Cigarette smoking and drug use in schoolchildren: IV--factors associated with changes in smoking behaviour

Factors associated with changes in the smoking behaviour of approximately 6000 schoolchildren (two cohorts aged between 10 and 12 years in 1979) over 12 months are described. They were measured twice as part of a randomized controlled trial of a smoking prevention programme. Four groups were defined: (a) those who became smokers (adopters); (b) those who remained non-smokers; (c) those who became non-smokers (quitters), and, (d) those who remained smokers. Personal and social variables were ordered using a logistic regression model according to the strength of their association with adopting and quitting smoking. Factors distinguishing adopters from children who remained nonsmokers were, being a member of the older cohort, having friends who smoke, having siblings who smoke, approving of cigarette advertising and having a relatively large amount of money to spend each week. Factors distinguishing quitters from children who continued to smoke were, having siblings who do not smoke, being a member of the younger cohort, disapproving of cigarette advertising and having a relatively small amount of money to spend each week. Initial attitude scores were indicative of future smoking behaviour and where smoking behaviour changed, attitudes also changed so that the two remained congruent. The younger cohort improved their knowledge of smoking hazards over the year irrespective of their smoking behaviour. The older cohort showed significant differences in knowledge which were dependent upon smoking category, with 1980 smokers having lower knowledge scores than non-smokers and showing an apparent decrement in their previous knowledge.     

Cigarette smoking among secondary schoolchildren in 1975. Prevalence of respiratory symptoms, knowledge of health hazards, and attitudes to smoking and health.

A questionnaire relating to smoking habits, respirator symptoms, and health attitudes was administered to 10 498 secondary schoolchildren in 1975. The results reported in this paper indicate that children who smoke regularly have a higher prevalence of upper respiratory tract infections and a higher incidence of the respiratory symptoms, cough, phlegm production with a cold, and shortness of breath, compared with non-smokers. Children are aware of the risks of lung cancer when smoking, but less aware of the other more immediate health risks, and this is particularly so in the younger age groups. It is suggested that health education should be directed towards younger children and that more use should be made of the fact that smoking clearly makes them less healthy.     

A population survey in Ontario regarding restrictive measures on smoking: relationship of smoking status to knowledge, attitudes and predicted behaviour

A population survey of Ontario residents regarding knowledge of the health effects of smoking, attitudes towards restrictive measures, and predicted behaviour was carried out. Telephone responses of 490 current, 290 former, and 581 never smokers were compared. For both active and passive smoking, never smokers were most knowledgeable about health effects, former smokers being less knowledgeable, and current smokers least so. While a majority of each smoking status group supported some restriction on smoking in all 13 settings examined, there were consistent differences among the groups as to degree. Never and former smokers were in close agreement and were more restrictive in their attitudes than current smokers. Prohibition was more strongly favoured by all groups for health and day care facilities, schools, stores, and local transit systems than for other settings. While a majority of smokers thought there would be compliance with restrictions, non-smokers were less optimistic. Smokers were less likely than non-smokers to see a role for governments in enactment; municipal involvement was favoured over other levels by all groups. No group indicated much support for enforcement by police. These findings remained when multivariate analyses controlling for inter-group differences in sociodemographic characteristics were carried out.     

Effect of medical education on smoking behaviour

At Manchester University medical students (n = 658) had more knowledge than law students (n = 245) about the hazards of smoking, were more convinced by the relevant evidence, and assessed the risk to health more highly. However, there was no significant difference in their smoking behaviour. Among medical students 61% were non-smokers, 10% ex-smokers, and 29% smokers, of whom three-fifths smoked regularly. During their training they were more likely to start smoking than to give it up, and more likely to increase their consumption than decrease it. Expansion of smoking occurred especially in the early years of the course, whereas the main increase in knowledge was in the clinical period. Students' knowledge and their opinion of the evidence were related to their stage of education, whereas their assessment of the risk was linked with their smoking behaviour. Expansion of smoking at medical school may be forestalled by providing information about the hazards as early as possible, although some smokers will continue the habit irrespective of knowledge.     

Relation between parents'' and children''s smoking behaviour and attitudes.

