Parental tobacco smoking behaviour and their children's smoking and cessation in adulthood

AIMS: To examine the extent to which childhood exposure to parental tobacco smoking, smoking cessation and parental disapproval of smoking predicts daily smoking and attempts to quit in adulthood. DESIGN: A longitudinal prospective design was used to examine the possible association between parental smoking variables in childhood and adolescence and subsequent smoking and cessation by age 26 years. PARTICIPANTS: Interview data were collected as part of a longitudinal study of some 950 individuals followed from birth to age 26 years. Outcome measures were daily smoking and self-reported attempts to quit smoking. FINDINGS: Less daily smoking among the participants at age 26 was related more strongly to parental smoking cessation in the adolescent years than the childhood years. By contrast, inconsistent advice about smoking in childhood and adolescence predicted later daily smoking. Cessation attempts to age 26 were unrelated to earlier parental quitting but were related to consistent advice in adolescence from both parents about smoking. CONCLUSIONS: Encouraging parents to voice consistent messages about their disapproval of smoking has a significant role to play in discouraging smoking in their adult children and promoting attempt to quit where their children are smokers.     

Physical activity in adolescence and smoking in young adulthood: a prospective twin cohort study

AIMS: To control for familial confounds, we studied the association between adolescent physical activity and later smoking in twin siblings discordant for their baseline physical activity. DESIGN AND MEASUREMENTS: In this prospective population-based twin study, we asked whether persistent physical activity/inactivity in adolescence (assessed at 16, 17 and 18.5 years) predicted questionnaire-reported daily smoking at ages 22-27. Twins who, on the three baseline questionnaires, consistently reported frequent leisure physical activity (more than three times weekly) were classified as persistent exercisers, those who exercised less than three times monthly were called persistently inactive, others were occasional exercisers. SETTING: Finland. PARTICIPANTS: A total of 4240 individuals, including 1870 twin pairs. Findings In analyses of individual twins, compared to persistent activity, persistent physical inactivity predicted increased risk of daily smoking (age- and sex-adjusted odds ratio 5.53, 95% confidence interval 3.88-7.88, P < 0.001). The risk remained elevated even after excluding all those who had smoked 50 cigarettes or more life-time at baseline and adjusted for educational level in adolescence. In within-pair analyses compared to the active members of discordant twin pairs, the physically inactive co-twins had increased risk of future daily smoking (sex-adjusted odds ratio 3.39, 95% confidence interval 1.56-7.39, P = 0.002). CONCLUSIONS: Persistent physical inactivity in adolescence relates to adult smoking, even after familial factors are taken into account.     

Childhood social disadvantage and smoking in adulthood: results of a 25-year longitudinal study

AIM: To examine the associations between exposure to socio-economic disadvantage in childhood and smoking in adulthood. DESIGN: A 25-year longitudinal study of the health, development and adjustment of a birth cohort of 1265 New Zealand children. MEASUREMENTS: Assessments of childhood socio-economic disadvantage, smoking in adulthood and potential mediating pathways, including: parental education, family socio-economic status, family living standards and family income; smoking frequency and nicotine dependence at age 25 years; child IQ, educational achievement by age 18 years, conduct problems ages 14-16 years, parental smoking 0-16 years and peer smoking at 16 years. FINDINGS: Smoking at age 25 was correlated significantly (P < 0.0001) with increasing childhood socio-economic disadvantage. Further, indicators of childhood socio-economic disadvantage were correlated significantly (P < 0.0001) with the intervening variables of childhood intelligence, school achievement, conduct problems and exposure to parental and peer smoking; which in turn were correlated significantly (P < 0.0001) with measures of smoking at age 25. Structural equation modelling suggested that the linkages between the latent factor of childhood disadvantage and later smoking were explained largely by a series of pathways involving cognitive/educational factors, adolescent behavioural adjustment and exposure to parental and peer smoking. CONCLUSIONS: The current study suggested that smoking in adulthood is influenced by childhood socio-economic disadvantage via the mediating pathways of cognitive/educational factors, adolescent behaviour and parental and peer smoking.     

Peer beliefs and smoking in adolescence: a longitudinal social network analysis

ABSTRACT

Background: Peer smoking is one of the strongest predictors of adolescent cigarette use, but less is known about whether other peer characteristics also contribute to this behavior. Objectives: This study examined the links between adolescent cigarette use and peer beliefs about smoking. It tested whether peer beliefs about smoking are associated with changes in cigarette use, whether this association is a result of changes in individual beliefs about smoking, and how beliefs inform friendship choices. Methods: Analyses drew on data collected from 29 school-based networks, each measured at five occasions as students moved from 6th through 9th grade, as part of the study of the PROSPER partnership model. Longitudinal social network models provided estimates of friendship selection and behavior for an average of 6,200 students at each measurement point and more than 9,000 students overall. Results: Peer beliefs about smoking influenced cigarette use both directly and through their impact on individual beliefs. Respondents tended to name friends whose beliefs about smoking were similar to their own, and the likelihood of being named as a friend was higher for those who reported more positive beliefs about smoking. Conclusion: The results from this study suggest that peer beliefs about smoking, in addition to peer cigarette use itself, are associated with adolescent smoking through several mechanisms. Because beliefs favorable to cigarette use are present before adolescents actually smoke, these results underscore the importance of implementing smoking prevention programs in early adolescence.     

