Volume of tobacco advertising in African American markets: systematic review and meta-analysis

OBJECTIVE: African Americans currently bear the greatest burden of morbidity and mortality due to smoking, and exposure to pro-tobacco media messages predicts smoking. This study compared the concentration (proportion of media messages that are for tobacco) and density (pro-tobacco media messages per person) of pro-tobacco media messages between African American and Caucasian markets. METHODS: We searched Medline (1966 to June 2006), PsychINFO (1974 to June 2006), and CINAHL (1982 to June 2006) for studies from peer-reviewed journals directly comparing the volume of pro-tobacco media messages in African American and Caucasian markets. From each study, we extracted the number of total media messages, the number of tobacco-related messages, and the number of residents living in each market area. We calculated the concentration and density of tobacco advertising in each market. RESULTS: Out of 131 studies identified, 11 met eligibility criteria, including seven comparing billboard/signage in African American and Caucasian markets and four comparing magazine advertising in African American and Caucasian markets. Meta-analysis estimated a pooled odds ratio of 1.7 (95% confidence interval [CI] 1.1, 2.6) for a given billboard being smoking-related in African American vs. Caucasian market areas (i.e., concentration). The pooled rate ratio of the density of smoking-related billboards was 2.6 (95% CI 1.5, 4.7) in African American vs. Caucasian market areas. Magazine data were insufficient for meta-analysis. CONCLUSION: Available data indicated that African Americans are exposed to a higher volume of pro-tobacco advertising in terms of both concentration and density. These findings have important implications for research, policy measures, and educational interventions involving racial disparities due to tobacco.     

江西省公共场所禁烟及人群被动吸烟状况调查

目的了解江西省公共场所吸烟状况，以及成年人和青少年吸烟和被动吸烟状况，为制定被动吸烟控烟对策提供依据。方法采用现场观察法对南昌市、景德镇市和井冈山市共44个公共场所吸烟状况进行调查，对600名成年人和800名学生进行问卷调查，问卷内容包括吸烟和被动吸烟情况、吸烟相关知识和态度、学校开展控烟健康教育状况等。结果公共场所控烟标识率为65．9％，吸烟发现率为37．1％，吸烟劝阻率为8．2％，交通工具等候室地面烟头数量较多，吸烟者较多。成年人吸烟率为32．7％，其中男性为61．8％，女性为2．4％，分别有76．0％、86．7％和64．8％的成年人在家庭、室内娱乐场所和室内工作场所中存在吸烟情况。学生尝试吸烟率为27．8％，其中男生为40．9％，女生为11．7％，分别有66．6％和20．5％在调查前7天内遭受过和每天遭受被动吸烟的危害，学校控烟健康教育活动开设率较低。结论江西省城市公共场所禁烟实施情况不理想，青少年和成年人被动吸烟情况严蕈。     

Violent Behaviors,Weapon Carrying,and Firearm Homicide Trends in African American Adolescents, 2001–2015

African American youths have the highest risk for firearm and other weapon related homicides. This study utilized the national Youth Risk Behavior Surveys from 2001 to 2015 to assess trends in violence related behaviors and weapon carrying of African American adolescents. Our analyses found statistically significant reductions in physical fighting and weapon carrying among African American male adolescents from 2007 to 2015. Planning suicide increased in both male and female African American adolescents since 2007. In addition, the number of firearm homicides increased in African American males. African American females and males had groups of items highly predictive of weapon carrying behaviors: alcohol, tobacco, and other drug use and violent risk behaviors. Both female and male students who made mostly A’s or B’s in school were significantly less likely to carry weapons in and out of school. Our findings indicate that firearm homicides have increased in African American adolescents, but weapon carrying in school going adolescents has significantly declined. School engagement and satisfactory school performance seems to have a significant protective effect on firearm homicides and violent behavior risks in African American adolescents.     

Peer Reviewed: Regional and Racial Differences in Smoking and Exposure to Secondhand Smoke: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Introduction

Stroke mortality rates differ by race and region, and smoking and exposure to secondhand smoke are associated with stroke. We evaluated regional and racial differences in current smoking and secondhand smoke exposure among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

Methods

African American and white adults (n = 26,373) aged 45 years or older were recruited during 2003 through 2007. Logistic regression was used to examine the likelihood of current smoking and secondhand smoke exposure by race (African American vs white) and region. We compared the buckle of the stroke belt (the coastal plain region of North Carolina, South Carolina, and Georgia) with the stroke belt (the remainder of North Carolina, South Carolina, and Georgia, plus Alabama, Mississippi, Tennessee, Arkansas, and Louisiana) and compared each of these regions with the remaining contiguous states.

