The influence of friends, family, and older peers on smoking among elementary school students: low-risk students in high-risk schools

BACKGROUND: This study examined how older smoking peers at school and the smoking behaviour of friends and family members are related to youth smoking. METHODS: Multi-level logistic regression analysis was used to examine correlates of ever smoking in a sample of 4286 grade 6 and 7 students from 57 elementary schools in Ontario, Canada (2001). RESULTS: Each 1% increase in the smoking rate among grade 8 students increased the odds that a student in grades 6 or 7 was an ever smoker versus never smoker [OR 1.05, 95% CI 1.02 to 1.08]. A low-risk student (no family or friends who smoke) was almost three times more likely to try smoking if he/she attended an elementary school with a relatively high prevalence of senior students who smoke than if he/she attended a school with a low prevalence of senior students who smoke. CONCLUSION: Low-risk grade 6 and 7 students are at significantly greater risk of smoking if they attend an elementary school with a relatively high prevalence of smoking among senior students. Prevention programs should target both at-risk schools and at-risk students.     

Factors related to adolescents' estimation of peer smoking prevalence

Although adolescents who overestimate peer smoking prevalence are more likely to smoke, little research has focused on the factors associated with why the majority of adolescents overestimate peer smoking rate. The purpose of this study was to examine demographic, social, environmental and behavioural characteristics related to overestimation of peer smoking prevalence among secondary school students. The current study analysed data collected in two Canadian studies that used the Tobacco Module of the School Health Action, Planning and Evaluation System, a school-based questionnaire. One study surveyed 23 458 students (Grades 9-13) in 29 schools during 2001-02, and the other surveyed 25 452 students in 39 schools in 2003. Results of multiple logistic regression indicate that grade, gender, close friends' smoking, seeing smoking at school, family members' smoking, smoking in the home and smoking status have a clear association with overestimation; school smoking rate and susceptibility to smoking show a tentative relationship and warrant further study. Other factors may also be important for prevalence estimation, and further research is needed to identify these factors. Since adolescents tend to overestimate peer smoking prevalence and perceived prevalence is in turn linked to smoking behaviour, interventions should focus on creating realistic perceptions of smoking prevalence.     

Individual and contextual determinants of perceived peer smoking prevalence among adolescents in six European cities

BackgroundYoung people perceiving a high peer smoking prevalence are more likely to initiate smoking. It is unclear which factors contribute to perceived peer smoking prevalence and if these factors vary according to education. This study aimed to assess the determinants of perceived smoking prevalence and assessed its variation at school and country-level.MethodsData of 10,283 14–17-year-old students in 50 secondary schools in six European cities were derived from the 2013 SILNE survey. The outcome was the perceived smoking prevalence score among peers at school (0–10 scale, 10 represented 100% smoking prevalence). Multilevel linear regression models estimated the associations of factors with perceived prevalence score and variance at school and country-levels. Analyses were also stratified by academic achievement of the adolescent and parental education.ResultsDeterminants of a higher perceived prevalence score were female sex, ever smoking, having friends who smoke, low academic achievement, low parental educational level, and higher actual prevalence of smoking in the school. The perceived prevalence score was not associated with school policies or with the availability of cigarettes near the school. Determinants were very similar across levels of academic achievement and parental education. Perceived prevalence scores substantially varied between schools and countries: 10% and 11% of total variance was related to schools and countries respectively.ConclusionAcross educational levels, perceptions of peer smoking are strongly determined by both individual characteristics and school and national contexts. Future studies should assess why perceived smoking prevalence varies between schools and countries and identify modifiable factors.     

广州市城乡结合部初中生吸烟行为特点的调查

目的:了解城乡结合部青少年吸烟行为的特点。方法:用自填式调查表对6所中学3 956名初中生进行流行病学调查。结果:初中生的尝试吸烟率为20.4%(男30.4%,女8.9%),不规律吸烟率14.7%(男21%,女7.7%),规律吸烟率5.7%(男9.4%,女1.2%)。吸烟率在不同性别和年级间存在差异,不同生源地的初中生吸烟率也有所区别。大部分尝试吸烟行为发生于10~14岁,初吸烟年龄中位数为12岁。吸第一支烟最主要的原因是“好奇尝试(70.3%),最主要的影响人是同伴(46.3%)。73%的规律吸烟者在过去1个月吸过烟,27%的只吸了1~5天。现在吸烟者的日均吸烟量平均值为5.12支,中位数为3支。46.6%的吸烟者只将烟雾吸入口腔。获得香烟的主要方式是别人给的,吸烟主要发生于伙伴聚会时。59%的规律吸烟者曾经戒过烟,主要是由于健康的缘故,戒烟成功率为28.8%。48.9%的现在吸烟者表明目前有戒烟的打算。结论:城乡结合部已成为烟草流行的重灾区,此趋势在青少年已有所表现。青少年控烟工作要联合政府、社会、家庭和学校等方多力量,结合其心理特征开展诸如同伴教育、提供戒烟辅助等有效措施。     

Peers, schools, and adolescent cigarette smoking.