The role of schoolmates' smoking and non-smoking in adolescents' smoking transitions: a longitudinal study

AIMS: The first longitudinal investigation of the extent to which same-age and older schoolmates' smoking and non-smoking are associated with adolescents' smoking transitions during three grade intervals. DESIGN: Same-age and older schoolmates' smoking and non-smoking were assessed when adolescents were at grades 5 (age 10), 7 (age 12) and 9 (age 14). Adolescents' smoking transitions were assessed at three grade intervals: 5th-7th (age 10-12), 7th-9th (age 12-14) and 9th-12th (age 14-17). SETTING: Forty Washington State school districts. PARTICIPANTS AND MEASUREMENTS: Smoking questionnaire data were gathered on a cohort of adolescents (n = 4354 for same-age schoolmate analysis; n = 1833 for older schoolmate analysis) that was 49% female and 91% Caucasian. FINDINGS: No significant evidence that same-age schoolmates' smoking or non-smoking was associated with any of the adolescent smoking transitions at any of the three grade intervals. In contrast, the probability that each older schoolmate's smoking was associated with the adolescent making the transition to trying smoking was 1% (95% CI: 0.4%, 1.5%) and with the transition from trying to monthly smoking was also 1% (95% CI: 0.2%, 2.0%) during the 7th-9th grade (age 12-14) interval. Moreover, each older schoolmate's non-smoking was associated with a 1.001-1.006 (all P < 0.05) relative risk of an adolescent not trying smoking or escalating from trying to monthly smoking at several grade intervals. CONCLUSIONS: Interventions should perhaps focus on the influence of both smoking and non-smoking older schoolmates during late childhood and early adolescence.     

Ethno-specific patterns of adolescent tobacco use and the mediating role of acculturation, peer smoking, and sibling smoking

AIMS: The objectives of this study are to identify the relationship between ethnic identity and tobacco use, and to examine the mediating effects of peer and sibling smoking and acculturation. DESIGN AND MEASUREMENTS: Data were drawn from a cross-sectional survey of 3400 Toronto students, sampled from 30 schools between 1998 and 2000. Primary ethnic identity was based on adolescents' self-identification of their ethnic heritage condensed to 12 groups for analysis. Tobacco use was measured as a dichotomy, predicting non-smoking in the past year. Multivariate logistic regression models were employed to test for baseline differences in non-smoking by ethnic identity. Subsequent models adjusted for controls (age, gender, social class, religious attendance, educational achievement) and introduced mediators. FINDINGS: Results indicated that smoking varied among adolescents of differing ethnic identities. Adolescents of western European, eastern European and southern European ethnicity were considerably less likely to be non-smokers, while Chinese, South Asian and East Indian and West Indian youth were more inclined to be non-smokers. The discrepancies in rates of non-smoking among western European and South Asian and East Indian adolescents were explained by a combination of peer and sibling smoking and acculturation; among southern European and eastern European youth via peer and sibling smoking; and by neither peer and sibling smoking nor acculturation for Chinese and West Indian youth. CONCLUSIONS: This paper demonstrates that disparities in tobacco use among certain ethnic groups can be explained by peer and sibling smoking and acculturation; however, for other ethnic groups, knowledge of the processes that account for differences in tobacco use remains less clear.     

Consistency of self-reported smoking over a 6-year interval from adolescence to young adulthood

AIMS: To examine the reliability of self-report cigarette smoking questions by describing recanting (denial of previous smoking reports) in a nationally representative sample of US adolescents followed throughout young adulthood. Predictors of recanting across stages of smoking uptake/progression are examined. DESIGN: A total of 12 985 respondents to cigarette smoking questions during in-home interviews at waves I and III (6 years apart) of the National Longitudinal Study of Adolescent Health (Add Health). The sample survey procedures of Stata 9.0 were used to produce nationally representative estimates, with standard errors adjusted for both clustering at the school level and stratification by geographical region. MEASUREMENTS: Recanting probabilities determined by reports of stages of smoking uptake/progression at each time-point were predicted by race/ethnicity, parental education, household income, poverty level, depression and peer daily smoking. FINDINGS: Stage-specific results indicated that recanting is higher when the earlier smoking was less frequent/intense. Recanters were older, from lower-income households and had higher baseline depression levels. Non-Hispanic black youth were significantly more likely to recant previous smoking compared to non-Hispanic white youth, even in multivariate models controlling for socio-demographic variables. Predictors of recanting differed by level of tobacco involvement. The greater likelihood of non-Hispanic black respondents to deny previous smoking may be a reflection of less intense or more intermittent use of tobacco that leads to recall differences over time. CONCLUSIONS: Racial/ethnic subgroups and/or respondents endorsing depressive symptoms may be more vulnerable to misclassification during interpretation of national survey data and subsequently not identified properly for prevention/intervention programs.     