Results

Among whites, no regional differences in current smoking were seen, but among African Americans, the odds of current smoking were 5% lower in the stroke belt, and 24% lower in the stroke buckle than those in the nonbelt region. Similarly, among whites no regional differences in exposure to secondhand smoke were found, whereas among African Americans, the odds of being exposed to secondhand smoke were 14% lower in the stroke buckle than for nonbelt residents.

Conclusions

These data suggest that rates of current smoking and secondhand smoke exposure are not higher in regions that have higher stroke mortality and therefore cannot contribute to geographic disparities; nevertheless, given that 15% of our participants reported current smoking and 16% reported secondhand smoke exposure, continued implementation of tobacco control policies is needed.     

西藏青少年2019年吸烟行为现状及相关因素分析

  目的  了解西藏青少年烟草使用现状及影响因素, 为开展有针对性的控烟干预提供技术依据。  方法  于2019年8—10月, 采用与人口数量规模成比例的整群抽样方法抽取西藏4 983名学生进行问卷调查, 采用χ2检验和非条件Logistic回归分析探讨西藏青少年现在吸烟率的相关因素。  结果  2019年西藏青少年现在吸烟率为11.3%(563/4 983), 尝试吸烟率为21.8%(1 086/4 983), 二手烟暴露率为62.4%(3 111/4 983)。82.9%的吸烟者表示想要戒烟, 79.9%的吸烟者在过去12个月内有过尝试戒烟行为, 仅有11.7%的吸烟者表示受到过专业人员的戒烟帮助或建议。Logistic回归分析结果显示, 城市(OR=2.38)、三年级(OR=1.51)、学校类型为普通高中(OR=2.90)或职业高中(OR=3.53)、男生(OR=16.93)、每周零花钱≥50元(OR=1.93)、暴露于二手烟(OR=16.12)、认为二手烟可能会(OR=1.40)或可能不会(OR=4.89)产生危害、暴露于烟草广告(OR=1.83)、朋友吸烟(OR=7.47)、几乎每天能看到教师吸烟(OR=1.79)与青少年现在吸烟行为均呈正相关; 认为吸烟行为能减少吸引力(OR=0.54)与青少年现在吸烟行为呈负相关(P值均 < 0.05)。  结论  2019年西藏青少年吸烟及尝试吸烟行为较普遍, 二手烟暴露问题较严重, 职业高中学生是开展控烟干预的重点人群, 学校为控烟干预的重点场所。     

Factors influencing openness to future smoking among nonsmoking adolescents

BACKGROUND: To investigate the correlates of youth tobacco use in terms of nonsmoking adolescents' openness to future smoking, a secondary analysis of the 2000 and 2004 Indiana Youth Tobacco Survey (IYTS) was conducted. METHODS: A representative sample of 1416 public high school students in grades 9-12 and 1516 public middle school students in grades 6-8 (71.44% and 72.53% response rates, respectively) were surveyed in 2000, and 3433 public high school students and 1990 public middle school students (63.04% and 65.44% response rates, respectively) were surveyed in 2004. RESULTS: Seventy-four percent of students in 2000 were not open to future smoking and 77% were not open in 2004. The adolescent cohort in 2004 became more exposed to antitobacco messages and less exposed to protobacco messages and environmental tobacco smoke (ETS) compared with their counterpart in 2000. Whereas gender, grade, race/ethnicity, and exposure to antitobacco messages were insignificant predictors for openness to future smoking, exposure to ETS either in homes or in cars was a strong predictor for openness to future smoking (the higher the exposure to ETS, the more open to future smoking) in both unadjusted and adjusted multivariate models. Exposure to protobacco messages had a greater effect on openness to future smoking than exposure to antitobacco messages. The rate of transition from openness to future smoking to tobacco use initiation is higher among white adolescents than among minority adolescents. CONCLUSIONS: More efforts should be made to reduce adolescents' exposure to ETS and protobacco messages.     