In the MRC/Derbyshire Smoking Study, a cohort of about 6000 adolescents was surveyed annually about their smoking behaviour, attitudes, and other issues from when they entered secondary school at 11-12 until 15-16 years and then again at 18-19 years. Their parents answered a similar questionnaire when their children were aged 11-12 and 15-16 years. In this paper we report the findings of an investigation focussed on the relation between parents' and childrens' smoking behaviour and attitudes at different stages of adolescence. It reveals substantial agreement between children's and parents' reports of parents' smoking behaviour and attitudes, that children from one-parent families are more likely than their peers to smoke, and that boys are more likely to smoke if their fathers smoke and girls if their mothers smoke. In addition, maternal attitudes were independently related to the boys' smoking behaviour. The implications of these findings for health education are discussed.     

Academic performance and social factors related to cigarette smoking by schoolchildren.

Factors which may influence boys and girls aged between 10 and 121/2 years to start smoking were studied. Information was obtained from 491 schoolchildren, their parents, and headteachers. In their own view and that of their headteachers children who did not smoke were academically better than smokers. Children who smoked were more likely than non-smokers to have a parent and siblings of the same sex who smoked. No association was found between the child's own smoking and that of parents and siblings of the opposite sex. Smokers were more likely to have friends who smoked. Most children did not think smoking was enjoyable or desirable and many thought it bad for health, irrespective of their own smoking habits. The majority thought people of their own age smoked to show off.     

Cigarette smoking: knowledge, attitudes and behaviour in an adult population in Italy

The study explores knowledge, attitudes, and behaviour regarding cigarette smoking and related factors in an adult population. A total of 935 parents of children attending the eighth class of ten randomly selected primary schools in Catanzaro (Italy) received a questionnaire consisting of questions on demographic and socioeconomic characteristics, knowledge, behaviour and attitudes about cigarette smoking. Six hundred and sixty-nine parents returned the questionnaire, with a response rate of 71.5%. Knowledge of risk associated to smoking was significantly higher in more educated subjects and in past smokers compared to current. Current and past smokers were respectively 39.6% and 17.2%, and current smokers were younger, not married, less prone to consider smoking as a major risk for their health and more likely to live with other smokers compared to past and never smokers. Females of higher education were more likely to be current smokers, whereas male current smokers were more likely to be less educated compared to past or never smokers. The results strongly recommend the provision of accurate information about the health consequences related to smoking, with a more intensive involvement of health care providers, particularly targeted to women and younger age groups.     

中国五城市餐饮业顾客对被动吸烟的认知和态度

目的 了解中国城市餐饮业顾客对被动吸烟的认知、态度.方法 2007年7-10月采用方便抽样的方法,对北京、西安、武汉、昆明、贵阳5个城市405家不同类型餐馆/酒吧的2109名顾客进行问卷调查.结果 43.1%的顾客对烟草危害有较全面的认识;近60%的顾客表示不曾主动反对他人在面前吸烟,近三分之一的顾客曾因接触"二手烟"感到不适而选择中途离开;支持餐馆/酒吧全部禁烟的比例分别为30.0%和19.8%;二项logistic回归模型分析表明,北京市顾客、≥25岁年龄组、大专及以上学历和非吸烟者更倾向于支持餐馆/酒吧禁烟;而北京市顾客、女性、大专及以上学历和非吸烟者更愿意去有禁烟规定的餐馆/酒吧消费.结论 尽管5个城市餐饮业顾客对烟草烟雾的认知还有待提高,但餐馆/酒吧禁烟符合广大顾客的意愿,是公共场所控烟的趋势之一.     

Smoking and respiratory disease symptoms inrural Bangladesh

Respiratory disease (excluding tuberculosis) is a largely untargetted health problem in Bangladesh. This study emphasises both that existing morbidity is considerable and that it is sure to increase if smoking spreads further. In two poor village populations 71% of men though only 1% of women were current smokers (one or more cigarettes or bidi per day); about one in five had begun smoking before the age of 10 years. Most heavy smokers and all women smoked bidi (hand-rolled coarse tobacco sticks). Expenditure on smoking absorbed up to 5% of household income but, seemingly paradoxically, one of the lowest socio-economic groups had the heaviest consumption.For men the striking effect of smoking in increasing respiratory disease symptom prevalence at all ages is clear. Nearly all male smokers reported “cough” but so did four out of five men and women who had never smoked. There were too few women smokers for meaningful analysis. However, “morning phlegm”, “an episode of increased phlegm” and “wheezing” as well as being common for non-smokers of both sexes, were two to three times more frequent among women than men who had never smoked. In women there must certainly be other causal factors for respiratory symptoms apart from smoking, the most important are likely to be smoke from cooking fires and respiratory infections in childhood. Improving immunization coverage and the treatment of respiratory infections in childhood would be useful preventive strategies for both men and women. The most urgent public health measure is to reduce the prevalence of smoking.     