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.     

Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries

Aims To investigate the associations between well‐known, cost‐effective tobacco control policies at country level and smoking prevalence among 15‐year‐old adolescents. Design Multi‐level modelling based on the 2005–06 Health Behaviour in School‐aged Children Study, a cross‐national study at individual level, and with country‐level variables from the Tobacco Control Scale and published country‐level databases. Setting Twenty‐nine European countries. Participants A total of 25 599 boys and 26 509 girls. Main outcome measures Self‐reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous). Findings Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross‐national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi‐level model for boys, besides the significance of the individual variables such as family affluence, country‐level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = ?0.010; b(partial restriction vending machines) = ?0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = ?0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = ?0.372, P = 0.06]. Conclusions For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.     

The influence of smoking and smokeless tobacco use on weight amongst men

OBJECTIVE: To explore the effect of tobacco use (smoking and smokeless tobacco) and cessation on body weight. DESIGN: Cross-sectional and prospective follow-up study. SETTING: Northern Sweden. SUBJECTS: A total of 2993 men aged 25-64 years who participated in the northern Sweden MONICA study in 1986, 1990 or 1994, 1650 of whom were followed up in 1999. MAIN OUTCOME MEASURES: The prevalence of overweight [body mass index (BMI) >/= 27] amongst tobacco users was compared with nonusers at entry into the study. The average annual percentage weight gain amongst men was also determined according to tobacco use both at entry and at follow-up, and the development of overweight amongst tobacco-use groups was reported using standardized incidence ratios. RESULTS: Smokers who quit tobacco during the follow-up period gained significantly more weight than smokers who switched to snus (annual gain 0.96% vs. 0.51%, P < 0.05). At entry, ex-smokers had higher prevalence of overweight than nonusers of tobacco [prevalence ratio (PR) = 1.24, 95% confidence interval (CI) = 1.10-1.40]. Snus users had slightly higher prevalence of overweight at entry (PR = 1.20, CI = 1.01-1.42). Snus users who quit gained more weight than nonusers (0.70% vs. 0.44%, P < 0.05) or those who continued to use snus (0.42%). CONCLUSIONS: Cessation of tobacco, either cigarettes or snus, leads to significantly increased weight gain. However, snus use may play a role in lowering the weight gain following smoking cessation.     

Childhood and adolescent psychopathology and subsequent tobacco smoking in young adults: findings from an Australian birth cohort

Aims To examine whether child and adolescent psychopathology predicts subsequent tobacco use at 14 and 21 years of age. Design Prospective birth cohort study. Setting Data are taken from the Mater Misericordiae Hospital and University of Queensland Study of Pregnancy and its outcomes (MUSP), a prospective longitudinal study which recruited women at their first antenatal visit in Brisbane, Australia. Participants A 5‐, 14‐ and 21‐year follow‐up of children whose mother's were recruited into the MUSP birth cohort study at their first antenatal visit. Measurements Psychopathology exposure was measured using the Achenbach's Child Behaviour Checklist (CBCL) at 5 years, the Youth Self Report (YSR) at 14 years and the Young Adult Self Report (YASR) at 21 years. Outcome measures were the children's tobacco smoking status at the 14 and 21 years' follow‐up and the Composite International Diagnostic Interview (CIDI) based DSM‐IV nicotine dependence at 21 years' follow‐up. Findings Externalizing symptoms had the strongest association with subsequent tobacco use. Children who met the criteria for CBCL aggression at 5 years were more likely to be tobacco smokers at the 14‐year follow‐up. YSR externalizing behaviours at the 14‐year follow‐up predicted tobacco smoking, but not DSM‐IV nicotine dependence at the 21‐year follow‐up. Internalizing behaviour (anxiety/depression) was associated with a reduced rate of smoking at the 14‐ and 21‐year follow‐ups, but externalizing behaviour and attention problems at 14 and 21 years were associated separately and cumulatively with nicotine dependence at the 21‐year follow‐up. Conclusion Childhood and adolescent psychopathology predict tobacco smoking, but some forms of psychopathology predict increased (aggression/delinquency; attention problems) and other forms decreased (anxiety/depression) smoking. There may be some benefits in targeting children with early onset aggressive/delinquent behaviour problems with tobacco smoking prevention initiatives.     