Racial/ethnic differences in perceived smoking prevalence: evidence from a national survey of teens

Prior studies show that perceived smoking prevalence is a significant predictor of smoking initiation. In this study, we examine racial/ethnic differences in perceived smoking prevalence and racial/ethnic differences in exposure to contextual factors associated with perceived smoking prevalence. We used cross-sectional time series data from the Legacy Media Tracking Surveys (LMTS), a national sample of 35,000 12- to 17-year-olds in the United States. Perceived smoking prevalence was the primary outcome variable, measured using an LMTS question: "Out of every 10 people your age, how many do you think smoke?" Multivariable models were estimated to assess the association between perceived smoking prevalence; race/ethnicity; and exposure to social contextual factors. Findings indicate that African American, Hispanic, and American Indian youth exhibit the highest rates of perceived smoking prevalence, while white and Asian youth exhibit the lowest. Minority youth are also disproportionately exposed to social contextual factors that are correlated with high perceived smoking prevalence. These findings suggest that disproportionate exposure to social contextual factors may partially explain why minority youth exhibit such high levels of perceived smoking prevalence.     

Tobacco Exposure,Weight Status,and Elevated Blood Pressure in Adolescents

The pathogenesis of hypertension begins in youth. An estimated 4 % of US adolescents have diagnosed hypertension and 17 % have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15–18. A convenience sample of 148 adolescents ages 15–18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35 % of the variance in systolic blood pressure and 18 % in diastolic blood pressure. One-fourth (25 %) of adolescent males and 11 % of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22 %) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.     

Factors associated with Taiwanese junior high school personnel advising students to quit smoking

BACKGROUND: Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco‐control efforts because they interact daily with students, are role models for students, teach about tobacco‐use prevention in school curricula, and implement school tobacco‐control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. METHODS: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self‐administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco‐related materials were more likely to advise students to quit smoking. Personnel who had received tobacco‐prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS: To reduce youth smoking prevalence, school tobacco‐control programs should support tobacco‐prevention training for school personnel.     

Cigarette smoking for weight loss or control among adolescents: gender and racial/ethnic differences.

PURPOSE: To describe gender and racial/ethnic differences in the prevalence of cigarette smoking for weight loss or control in an adolescent population-based sample, and relationships among heavy smoking, weight concerns and smoking to lose or control weight. METHODS: Anonymous questionnaires were administered to 81,247 9th and 12th grade public school students across the state of Minnesota in 1998. Variables of interest included smoking frequency, weight concerns, and smoking for weight loss or control. Logistic regression analyses were used to estimate the odds of smoking to lose or control weight by race/ethnicity and gender, and to evaluate the relationships between smoking to lose or control weight and heavy smoking, perceptions of overweight, and weight concerns by race/ethnicity and gender. RESULTS: With the exception of black females, female smokers of different racial/ethnic groups were as likely as white girls to smoke for weight loss or control. Compared to white male smokers, American Indian and Asian American male smokers were more likely to smoke for weight loss or control, and black, Hispanic, and mixed race male smokers were equally likely to smoke for weight loss or control. Heavy smokers, smokers who perceived themselves as overweight or were weight-concerned were significantly more likely to report smoking as a weight control method. CONCLUSIONS: Smoking for weight control is prevalent across many race/ethnic groups and both genders among adolescents.     

Viewing tobacco use in movies: does it shape attitudes that mediate adolescent smoking?

