Cigarette smoking and children's respiratory symptoms: validity of the questionnaire method

Children who report that they smoke cigarettes, also report increased respiratory symptoms. Could this be an artefact of the questionnaire method? Reports of children's respiratory symptoms obtained from children and from their parents were compared. There was a significant association between these reports, although the relationship was not close. The relationship between symptoms and cigarette smoking was consistent, whichever report was used. It is concluded that the questionnaire technique is valid, and that children who smoke cigarettes are more likely than non-smokers to have respiratory symptoms.     

Community perceptions about the tobacco industry and tobacco control funding

OBJECTIVES: To determine community views about the believability and standards of honesty and ethics of tobacco companies, related policy options, and mechanisms for tobacco control funding. METHOD: A representative population survey of 808 South Australians aged 18 years and older, contacted by telephone, using an electronic white pages sampling frame, with a response rate of 72%. RESULTS: 80% of respondents and 74% of smokers thought tobacco companies mostly did not or never told the truth about smoking and health, children and smoking and addictiveness of tobacco. With regard to perceived standards of honesty and ethics, tobacco company executives were rated the lowest of all professional groups, with 74% of respondents judging them to have low or very low standards. 89% of smokers would support full product information on the pack about chemicals and additives in cigarettes. 77% thought shopkeepers should pay back the amount they gain from children smoking cigarettes and 80% thought tobacco companies should do so, or be fined or taxed accordingly. 53% agreed the government should spend an amount equal to the amount gained from children's smoking and 21% indicated a higher expenditure. CONCLUSION: Tobacco companies are held in low regard by the public and by smokers who are their customers. There is a high degree of support for tobacco control efforts to be financed by being indexed to the level of children's smoking in the community, through the amount made by shopkeepers, manufacturers and the government from children's cigarette consumption.     

Children's health in families with cigarette smokers.

Recent studies have indicated higher rates of certain respiratory conditions among children who live in households with adults who smoke cigarettes. This paper analyzes data from the 1970 National Health Interview Survey. Children in families with no smokers had an average of 1.1 fewer restricted-activity days and 0.8 fewer bed-disability days per year than did children in families with two smokers. Children in families with one smoker were in between. Acute respiratory illness accounted for the difference in disability days among children in families with different smoking characteristics. Family smoking was also measured by the combined number of cigarettes smoked by adults; children in families which smoked 45 or more cigarettes a day had 1.9 more restricted activity days and 0.9 more bed-disability days due to acute respiratory conditions than did children in families who did not smoke cigarettes. The age of the child, the number of adults in the family, the education of the family head, and the family income were all controlled and did not eliminate the relationship between children's health and family smoking.     

Anxious adults vs. cool children: children's views on smoking and addiction

Tobacco addiction represents a major public health problem, and most addicted smokers take up the habit during adolescence. We need to know why. With the aim of gaining a better understanding of the meanings smoking and tobacco addiction hold for young people, 85 focused interviews were conducted with adolescent children from economically deprived areas of Northern Ireland. Through adopting a qualitative approach within the community rather than the school context, the adolescent children were given the opportunity to freely express their views in confidence. Children seem to differentiate conceptually between child smoking and adult smoking. Whereas adults smoke to cope with life and are thus perceived by children as lacking control over their consumption, child smoking is motivated by attempts to achieve the status of cool and hard, and to gain group membership. Adults have personal reasons for smoking, while child smoking is profoundly social. Adults are perceived as dependent on nicotine, and addiction is at the core of the children's understanding of adult smoking. Child smoking, on the other hand, is seen as oriented around social relations so that addiction is less relevant. These ideas leave young people vulnerable to nicotine addiction. It is clearly important that health promotion efforts seek to understand and take into account the actions of children within the context of their own world-view to secure their health.     

Smoking and its correlates among preadolescent children in France

BACKGROUND: Smoking often begins in early adolescence, and addiction can occur rapidly. For effective smoking prevention efforts with younger children, knowledge of their early smoking experience is needed. The purpose of this paper was to report the smoking experience of French elementary school children and to describe their lifestyle habits and health knowledge. METHODS: A cross-sectional study of 913 children age 9-11 years in 31 randomly selected schools of the Loire administrative department in France was conducted, using anonymous previously validated questionnaires. Correlates of smoking initiation and intention to smoke in the future were assessed by unconditional logistic regression analysis. RESULTS: A total of 12.3% of the children had smoked at least one cigarette, 5.1% within the previous 30 days. Correlates of ever smoking were male sex, older age, engaging in physical activity, reporting not following safety-related recommendations, or drinking alcohol. Of the 112 children who reported ever smoking, 45.5% stated that they did not want to remain smokers in the future and an additional 26.8% were not sure. CONCLUSIONS: Information on the smoking experience of preadolescents should help in designing effective prevention programs, which are essential for reinforcing abstinence in nonsmokers and preventing others from progressing to addiction.     

Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence. A cohort of children (n = 270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender 9P = 0.041) paternal smoking (P = 0.001) fraternal smoking (P = 0.017) a best friend who smoked (P = 0.026) and knowing someone with a smoking-related disease (P = 0.006) Intentions to smoke at age 9 did not predict smoking at age 11 (P < 0.001). In univariate analyses, child smoking was also associated with maternal smoking (P = 0.002 at age 11), living in a low-income household (P < 0.001 at age 10) and living in a deprived area ( P = 0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.     

Through the haze of cigarettes: teenage girls' stories about cigarette addiction

Narrative inquiry was used to explore the meaning of nicotine addiction among teenage girls, age 14 to 17 years, who had recent experience with smoking. The following three narratives emerged: invincibility, giving in, and unanticipated addiction. Those who told a story of invincibility depicted how they were in control of their smoking and not addicted. Participants who gave accounts of giving in to smoking described yielding to external forces. In the narrative of unanticipated addiction, participants recounted their surprise at realizing that they were addicted. Two subnarratives, needing to quit and repeating history, were also uncovered. The study findings reveal the importance of semantics and identity issues as teenage girls talked about nicotine addiction. Listening to their stories is paramount in continued efforts in the reduction of tobacco consumption.     

Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions

BACKGROUND: Explanations of adolescent smoking often make reference to adolescents' beliefs that they are invulnerable to harm. However, empirical examination of whether adolescents do acknowledge risks. Further, few studies have considered perceived benefits in adolescents' behavioral decisions. This study examined perceived smoking-related physical and social risks and benefits between adolescents who have vs. have not smoked and do vs. do not intend to smoke. METHODS: Three hundred and ninety-five students (mean age = 14.0) completed a survey concerning their smoking experiences, intentions, and perceived risks and benefits of smoking. RESULTS: Adolescent smokers and those who intend to smoke estimated their chance of experiencing a smoking-related negative outcome as less likely than did nonsmokers and non-intenders. Smokers and intenders also reported the chance of addiction as less likely than did others. In contrast, adolescent smokers and intenders perceived the chance of experiencing a smoking-related benefit as more likely than did nonsmokers and non-intenders. CONCLUSIONS: The data suggest that rather than solely focusing on health risks as a way to deter adolescent smoking, the role of perceived social risks and benefits in adolescents' smoking may be an additional critical focus for intervention. In addition, efforts should be made to increase adolescents' awareness of the addictive nature of cigarettes.     

Determinants of children's exposure to environmental tobacco smoke (ETS): a study in Southern Germany

Maternal smoking has been repeatedly found to be the most important determinant of children's exposure to environmental tobacco smoke (ETS). Here, we further investigated predictors for the urinary cotinine/creatinine ratio (CCR, ng/mg) in 1220 preschool children for the year 1996. Children from smoking homes (35.1%) had significantly higher CCR than children from nonsmoking homes (mean: 55.5 vs. 14.9 ng/mg). The level of education of the parents was a strong predictor for CCRs even after adjusting for number of cigarettes smoked, maternal smoking and dwelling space. Additionally, dwelling space was inversely related to children's urinary cotinine level. The CCR- levels in children investigated in 1996 and 1998 were significantly correlated (Pearson's r=0.67). The parents of 806 children agreed for a visit to their homes. In 79 of the 536 (14.7%) of the self-reported, nonsmoking households, smoking was admitted during the visit. The mean urinary CCR of these children was 25.2 ng/mg. We conclude that in addition to parental smoking behaviour, other variables such as dwelling space and social and educational status predict the children's exposure to ETS. Our data also revealed that a considerable percentage of parents denied the ETS exposure of their children at home.     

