at waves 1, 2 and 3, respectively. Parents’ smoking behaviours explained part of the common environment. Biometric modelling of the covariation between smoking involvement and peer smoking suggested that genes might influence smoking involvement at wave 1 by influencing choice of peers. Conclusion Environmental factors play the greatest role in determining variation in tobacco smoking among adolescents and young adults. Among adolescents, genes may influence variation in smoking behaviours indirectly by influencing choice of peers. However, genes seem to have a direct influence on variations in the smoking behaviours of young adults.     

Association of a single nucleotide polymorphism in neuronal acetylcholine receptor subunit alpha 5 (CHRNA5) with smoking status and with 'pleasurable buzz' during early experimentation with smoking

AIMS: To extend the previously identified association between a single nucleotide polymorphism (SNP) in neuronal acetylcholine receptor subunit alpha-5 (CHRNA5) and nicotine dependence to current smoking and initial smoking-experience phenotypes. DESIGN, SETTING, PARTICIPANTS: Case-control association study with a community-based sample, comprising 363 Caucasians and 72 African Americans (203 cases, 232 controls). MEASUREMENTS: Cases had smoked > or = five cigarettes/day for > or = 5 years and had smoked at their current rate for the past 6 months. Controls had smoked between one and 100 cigarettes in their life-time, but never regularly. Participants also rated, retrospectively, pleasurable and displeasurable sensations experienced when they first smoked. We tested for associations between smoking phenotypes and the top 25 SNPs tested for association with nicotine dependence in a previous study. FINDINGS: A non-synonymous coding SNP in CHRNA5, rs16969968, was associated with case status [odds ratio (OR) = 1.5, P = 0.01] and, in Caucasians, with experiencing a pleasurable rush or buzz during the first cigarette (OR = 1.6, P = 0.01); these sensations were associated highly with current smoking (OR = 8.2, P = 0.0001). CONCLUSIONS: We replicated the observation that the minor allele of rs16969968 affects smoking behavior, and extended these findings to sensitivity to smoking effects upon experimentation. While the ability to test genetic associations was limited by sample size, the polymorphism in the CHRNA5 subunit was shown to be associated significantly with enhanced pleasurable responses to initial cigarettes in regular smokers in an a priori test. The findings suggest that phenotypes related to subjective experiences upon smoking experimentation may mediate the development of nicotine dependence.     

The association between use of snus and quit rates for smoking: results from seven Norwegian cross-sectional studies

Aim Swedish studies have shown that experience of using snus is associated with an increased probability of being a former smoker. We examined whether this result is also found in Norway. Design Seven cross‐sectional data sets collected during the period 2003–08. Setting Norway. Participants A total of 10 441 ever (current or former) smokers Measurements Quit ratios for smoking were compared for people with different histories of snus use. Motive for snus use was examined among combination users (snus and cigarettes). Smoking status was examined among snus users. Findings Compared to smokers with no experience of using snus, the quit ratio for smoking was significantly higher for daily snus users in six of seven data sets, significantly higher for former snus users in two of five data sets and significantly lower for occasional snus users in six of seven data sets. Of combination users who used snus daily, 55.3% [confidence interval (CI) 44.7–65.9] reported that their motive for using snus was to quit smoking totally. This motive was reported significantly less often by combination users who used snus occasionally (35.7%, CI 27.3–44.2). Former smokers made up the largest proportion of daily snus users in six of seven data sets. In the remaining data set, that included only the age group 16–20 years, people who had never smoked made up the largest segment of snus users. Conclusions Consistent with Swedish studies, Norwegian data shows that experience of using snus is associated with an increased probability of being a former smoker. In Scandinavia, snus may play a role in quitting smoking but other explanations, such as greater motivation to stop in snus users, cannot be ruled out.     

Prevalence of tobacco smoking and its socioeconomic determinants: Tobacco smoking and its determinants