BACKGROUND: Social cognitive theory posits that children develop intentions and positive expectations (utilities) about smoking prior to initiation. These attitudes and values result, in part, from observing others modeling the behavior. This study examines, for the first time, the association between viewing tobacco use in movies and attitudes toward smoking among children who have never smoked a cigarette. DESIGN/SETTING: Cross-sectional school-based survey was used among randomly selected Vermont and New Hampshire middle schools. The sample consisted of 3766 middle school students (grades 5-8). The sample was primarily white and equally distributed by gender. The primary exposure was number of movie tobacco-use occurrences viewed. We first counted occurrences of tobacco use in each of 601 recent popular motion pictures. Each student was asked to select movies they had seen from a random subset of 50 movies. Based on movies the adolescent had seen, movie tobacco-use occurrences were summed to determine exposure .The outcome was susceptibility to smoking, positive expectations, and perceptions of smoking as normative behavior for adolescents or adults. RESULTS: The movies in this sample contained a median of five occurrences of tobacco use (interquartile range=1, 12). The typical adolescent never-smoker had viewed 15 of the 50 movies on his/her list. From movies adolescents reported seeing, exposure to movie tobacco-use occurrences varied widely: median=80, and interquartile range 44 to 136. The prevalence of susceptibility to smoking increased with higher categories of exposure: 16% among students who viewed 0 to 50 movie tobacco occurrences; 21% (51 to 100); 28% (101 to 150); and 36% (>150). The association remained statistically significant after controlling for gender, grade in school, school performance, school, friend, sibling and parent smoking, sensation-seeking, rebelliousness, and self-esteem. Compared with adolescents exposed to < or =50 occurrences of tobacco use, the adjusted odds ratio of susceptibility to smoking for each higher category was 1.2 (95% confidence interval 0.9, 1.5), 1.4 (1.1, 1.9), and 1.6 (1.3, 2.1), respectively. Similarly, higher exposure to tobacco use in movies significantly increased the number of positive expectations endorsed by the adolescent and the perception that most adults smoke, but not the perception that most peers smoke. CONCLUSIONS: This study provides empirical evidence that viewing movie depictions of tobacco use is associated with higher receptivity to smoking prior to trying the behavior.     

淄博市初中生尝试吸烟及二手烟暴露情况调查

目的 了解淄博市初中生尝试吸烟及二手烟暴露情况,为淄博市青少年控烟工作的开展提供依据.方法 随机整群抽取淄博市3所初中,使用统一的调查问卷对在校学生进行烟草流行情况调查,并采用尝试吸烟率、二手烟暴露率以及烟草信息接收等指标进行分析.结果 共调查451名初中生,尝试吸烟率为6.0％,其中男生(6.3％)高于女生(5.7％...     

Text Message Delivered Peer Network Counseling for Adolescent Smokers: A Randomized Controlled Trial

Although adolescent tobacco use has declined in the last 10 years, African American high school seniors’ past 30-day use has increased by 12 %, and as they age they are more likely to report lifetime use of tobacco. Very few urban youth are enrolled in evidenced-based smoking prevention and cessation programming. Therefore, we tested a text messaging smoking cessation intervention designed to engage urban youth through an automated texting program utilizing motivational interviewing-based peer network counseling. We recruited 200 adolescents (90.5 % African American) into a randomized controlled trial that delivered either the experimental intervention of 30 personalized motivational interviewing-based peer network counseling messages, or the attention control intervention, consisting of text messages covering general (non-smoking related) health habits. All adolescents were provided smart phones for the study and were assessed at baseline, and at 1, 3, and 6 months post intervention. Utilizing repeated measures general linear models we examined the effects of the intervention while controlling for race, gender, age, presence of a smoker in the home, and mental health counseling. At 6 months, participants in the experimental condition significantly decreased the number of days they smoked cigarettes and the number of cigarettes they smoked per day; they significantly increased their intentions not to smoke in the future; and significantly increased peer social support among girls. For boys, participants in the experimental condition significantly reduced the number of close friends in their networks who smoke daily compared to those in the control condition. Effect sizes ranged from small to large. These results provide encouraging evidence of the efficacy of text messaging interventions to reduce smoking among adolescents and our intervention holds promise as a large-scale public health preventive intervention platform.     

北京市房山区2019年中小学生尝试吸烟状况及影响因素分析

目的 为了解房山区中小学生尝试吸烟状况及其影响因素,以及烟草相关知信行情况,为进一步做好青少年控烟工作提供科学依据。 方法 采用多阶段分层整群抽样方法抽取房山区3所小学、2所初中、1所高中和1所职高共1 507名学生进行了问卷调查。分析不同学段学生尝试吸烟情况以及对烟草的知信行情况。使用多因素logistic回归分析儿童青少年吸烟行为的相关影响因素。 结果 房山区2019年中小学生尝试吸烟率为6.30%,小学、初中、高中、职高学生尝试吸烟率分别为3.46%、4.12%、3.53%、25.56%,差异有统计学意义(χ²=145.304,P＜0.01)。多因素logistic回归分析显示职高学段、身边有朋友吸烟、见到电视电影中有吸烟镜头、模仿偶像吸烟等变量是中小学生尝试吸烟的危险因素。烟草相关知识各题目的正确率学段差异均有统计学意义(P＜0.01)。男生对于烟草的肯定比例明显高于女生,性别、学段差异均有统计学意义(P＜0.01)。78.90%的学生表示今后肯定不会吸烟。52.02%的学生会劝阻身边吸烟的人,1.26%的学生会跟随身边人一起吸烟。22.16%的学生表示会模仿明星偶像抽烟,性别和学段差异有统计学意义(P＜0.01)。 结论 作者简介:孟毅(1982-),女,北京市房山人,学士,主管医师,主要从事学校卫生工作和健康教育工作。儿童青少年的控烟是今后降低全社会人群吸烟率的关键。控制儿童青少年吸烟需要学校、家庭和社会的综合防控,创建轻松和谐、无烟健康的支持性环境,强化知识宣教与干预,使儿童青少年牢固掌握相关知识的同时,产生心理认同,将控烟行动坚持一生。     