PURPOSE: To investigate the effects of popularity, best friend smoking, and cigarette smoking within the peer networks on current smoking of seventh- through 12th-grade students. These factors were examined for adolescents attending schools with varying rates of student cigarette smoking. METHODS: This study used data from the saturated school sample of National Longitudinal Study of Adolescent Health (Add Health), a nationally representative school-based sample. The sample for the present study was 2525 adolescents in Grades 7-12 who completed an in-school questionnaire and an in-home interview. Information from the in-school questionnaire was used to construct measures of school smoking prevalence and popularity. Using peer nominations from the in-home interview, best friend smoking, and peer network smoking exposure were constructed using the peers' own reports of their cigarette smoking. Multiple regression techniques were used to estimate the risk of current cigarette smoking as a function of popularity, best friend smoking, peer network smoking, and school smoking prevalence, and all first-order interactions between measures of peer and school smoking prevalence. RESULTS: Adjusting for age, gender, race/ethnicity, parent education, school, and availability of cigarettes in the home, the risk of current smoking was significantly associated with peer networks in which at least half of the members smoked [odds ratio (OR) = 1.91], one or two best friends smoked (OR = 2.00), and with increasing rates of school smoking prevalence (OR = 1.73). In addition, there was a significant interaction of popularity and school smoking prevalence such that risk of current smoking was somewhat greater among popular students in schools with high smoking prevalence than among popular students in schools with low smoking prevalence. CONCLUSION: Findings suggest that school environments are important contexts for understanding peer group influences on adolescent cigarette smoking.     

Could the peer group explain school differences in pupil smoking rates? An exploratory study

Schools differ in the proportion of their pupils who smoke. Such differences transcend pupil intake characteristics and relate to the internal life of the school. Although adolescents' smoking behaviour has been associated with that of their peers, little consideration has been given to whether peer structures and processes contribute to school differences in pupil smoking rates. In two relatively deprived Scottish schools, one with a higher and one with a lower rate of pupil smoking, 13 and 15 year-olds were surveyed. Sociometric data and information on pupils' smoking behaviour and views were gathered. Twenty-five single-sex discussion groups were then held with a sub-sample of the 13 year-olds in order to explore in detail their views on smoking, smokers and fellow pupils. Findings showed that in the higher smoking school, pupils were more often in groups, smokers were identified as popular, and attitudes (especially among non-smoking females) were more pro-smoking. In the lower smoking school, by contrast, there were more isolates and dyads, there were no popular smokers and attitudes (especially among non-smoking females) were much less pro-smoking. Thus, evidence suggests peer group structures and related influences could be one explanation for school differences in smoking, and that the popularity of smokers together with the views of non-smoking females may be particularly important in creating such differences.     

Characterization of the smoking habit among high school students in Syria

Objectives: To establish an accurate estimate of the prevalence of smoking among high school students in Aleppo–Syria and to characterize the smoking habit in this age group. Design: A cross-sectional survey was performed, in which a self-administered questionnaire was distributed to 10th, 11th and 12th graders. Subjects: A sample of 1587 students (784 males; mean age 16 years, and 803 females; mean age 15.9 years) was studied. This sample was drawn from 16 schools randomly selected from a total of 73 schools in the city. Results: The prevalence of current smoking was 15.9% for males and 6.6% for females. The prevalence of daily smoking was 2.4% for males and 0.5% for females. Almost all smoking categories increased with age and grade. Forty seven percent of male daily smokers were heavy smokers. Peer influence was evident in all stages of the smoking process, especially for males. Parental smoking was also an important associated factor. The combination of parental and siblings smoking was the strongest predictor of the smoking status of the surveyed (OR: 4.4; 95% CI: 2.7–7). Thirty eight percent of male smokers and 47.2% of female smokers smoke out of boredom. Fifty one percent of male smokers were introduced to smoking by a friend. Forty percent of male smokers buy their cigarettes, while 56.6% of female smokers obtain their cigarettes from home. Logistic regression analyses showed that parental and siblings smoking were the most important predictors of ever trying to smoke or current smoking among male and female students. Conclusions: Our study shows that smoking is more frequent in male than female students. Parental and sibling smoking are the most important factors associated with smoking in this population, and peer influence is important particularly in the smoking initiation stage. Pattern of smoking and associated factors differed substantially between males and females in this study.     