IntroductionThe epidemic tobacco use is a public health concern worldwide. This study aimed to evaluate the prevalence of tobacco use and its socioeconomic determinants in the city of Shiraz, Iran.MethodsIn total, 5873 adults aged 20 and older were included in this study from the city of Shiraz, Iran, from June to October 2015. The sampling was conducted using the stratified random sampling method. Active cigarette, hookah, and second‐hand smokers were labeled as tobacco users in this study. Past smokers and non‐smokers were labeled as non‐tobacco users. The participants'' socioeconomic status (SES) was determined based on their self‐reported level of education, occupation, income, and residence.ResultsIn this study, 35.4% of the participants were tobacco users. The prevalence of active cigarette, active hookah, dual‐users, and secondhand smokers was 13.3%, 8.3%, 0.4%, and 13.4%, respectively. The prevalence of tobacco use was highest among individuals with primary education level (40.9%), manual jobs (46.4%), lowest income level (38.1%), and those living in the suburban areas (36.4%). In multivariate analysis, the most socioeconomic factors related to tobacco usage were lack of academic education, manual job, and low‐income level.ConclusionsTobacco control efforts should be more focused on vulnerable groups of cigarette and hookah users in the southwest of Iran. Moreover, SES and reduction of health‐related disparities and inequality should be considered a crucial concern in this regard.     

Intention to quit smoking according to smoking preferences and perceptions of electronic cigarettes among university students in South Korea

This study aimed to alleviate unhealthy smoking habits among university students and provide the basic data necessary for public health-oriented approaches such as developing regulations and policies on electronic cigarettes by analyzing the relationship between university students’ smoking preferences, perceptions of electronic cigarettes, and intention to quit smoking.This study involved 567 college students and conducted frequency and chi-squared analyses of the general characteristics, smoking preferences, and perceptions of electronic cigarettes. This study also performed logistic regression analysis to analyze the relationship between intention to quit smoking stratified by smoking preferences and the perceptions about electronic cigarettes. SPSS version 25.0 was used for data analysis.This study showed that electronic cigarette smokers were approximately 6.4 to 10.8 times more likely to think that electronic cigarettes positively affect smoking cessation attitude than nonsmokers. This study showed that regular cigarette smokers were approximately 1.7 to 2.2 times and other smoker 3.3 to 3.9 times more likely to think that electronic cigarettes positively affect smoking cessation attitude than nonsmokers. Those who perceived harmless to the human body, capable of reducing the frequency of smoking, and less harmful than tobacco were approximately 2.6 to 2.9, 11.6 to 12.8, and 3.3 to 3.7 times more likely have intention to quit smoking, respectively.Regular health education, advertising awareness of health hazards, and public health science-oriented approaches and policies for smoking cessation support services are needed to create awareness on electronic cigarettes among university students.     

Five-year outcomes for a smoking cessation clinic

BACKGROUND AND OBJECTIVES: In Turkey, smoking cessation clinics have increased rapidly in recent years. We evaluated the demographic characteristics and the factors influencing the success of quitting among participants in a smoking cessation programme who completed a 5-year follow up. METHODS: An observational study was conducted on all smokers who attended a smoking cessation clinic between April 2000 and June 2005. RESULTS: Of the 350 participants recruited, 58% (n = 203) were male and 42% (n = 147) were female; 43.7% were university graduates. The average age of participants was 37.4 +/- 11.8 years; the average nicotine addiction level, according to the Fagerstrom nicotine dependence questionnaire, was 5.4 (+/-2.0). Seventy-eight (40.2%) of the 194 individuals who stopped smoking were women. At the end of 5 years, 34.6% of participants who attempted to quit were still successful. There was no difference between men and women in terms of their success in quitting after 5 years. Participants who received nicotine replacement therapy remained free of cigarettes 1.9 times (95% CI: 1.2-2.9) longer than those who did not. CONCLUSION: Smoking cessation programmes should use a combination of behavioural and pharmacological therapies.     

Genes and cigarette smoking

AIMS: Attempts to further our understanding of the determinants of cigarette smoking, tobacco addiction and related behaviours have included the dissection of genetic influences on these phenotypes. This review summarizes the current state of evidence from both twin and adoption studies and molecular genetic studies. We also review future research horizons and the direction which studies of this kind are likely to take in the near future. FINDINGS: There is consistent evidence from twin and adoption studies that genetic factors play a role in the aetiology of cigarette smoking. Nevertheless, despite a large number of candidate gene studies, and a smaller number of linkage studies, few reported associations and chromosomal regions of interest have proved to replicate reliably. This is due most probably to the small effects of individual loci on complex behaviours such as smoking. CONCLUSIONS: Future research is likely to include the study of gene x environment interactions (including gene x treatment interactions, which offer the prospect of genetically tailored smoking cessation treatment) and the use of more sophisticated smoking-related phenotypes, such as longitudinal smoking trajectories, and intermediate phenotypes which use technologies such as neuroimaging and other laboratory and biobehavioural measures.