Characteristics of tobacco smoking in schools in Andorra]

1600 schoolchildren aged 13 to 18 answered an anonimus, self administered questionnaire, in a cross sectional study to estimate the prevalence of cigarette smoking in the high grades schools in Andorra. 46.6% answered they did smoke cigarettes, either daily (11.2%) or occasionally (35.4%). Ten per cent of actual smokers did already smoke at age 10, and 50% at age 13. More girls (48.8%) than boys (44.4%) smoked (p less than 0.05) but boys smoked a greater number of cigarettes (p less than 0.001). Ninety five percent smoked Virginia tobacco, and little more than 50% used filter tipped cigarettes. Two thirds of smokers inhaled the smoke of cigarettes; this was more common among daily smokers. Again two thirds of smokers answered they would be prepared to quit smoking. 31% of those who had tried smoking said they believed they would smoke in the future, while only 5.6% of those that never smoked previously said so (p less than 0.001). Actual smokers answered they believed that they would not smoke in the future much less often than non smokers. Parents let boys smoke more than girls when the children started doing so, particularly before age thirteen and after age fifteen. These are the first available data about the community studied describing some features of its cigarette smoking habit. Their knowledge may well help to plan disease protection and health promotion developments addressed to youngsters in Andorra.     

The effect of Taiwan's tax-induced increases in cigarette prices on brand-switching and the consumption of cigarettes

The effect of raising cigarette taxes to reduce smoking has been the subject of several studies, which often treat the price of cigarettes as an exogenous factor given to smokers who respond to it by adjusting their smoking behavior. However, cigarette prices vary with brand and quality, and smokers can and do switch to lower-priced brands to reduce the impact of the tax on the cost of cigarettes as they try to consume the same number of cigarettes as they had before a tax hike. Using data from a two-year follow-up interview survey conducted before and after a new cigarette tax scheme was imposed in Taiwan in 2002, this study examines three behavioral changes smokers may make to respond to tax-induced cigarette price increase: brand-switching, amount consumed, and amount spent on smoking. These changes were studied in relation to smoker income, before-tax cigarette price, level of addiction, exposure to advertizing, and consumer loyalty.We found that smokers, depending upon exposure to advertizing, level of consumer loyalty and initial price of cigarettes, switched brands to maintain current smoking habits and control costs. We also found that the initial amount smoked and level of addiction, not price, at least not at the current levels in Taiwan, determined whether a smoker reduced the number of cigarettes he consumed.     

Children talking: emerging perspectives and experiences of cigarette smoking

Despite efforts to prevent the onset of smoking, the rate among older children remains high. In this article, the authors report on a longitudinal, qualitative study of 11 to 16-year-old children describing children's construction of what it means to be a smoker, the reasons given for children smoking, and their views of smoking behavior. Findings indicate that children adopt broad interpretations of what constitutes smoking behavior; although they strongly disapprove of children who smoke, they are less disapproving of older children or adult smokers and are increasingly tolerant of smoking behavior as they get older. Children's disapproval of smoking acts as a protective mechanism against smoking for younger participants. Participants' broad interpretation of what it means to be a cigarette smoker, their association of smoking with adulthood, and their increasing tolerance of and exposure to smoking behavior as they move into adolescence appears to increase susceptibility to becoming cigarette smokers.     

Cigarette smoking behavioral distinctions between experimental nonadopters and adopters in children and adolescents--a consideration of transitional smoking experience: the Bogalusa Heart Study

A cigarette-smoking questionnaire to examine behavior, attitudes, and beliefs related to cigarette use was administered to children, ages 8-17, in a biracial community. Children who experimented with cigarettes but did not adopt the habit (experimental nonadopters) and children who continued to smoke (adopters) were identified and characterized. Follow-up behavior was examined 2 years later. Adopters were more likely to have smokers as friends and family members, more likely to have purchased their first cigarettes, more likely to believe smoking to be pleasurable for themselves and others, and less likely to consider smoking harmful. Adopters who maintained smoking behavior 2 years later had, during the initial survey, reported having more friends who also smoked and were more likely to believe smoking to be enjoyable. Experimental nonadopters were more likely to try the first cigarette alone, reported having fewer friends and family members who smoked, and believed greater health risks to be associated with cigarette use. Experimental nonadopters who maintained nonsmoking behavior 2 years later, especially in the older cohort, exhibited higher agreement with the negative consequences of cigarette smoking (health beliefs) and theories concerning smoking behavior of others.     