'You think that I'm smoking and they're not': why mothers still smoke in the home

Past research into smoking and motherhood has explained how smoking enables mothers to care in conditions of hardship and poverty. However, much of this research was conducted before the risks to the health of non-smokers of inhaling tobacco smoke were widely known, and so mothers' attitudes towards passive smoking and caring remain under explored. Children living with smokers are at risk of developing serious acute and chronic conditions during childhood and later life. Despite increased awareness of health messages among parents, young children are still exposed to environmental tobacco smoke (ETS) in the home, with maternal smoking identified as the primary source of exposure. In this paper, we present the findings from a project set up to explore the changing social and environmental context of smoking and motherhood. Using focus groups, 54 mothers of children aged under five years from the Merseyside area of England, who smoked, discussed their beliefs about smoking, passive smoking and the health of their children. Although mothers were aware of the messages linking ETS exposure to childhood illnesses they appeared to rely more on their own explanations for any ill health experienced by their children, discounting smoking as a primary cause and preferring alternative explanations including 'genetics' and 'pollution'. These alternative explanations were common both within and between groups, suggesting that they form part of a wider resistant dialogue constructed within families and communities, where information about smoking and child health is received, challenged, and reconciled with existing knowledge, before being either accepted or rejected. Crucially, this alternative dialogue supports the mothers' continued smoking, and is inevitably linked to their personal need to smoke while caring. These findings have implications for the development of future strategies for promoting the health of children with mothers who are reluctant, or feel unable, to accept that smoking can affect the health of their children.     

Exploring children's conceptions of smoking addiction.

Tobacco addiction is a major health problem for both adults and young people--between 20 and 60% of adolescents are dependent on nicotine and more than two-thirds who attempt to quit experience withdrawal symptoms. Yet, anti-smoking efforts targeted at children emphasize primary prevention and ignore addiction education, which is generally considered relevant only to adult smoking and cessation efforts. This study reports children's concepts of smoking and addiction from interviews with 32 Western Australian boys and girls, aged 9-10 years, all non-smokers. Results suggest children's concepts of smoking addiction may influence attitudes toward smoking trials. Children who thought addiction happened immediately were committed to never smoke at all. Others who thought addiction happened after several cigarettes expressed intentions to experiment. These children believed they could avoid addiction by smoking less than the number of cigarettes that caused addiction. Children who defined addiction as 'liking' or 'enjoying the taste of cigarettes' believed they could avoid being 'hooked' as long as they managed to avoid enjoying the experience. Recent findings that children can get 'hooked' within a few days of smoking highlight the importance of addiction strategies targeted at children, particularly in relation to influencing intentions to experiment with smoking.     

Differences by education in smoker/non-smoker beliefs about the dangers of smoking

Surveys consistently demonstrate that smokers are less likelythan non-smokers to acknowledge the health hazards of cigarettesmoking. Similarly, compared with high education individuals,persons with lower educational attainment are less likely toacknowledge smoking's dangers. We find, however, that as educationlevel rises, smokers' acceptance of the dangers of smoking risessignificantly less than does the acceptance by non-smokers.Thus, relative to non-smokers with the same educational attainment,high-education smokers are less likely to acknowledge the hazardsof smoking than are smokers with lower levels of education.     

Smoking among Shanghai medical students and the need for comprehensive intervention strategies

By cluster sampling, 1392 medical students of Shanghai Medical University were investigated with regard to smoking status and their knowledge and attitudes towards smoking and anti-smoking campaigns. The results showed that the smoking rate of medical students was 12.07%-21.42% for male students and 1.81% for female students. Both daily and occasional smoking rate increased as the curriculum year progressed. Of smoking students, 36.69% had made at least one serious attempt to quit smoking; 11.18% of smoking students intended to be non-smokers by the end of 5 years; and 87.07% of non-smokers and 68.35% of smokers agreed that smoking was harmful to one's health. There were widespread deficiencies in knowledge of smoking as an important causal factor in many diseases and in medical students' knowledge as to the appropriate role of doctors in anti-smoking campaigns. There existed some differences between smokers and non-smokers with respect to knowledge and attitudes towards smoking, doctors' professional responsibilities and smoking-controlling regulations. This study indicates that the current system of medical education in China has little or no effect on the attitudes and behaviours of medical students regarding smoking. It is therefore highly necessary and possible to adopt comprehensive smoking-control interventions and health education among this group.     