Adolescents'' Reasons for Smoking

Part of the Hutchinson Smoking Prevention Project, this study provides information on reasons reported by adolescents for their smoking behavior. A total of 1,615 10th grade students in 20 rural and suburban school districts in Washington state were asked why they currently smoke and why they first smoked. For beginning smoking, curiosity, social norms, and social pressure were the most frequently given reasons for smoking. For current smoking, pleasure and addiction were mentioned most often. A number of gender differences occurred with 10th grade students beginning and current smoking. More females than males reported social norms and social pressure as reasons for beginning to smoke, whereas for currently smoking, pleasure was given as a reason more frequently by females than males. When developing interventions, smoking prevention programs need to consider students' current and past smoking behavior, and the reasons they give for smoking.     

河北省大中小学生被动吸烟状况调查

目的了解河北省大中小学生被动吸烟状况。方法通过问卷调查的方式调查河北省3个城市大学、高中、初中及小学4年级以上8所学校的学生。结果共调查9～25岁大中小学生818名，被动吸烟率为56．8％，小学生、初中生、高中生、大学生分别为50、7％、52．0％、70．3％和63．0％（P〈0．01），男生为63．3％，高于女生50．9％（P〈0．01）；家长、老师及朋友吸烟的学生被动吸烟率较高；465名被动吸烟的学生接触二手烟的场所为70．5％在家中、75．7％在家外；81．5％的学生认为被动吸烟有害健康，51．5％的学生赞同禁止在公共场所吸烟，67．6％的学生反对他人当着自己的面吸烟。结论河北省大中小学生大多数都遭受二手烟的侵害，应加强学校、社区控烟健康教育、禁止在公共场所吸烟等控烟干预活动，减少二手烟的危害。     