Prenatal exposure to tobacco: II. Effects on cognitive functioning at age three

Three-year-old children, born to women who smoked ten or more cigarettes at the beginning of pregnancy and identified at the time of registration for prenatal care, were assessed by the McCarthy Scales of Children's Abilities and the Minnesota Child Development Inventory. Children whose mothers quit smoking during pregnancy relative to children whose mothers persisted in smoking performed at a statistically significant higher level on the General Cognitive Index of the McCarthy and on each of the three subscales from which the General Cognitive Index is derived. The scores on the Minnesota Child Development Inventory were similar in showing a higher performance in the children of quitters. Statistical adjustment for environmental factors, characteristics of the child, and fetal maturity did not account for the observed differences between children of women who quit smoking and those of women who continued to smoke.     

Tobacco taxation: economic and public health issues

Cigarette smoking is a major public health issue. An increase of cigarette tax might be a way for promoting tobacco control. This article reviews the economist's perspective of tobacco control. It shows that a crucial economic criteria for supporting an increase of cigarette tax--the cost of externalities--is not fulfilled, since smokers may well have been paying their own financial externalities. However, the theory of rationale addiction cannot fully explain smoking behavior because of risk perception bias. The nicotine dependence and the onset of nicotine addiction occurring mostly during childhood and adolescence explain why consumption decision cannot be assumed to be the product of informed, rational choice by mature individuals. Children and teenagers fail to appreciate the risks associated with behavior and heavily discount the future. Protecting children and teenagers constitutes the strongest argument favoring increased taxation of cigarettes.     

“Cloud chasers” and “substitutes”: e‐cigarettes,vaping subcultures and vaper identities

The use of e‐cigarettes is increasing, a practice denoted as vaping. We explore user motives, self‐identity as vapers and involvement in vaping subcultures, drawing on sociological theory of stigma, subcultures and symbolic boundaries. Based on analyses of semi‐structured interviews with 30 Norwegian vapers, we find that there is a vaping subculture in Norway. We identify two dominant vaper identities. The first is labelled cloud chasers. These were dedicated vapers who identified with symbols and values in the subculture. Many were politically engaged in improving vaping regulation regimes and felt a sense of belonging to a vaping community. The second group is labelled substitutes. These were former daily smokers who used e‐cigarettes for smoking cessation in a more pragmatic and defensive manner, to avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group, self‐identity as a vaper was generally lacking. Vaping was often symbolically linked to the stigmatised smoker identity they wanted to escape, and was restricted to private contexts. The perceived symbolic meaning of e‐cigarettes varies: for some, they are a symbol of pleasure and community. For others, they connote the stigmatised status of the addicted smoker seeking an alternative to cigarettes.     

Predictors of continued smoking over 25 years of follow-up in the normative aging study

OBJECTIVES: This study tested the hypothesis that high daily cigarette consumption and addiction to smoking are risk factors for the long-term continuation of smoking. METHODS: Using longitudinal data from 986 male smokers, we entered cigarettes per day, psychological addiction, age, and education into a survival analysis as predictors of continued smoking over a 25-year period. RESULTS: Younger men and those who smoked more cigarettes per day were more likely to remain smokers in the long term. Addiction and education level were not significant predictors of continued smoking. CONCLUSIONS: Heavier smokers are more at risk than lighter smokers for long-term smoking. It is therefore very important to provide smoking cessation treatments for heavy smokers as early as possible after the initiation of smoking.     

Development trends of first cigarette smoking experience of children: the Bogalusa heart study.

During one school year a health habits survey investigated cigarette smoking behavior in a total biracial population of children, ages 8 to 17 years old. Information was collected concerning each child's first smoking experience. Over 60 per cent of the children reported they were given their first cigarettes. Half of those starting before age 12 smoked their first cigarettes with a family member or an older fried. The smoking habit appears to have become established by age 14, with a two-year gap between initiation and maintenance.     

'I didn't really like it, but it sounded exciting': admission to hospital for surgery from the perspectives of children

It is a mark of respect for children that their views around their healthcare are listened to and considered. To date, too little attention has been paid to children's views and experiences of admission to hospital for surgery. This paper presents findings from a constructivist grounded theory study of children's experiences of admission to hospital for surgery (from their perspectives). Age appropriate data collection techniques were used and included interviews with children and their drawings and stories. Ten children, aged 6-12 years, who were admitted to hospital for surgery participated in the research. The children were able to clearly articulate aspects of their experience, including their fears and anxieties, the things they enjoyed and the things that assisted them to cope with their experience. The substantive theory developed was 'children's reframing of their sense of selves to incorporate the experiences of hospitalization and surgery'. Children require information and support to alleviate their anxieties around the time of their surgery. With pressures on children's services, increased day surgery rates and shorter admissions, nurses who care for children around this time are challenged to find ways of knowing each child's story and the fears that they have.