Effect of diet and physical exercise intervention programmes on coronary heart disease risk in smoking and non-smoking men in Sweden.

STUDY OBJECTIVE: To investigate differences between smokers and non-smokers in health behaviour, cardiovascular risk factors, coronary heart disease (CHD) risks, health knowledge, health attitudes, and compliance with a CHD prevention programme. DESIGN: Differences between smokers and non-smokers were studied via medical examinations, questionnaires, physical exercise activity logs, and food record sheets. Data were analysed using univariate and multivariate analyses. The five and 10 year CHD risks were assessed using the Framingham CHD risk estimate. SETTING: The Karolinska Hospital, Stockholm, and Sollentuna Primary Health Centre, Sollentuna, Sweden. PARTICIPANTS: The analyses were based on 158 healthy smoking and non-smoking men aged 35-60 years with raised cardiovascular risk factors who enrolled in controlled, randomised six month diet and exercise programmes. MAIN RESULTS: Discriminant analysis suggested that smokers, compared with non-smokers, were characterised by a higher alcohol energy percent, lower HDL cholesterol concentration, lower systolic blood pressure, and a higher plasminogen activator inhibitor-1 (PAI-1) value. Knowledge of the risk factors for CHD was not a discriminating factor. Both smokers and non-smokers increased the exercise taken, improved their diet, and lowered their CHD risk. Before, as well as after the intervention, smokers had a higher CHD risk than non-smokers. CONCLUSIONS: The best CHD prevention action that could be taken by smokers would of course be to quit smoking. Those who cannot stop should be encouraged to improve their diet and increase the amount of physical exercise they take in order to reduce the health hazards of their smoking behaviour.     

营养健康教育对单纯性肥胖儿童营养知识-态度-行为的研究

目的:了解和提高肥胖儿童营养知识水平,培养肥胖儿童良好的饮食习惯。方法:将840例肥胖儿童分为扑克牌组和对照组各420例,扑克牌组根据研究制订的营养健康教育模型进行健康教育,对照组采用传统营养教育方法。结果:营养健康教育后,肥胖儿童营养知识得到提高,食物选择及饮食行为趋于合理。扑克牌组的营养知识明显高于对照组(P<0.05)。结论:对肥胖儿童进行扑克牌营养健康教育寓教于乐,有助于增加其营养知识,改善其营养态度及饮食行为,最终达到减少儿童肥胖症的目的,值得推广和普及。     

Girls, pecking order and smoking

Against a background of growing concern about the failure to reduce cigarette smoking amongst young people, particularly girls, this paper attempts to unravel the complex interrelationships between smoking, peer group structure and gender. We were particularly intrigued to explore a recent hypothesis in the literature that suggests that girls who smoke, far from lacking self-esteem, are more self-confident and socially skilled than their non-smoking peers. Sociometric and qualitative analyses revealed that smoking behaviour was indeed shaped by gender, and that the psychosocial processes involved in smoking uptake may be different for boys and than for girls. Peer group structure, consistently described by young people as hierarchical, was closely related to smoking behaviour. Girls at the top of the social pecking order who projected an image of high self-esteem were identified as most likely to smoke, while only a small minority of girls fitted the stereotype of the young female smoker who has poor social skills and low self-esteem. Boys of high social status were less vulnerable, since sport and a desire to be fit to some extent protected them. Our findings raise fundamental questions about the meaning of self-esteem in relation to smoking uptake, arguing instead for an exploration of the term “self-worth”. They suggest the need for health education programmes which are sensitive both to gender and to peer group structures.     