Parental smoking and respiratory illness during early childhood: a six-year longitudinal study

The relationship between parental smoking habits and lower respiratory illness and symptoms during the first 6 years of life was studied in a birth cohort of New Zealand children. This showed that maternal (but not paternal) smoking was associated with significant increase in rates of lower respiratory infection and lower respiratory symptoms during the child's first 2 years. This association persisted when a range of perinatal, social, and familial factors were taken into account statistically. After two years there was no detectable association between parental smoking habits and lower respiratory infection. Further, there was no evidence to suggest that children whose parents smoked had increased risks of asthma or rates of asthmatic attacks during early childhood.     

The association of snus and smoking behaviour: a cohort analysis of Swedish males in the 1990s

Background   The European Union has banned sales of moist snuff (snus) in all member states, with the exception of Sweden. The ban is motivated by the potential adverse health effects of snus, but snus may also help people to avoid smoking or stop tobacco use.
Aims   The purpose of this study is to investigate the association between snus and smoking behaviour.
Measurements   The Swedish Survey of Living Conditions (ULF) health interview panel running from 1988/9 to 1996/7 was used to examine the gross and net flows between smoking and snus among Swedish males. Females were excluded from the analysis due to low snus prevalence. Contingency table models were used to investigate several hypotheses about the relationships between snus and smoking behaviour.
Findings   We found clear associations between the two habits. For the younger cohort (age 16–44 years), snus use contributed to approximately six smoking quitters per smoking starter attributable to snus. For the older cohort (age 45–84) there were slightly more than two quitters per starter. In terms of odds ratios, in the younger group smoking cessation attributable to snus was twice as common as smoking initiation, but in the older group the odds of starting smoking attributable to snus was 2.5 times higher than for quitting.
Conclusions   Snus contributed to the reduction of smoking among Swedish males in the 1990s. Snus had different effects among non-smokers and smokers in different age groups.     

Recent trends in smoking and the role of public policies: results from the SimSmoke tobacco control policy simulation model

AIMS: After a period of steady decline in smoking prevalence, smoking rates leveled off in the United States between 1990 and 1997, but began falling between 1997 and 2003. Trends in smoking prevalence, and the role of tobacco control policies in affecting those rates, are examined. DESIGN: A computer simulation model is used in which smoking prevalence evolves through initiation and cessation, which are in turn influenced by tobacco control policies. METHODS: The results of the model are compared to smoking prevalence measures from the US National Health Interview Survey between 1993 and 2003. We also consider the role of tax/price, clean air laws, media campaigns and youth access policies in influencing these rates. FINDINGS: Both the SimSmoke model and data for recent years indicate that adult smoking prevalence changed little between 1993 and 1997, and even increased among youth. Between 1997 and 2003, smoking prevalence has been declining. Most age, gender and racial-ethnic groups show patterns similar to that of the entire population, with differences for those aged 18-24 years. The predominant trends were explained mainly by changes in price, with some residual effect of clean air laws, media campaigns and youth access laws. CONCLUSIONS: Among public tobacco control policies, price had the dominant effect on smoking prevalence between 1993 and 2003, because few states implemented other policies to the degree necessary to affect much change. Through continued tax increases, stronger clean air laws, extensive media campaigns and broader cessation treatment programs, there is the potential to have much larger reductions in smoking prevalence.     

Impact of smokeless tobacco use on smoking in northern Sweden

BACKGROUND AND OBJECTIVES: For many years Swedish men have had the world's lowest rates of smoking and smoking-related mortality. Despite these facts, a thorough analysis of tobacco use patterns in Sweden has not been performed. The purpose of this study was to examine the prevalence and interaction of cigarette smoking and use of Swedish moist snuff (snus) in the population of northern Sweden. DESIGN: The study cohort of 2998 men and 3092 women aged 25-64 was derived from the northern Sweden MONICA study, consisting of population-based surveys in 1986, 1990, 1994 and 1999. Detailed information on tobacco use was used to develop prevalence data, and the prevalence ratio was used to compare rates amongst various subgroups. RESULTS: Amongst men ever-tobacco use was stable in all survey years at about 65%, but the prevalence of smoking declined from 23% in 1986 to 14% in 1999, whilst snus use increased from 22% to 30%. In women the prevalence of smoking was more stable in the first three surveys (approximately 27%) but was 22% in 1999, when snus use was 6%. In all years men showed higher prevalence of ex-smoking than women. A dominant factor was a history of snus (PR = 6.18, CI = 4.96-7.70), which was more prevalent at younger ages. CONCLUSIONS: The recent transition from smoking to snus use amongst men, and incipiently amongst women, in northern Sweden is remarkable and relevant to the global discussion on strategies to reduce smoking.