Water Pipe Tobacco Smoking Among Middle and High School Students

Objectives. We examined prevalence rates of water pipe tobacco smoking among young people as a first step in assessing the health implications of this form of tobacco use.Methods. We examined water pipe use with data from the 2007 Florida Youth Tobacco Survey, which assessed tobacco-related beliefs, attitudes, and behaviors among the state''s middle and high school students.Results. Four percent of middle school students and 11% of high school students reported ever having used a water pipe. Adolescent boys were significantly more likely than adolescent girls to use water pipes, and African American adolescents were significantly less likely than adolescents from other racial/ethnic backgrounds to do so. Those who indicated ever having tried cigarettes and those who reported positive attitudes toward the social nature of cigarette use were more likely to have tried water pipes.Conclusions. Water pipe use appears to be widespread among middle and high school students. Further research is needed to assess the health risks associated with water pipe tobacco smoking as well as young people''s attitudes toward this form of tobacco use.Although the results of self-report studies indicate the apparent popularity of water pipe tobacco (also known as “hookah”) smoking among adolescents and young adults,^1–3 no population-based studies, to our knowledge, have estimated the prevalence of this form of tobacco use. Very little is known regarding water pipe tobacco smoking among adolescent groups. The few self-report studies that have examined use among adolescents have oversampled Arab American students, given the tradition of this form of tobacco use among individuals from the Middle East, Southeast Asia, and South Africa. For example, Weglicki et al.¹ compared water pipe tobacco and cigarette smoking rates among Arab Americans (representing 45% of their sample) and non-Arab Americans. The rate of water pipe use was higher among Arab Americans than among their non–Arab American counterparts (17% vs 11%).¹In addition to assessing patterns of water pipe tobacco smoking, it is important to assess the relationships between water pipe use and use of other tobacco products. Studies have shown that adolescents with a history of water pipe tobacco smoking are 4 to 16.5 times more likely than their counterparts without such a history to experiment with cigarettes.^2,4–6 Also, higher rates of water pipe use have been reported among adolescent males than among adolescent females.^2,5,6Although water pipe smoking is spreading worldwide,⁷ the overall prevalence of this practice in the United States remains unknown. However, estimates are available for certain groups, including college students. Smith et al.,⁸ in describing data collected in 2004, found that 15.3% of freshmen attending an East Coast private university had used a water pipe in the preceding 30 days. In another study, conducted in 2006 at Virginia Commonwealth University, 20.4% of students indicated water pipe use in the preceding 30 days and 48.4% reported a history of water pipe use.⁹In their study of a random sample of students enrolled at a large, urban, public university in the Northeast, Primack et al.¹⁰ found that 9.5% of students had used a water pipe in the preceding 30 days, 31% had done so in the past year, and 41% had a history of water pipe use. Of those who had used a water pipe in the past year, more than one third (35.4%) had never smoked a cigarette.¹⁰ Jackson and Aveyard¹¹ found similar results in a cross-sectional survey of college students who were customers of a water pipe cafe; most students (65%) who reported regular smoking of water pipe tobacco did not smoke cigarettes. Jackson and Aveyard also reported that rates of water pipe use increased across the college years,¹¹ a pattern opposite to that observed with cigarette smoking.¹²In addition to estimating water pipe use rates among different populations in the United States, researchers have assessed perceptions of the risks involved in this practice and the correlates of water pipe tobacco smoking. In a study of students at a private East Coast university, Smith-Simone et al.¹³ found that friends were the most likely source of influence on water pipe use in the following year; also, students reported that water pipe tobacco smoking was the most socially acceptable form of tobacco use among their peers and that their peers looked “cooler” when using water pipes than when smoking cigarettes or cigars.Eissenberg et al.,⁹ in a cross-sectional study conducted at a large public university, found that students who were current water pipe users were more likely than students with no history of water pipe use to have smoked cigarettes, cigars, or cigarillos in the preceding 30 days; to believe that water pipe use makes their peers look cool; and to believe that water pipe use is socially acceptable among their peers. They also found, in general, that water pipe users were younger, that they were less likely to be African American, that they report lower perceived harmfulness or addictiveness of water pipe use compared with cigarette use, and that they report lower perceived social acceptability of cigarette use among peers.In the earlier-mentioned study of Primack et al.,¹⁰ the authors reported that 33% of the college students in their sample believed that water pipe smoking is less harmful than cigarette smoking, and 52% believed that it is less addictive than cigarette smoking. In addition, 36% believed that water pipe smoking is “very socially acceptable.”Although individuals of college age seem to be the group most vulnerable to water pipe use, high school populations are also prone to the increasing popularity of this form of tobacco use, which is primarily social in nature. Many students reach 18 years of age, the legal age to purchase and use tobacco products, while they are still high school seniors, and with the dramatic increase in water pipe cafes (between 2000 and 2004, more than 200 new hookah cafes opened for business nationwide¹⁴), these students now have establishments available to them for water pipe use.To address gaps in the current literature on water pipe tobacco smoking among adolescents, we tested 3 hypotheses. First, older, White, male adolescents will be more likely to use water pipe tobacco than younger, non-White, female adolescents. Second, a history of having tried cigarettes will increase the likelihood of trying water pipe tobacco. Finally, adolescents who believe that cigarettes are acceptable to alleviate stress and for use in social situations will be more likely to use water pipe tobacco.We constructed models designed to assess associations between individual-level variables and water pipe tobacco smoking via hierarchical logistic regression analyses. Demographic data were included in the first model, which tested the hypothesis that water pipe tobacco smoking would be more prevalent among older, White, adolescent boys. We then added history of cigarette use in model 2 to assess our second hypothesis. Finally, in model 3, we assessed whether attitudes toward cigarette smoking with respect to social situations and stress relief would be associated with water pipe tobacco smoking, given that its relaxing and social nature is often cited as a reason for its use.     