河南省居民对吸烟危害的认知及对禁烟态度的调查

目的了解河南省居民对烟草危害的认知和对公共场所禁烟的态度,为开展针对性的控烟工作提供依据。方法于2010年8—9月,采用4阶段分层整群抽样的方法,抽取河南省2056名15～69岁居民,由调查员进行人户问卷调查,调查问卷包含个人信息、吸烟情况、戒烟情况、受二手烟危害情况及对吸烟危害的知识、态度和认识等部分。结果河南省居民的吸烟率为21．11％。调查居民中知道吸烟会造成严重疾病的占79．13％,知道吸烟会造成中风的占39．93％,知道吸烟会造成心脏病发作的占40．95％,知道吸烟会造成肺癌的占78．06％,但仅有11．38％的居民认为标明低焦油含量的卷烟的危害不比一般卷烟小。36．58％的居民非常赞同在公共场所室内完全禁烟不设吸烟室,吸烟者与不吸烟者对于在公共场所室内完全禁烟不设吸烟室态度有差异（X2=92．01,P〈0．05）。结论居民缺乏吸烟对人体危害的具体认识,对公共场所禁烟缺乏足够支持。应积极开展健康教育和健康促进,提高居民对吸烟有害健康的认知,争取其对公共场所禁烟的全面支持。     

Korean adolescents' perceptions of nutrition and health towards fast foods in Busan area

Adolescents in Busan area were asked in a survey about their perception and attitudes towards fast food. Most respondents answered that they consume fast food once a month because it is fast, easily accessible and tasty. Although they perceived fast food as unhealthy and less nutritious, they were less aware of its effect on their health and nutritional status. The more knowledgeable respondents were about nutrition and health the less likely they were to choose fast food over other meals. However, respondents who had little or no knowledge about the nutritional factors of fast food accounted for 43.1%. As to their source of dietary information, students relied on themselves (31.0%), parents (20.5%) and friends (19.9%). The medium through which students got the most nutrition and health information was television (66.8%), followed by the Internet (36.7%) and magazines (29.7%). This study will enable educators to plan more effective strategies for improving the dietary knowledge of the adolescent population.     

Smoking habits of Grampian school children and an evaluation of the Grampian Smoke Busters campaign

To determine the effect of a Smoke Busters club in reducing the numbers of children recruited to smoking, levels of smoking in Grampian amongst 11-14 year olds were determined at the launch of the club and again 22 months later, using a self-completion questionnaire. Initial smoking levels were similar to Scottish Office of Population Censuses and Surveys (OPCS) 1986 figures taken 2 years prior to the first Grampian survey. OPCS findings indicated that in Scotland smoking levels had remained fairly stable among girls and had increased among boys between 1986 and 1990. At the second survey in Grampian, smoking levels among girls and boys were lower than in Scotland generally, but it is not possible to know whether this was a result of the campaign or not. There was evidence of a relationship between the smoking habits of children and parents, particularly their mothers. Life-style questions showed that smokers were more likely to take part in activities characteristic of older teenagers and to prefer music which was associated with alternative, rebellious attitudes. Smoke Busters clubs aim to promote a non-smoking life-style amongst young teenagers. After 22 months of a Smoke Busters club, it was evident that at least 32.9% of the target group had joined the club at some point and that it was very popular with its members. Those who joined Smoke Busters were more than twice as likely to remain non-smokers as those who were non-members, but this might not be a function of cause and effect. A further survey is to be undertaken at 4 years after the launch of the club and may allow assessment of any longer-term effects of the club in Grampian.     

Attitudes toward genetic testing and personalised nutrition in a representative sample of European consumers

Negative consumer opinion poses a potential barrier to the application of nutrigenomic intervention. The present study has aimed to determine attitudes toward genetic testing and personalised nutrition among the European public. An omnibus opinion survey of a representative sample aged 14-55+ years (n 5967) took place in France, Italy, Great Britain, Portugal, Poland and Germany during June 2005 as part of the Lipgene project. A majority of respondents (66 %) reported that they would be willing to undergo genetic testing and 27 % to follow a personalised diet. Individuals who indicated a willingness to have a genetic test for the personalising of their diets were more likely to report a history of high blood cholesterol levels, central obesity and/or high levels of stress than those who would have a test only for general interest. Those who indicated that they would not have a genetic test were more likely to be male and less likely to report having central obesity. Individuals with a history of high blood cholesterol were less likely than those who did not to worry if intervention foods contained GM ingredients. Individuals who were aware that they had health problems associated with the metabolic syndrome appeared particularly favourable toward nutrigenomic intervention. These findings are encouraging for the future application of personalised nutrition provided that policies are put in place to address public concern about how genetic information is used and held.