Racial and socioeconomic disparities in arterial stiffness and intima media thickness among adolescents

Racial and socioeconomic status (SES) disparities in cardiovascular disease (CVD) risk are well established among adults. However, little is known about disparities in CVD risk among adolescents, particularly considering indices of subclinical CVD. Our aim was to examine socioeconomic and racial disparities in subclinical CVD indices among adolescents. We hypothesized that African American and lower SES adolescents would show greater arterial stiffness and intima media thickness compared to Caucasian and higher SES adolescents, respectively. Participants were 81 African American and 78 Caucasian adolescents (mean age = 17.8) from two schools in Pittsburgh, PA, USA. Measures of subclinical CVD were pulse wave velocity and intima media thickness, as assessed by Doppler and B-mode ultrasound, respectively. SES indices included parental education, family income, family assets, subjective social status, and census-derived neighborhood SES. Hypotheses were evaluated in multiple linear regression models with the covariates age, gender, body mass index, and systolic blood pressure. Results indicated that African American adolescents were more often in low SES positions than Caucasians. When considered individually, racial and SES disparities in pulse wave velocity, and to a lesser extent, intima media thickness, were evident. When race and SES were considered together, high school education, low or medium income, and low neighborhood SES were associated with higher pulse wave velocity. Fewer assets were associated with higher intima media thickness. In conclusion, racial and SES disparities in indices of subclinical CVD were observed, with findings most pronounced for SES disparities in pulse wave velocity. This study extends previous findings in adults to adolescents, indicating that disparities in arterial stiffness and intima media thickness occur as early as adolescence. Efforts to reduce socioeconomic and racial disparities in CVD should target disparities early in life.     

Smoking behavior among urban and rural Native American adolescents in California

BACKGROUND: Previous studies have documented a high prevalence of tobacco use among Native American adolescents. However, little is known about the smoking behavior of Native American adolescents who live in urban areas. This study used statewide data from California to examine the smoking behavior and related psychosocial risk factors among Native American adolescents living in urban and rural counties. METHODS: The Independent Evaluation of the California Tobacco Control Program conducted three population-based statewide surveys of 10th-grade California public school students in 1996, 1998, and 2000. Past-month smoking and psychosocial correlates were examined among 22,440 respondents, including 1060 Native Americans. RESULTS: Native Americans had a 32% excess risk of past-month smoking compared with other ethnic groups. Smoking prevalence did not differ between urban (27.7%) and rural (29.3%) Native Americans. Native Americans reported higher access to cigarettes and exposure to smoking peers than other groups. Those psychosocial variables explained some, but not all, of the excess risk of smoking among Native Americans. CONCLUSIONS: Effective smoking prevention and cessation interventions are needed for Native American adolescents in urban and rural areas of California.     

Smoking in young adolescents: an approach with multilevel discrete choice models

STUDY OBJECTIVE: To understand the context for tobacco smoking in young adolescents, estimating the effects of individual, family, social, and school related factors. DESIGN: Cross sectional analysis performed by multilevel logistic regression with pupils at the first level and schools at the second level. The data came from a stratified sample of students surveyed on their own, their families' and their friends' smoking habits, their schools, and their awareness of cigarette prices and advertising. SETTING: The study was performed in the Island of Gran Canaria, Spain. PARTICIPANTS: 1877 students from 30 secondary schools in spring of 2000 (model's effective sample sizes 1697 and 1738). MAIN RESULTS: 14.2% of the young teenagers surveyed use tobacco, almost half of them (6.3% of the total surveyed) on a daily basis. According to the ordered logistic regression model, to have a smoker as the best friend increases significantly the probability of smoking (odds ratio: 6.96, 95% confidence intervals (CI) (4.93 to 9.84), and the same stands for one smoker living at home compared with a smoking free home (odds ratio: 2.03, 95% CI 1.22 to 3.36). Girls smoke more (odds ratio: 1.85, 95% CI 1.33 to 2.59). Experience with alcohol, and lack of interest in studies are also significant factors affecting smoking. Multilevel models of logistic regression showed that factors related to the school affect the smoking behaviour of young teenagers. More specifically, whether a school complies with antismoking rules or not is the main factor to predict smoking prevalence in schools. The remainder of the differences can be attributed to individual and family characteristics, tobacco consumption by parents or other close relatives, and peer group. CONCLUSIONS: A great deal of the individual differences in smoking are explained by factors at the school level, therefore the context is very relevant in this case. The most relevant predictors for smoking in young adolescents include some factors related to the schools they attend. One variable stood out in accounting for the school to school differences: how well they enforced the no smoking rule. Therefore we can prevent or delay tobacco smoking in adolescents not only by publicising health risks, but also by better enforcing no smoking rules in schools.