Senior student smoking at school, student characteristics, and smoking onset among junior students: a multilevel analysis

BACKGROUND: Current research on the etiology of tobacco use has largely focused on identifying the influential psychosocial characteristics of individual students; the influences of characteristics in the school environment are generally ignored. The purpose of this study was to simultaneously examine how school and individual student characteristics were related to smoking onset. METHOD: Multilevel logistic regression analysis was used to examine how the senior student smoking rate at a school and the psychosocial characteristics of students were able to differentiate tried-once smokers from experimental smokers in a sample of 4850 grade 9, 10, and 11 students from the School Smoking Profile (SSP) project. RESULTS: Each 1% increase in smoking rate among high school seniors increased the odds that a junior student was an experimental smoker vs. a tried-once smoker (OR 1.07, 95% CI 1.03-1.12). A significant contextual interaction was identified where the senior student smoking rate at a school moderates the negative influence of having close friends who smoke. Influential student characteristics were also identified. CONCLUSIONS: The smoking prevalence of older students at a school is directly related to smoking onset among younger students at that school. Prevention programs should target schools that put students at-risk.     

Factors associated with stages of cigarette smoking among Turkish youth

BACKGROUND: This study examines prevalence and determinants of cigarette smoking among Turkish youth and transition among smoking stages. METHODS: Cross-sectional data from the Global Youth Tobacco Survey (GYTS) obtained from 15 197 youth were used to study factors associated with various stages of cigarette smoking among Turkish youth. RESULTS: Males and high-school students have higher odds of being susceptible to smoking compared with other non-smokers and higher odds of becoming established smokers. Exposure to parent, teacher, and peer smoking, anti-tobacco curricula, cigarette promotions, and perceived ease of access to cigarettes are all significant predictors of being susceptible to smoking and established smoking. Turkish youth who attribute positive traits to smokers are more likely to be susceptible to smoking and to become established smokers. Parental advice and media exposure to anti-tobacco messages were not significantly associated with becoming an established smoker. CONCLUSION: The results reveal the importance of early prevention programmes, which should begin before high school, and targeting efforts towards male students and all students who are not yet smokers but susceptible to smoking. Findings also suggest that prevention policies that challenge the cultural perceptions of smokers among Turkish youth are needed.     

Patterns of Change in Adolescent Smoking Behavior and Results of a One Year Follow-up of a Smoking Prevention Program*

A smoking prevention program for adolescents conducted in two public middle schools focused on resisting peer pressure to smoke and understanding the intent of commercial cigarette advertising. One class in each school participated in the program group and one served as a control group. The program consisted of eight sessions and was conducted by first-year medical students. Data on smoking behavior and related information were obtained from self-administered questionnaires at baseline, at the conclusion of the program, and one year later. One year after the program was concluded, the proportion of non-smokers was higher among those who had participated in the program than among the controls. This suggests that routine implementation of smoking prevention programs in conventional school settings may be productive in reducing the prevalence of cigarette smoking.     

Prevalence of Tobacco Use Among Junior High and Senior High School Students in Taiwan

BACKGROUND: Tobacco use is a major preventable cause of death in the world. This article describes and compares tobacco use prevalence for students attending junior high schools and senior high schools in Taiwan. METHODS: This report uses data from the Global Youth Tobacco Survey (GYTS) completed among 4689 junior high school students and 4426 senior high school students in Taiwan in 2004‐2005. The GYTS uses a 2‐stage sampling design to produce nationally representative data for junior and senior high students in general and vocational schools. RESULTS: Higher smoking prevalence was observed among senior high (10.1% general schools and 15.9% vocational schools) than junior high (5.5%) school students. Smoking prevalence of girls in junior high (3.2%) and senior high schools (4.6% general and 11.1% vocational) was almost as high or higher than adult females’ (4.3%) smoking rates. The pattern of smoking intensity across school years and type of school shows that the percentage of smokers who were experimenters (47.1%) was higher in junior high school and the percentage of smokers who were regular/established smokers (over 50%) was higher in senior high school. CONCLUSIONS: Smoking prevalence described in this report shows that there are challenges facing the tobacco prevention and control program in Taiwan. The findings suggest that schools should increase their smoking initiation prevention efforts and make available cessation programs and counseling to help students quit smoking. If effective youth tobacco control programs are not developed and implemented in Taiwan, future morbidity and mortality attributed to tobacco will surely increase, especially among women.     

2006年龙岩市部分高中学生吸烟情况调查

[目的]了解龙岩市高中学生吸烟情况以及对控制吸烟的态度，为今后教育和干预措施提供科学理论依据。[方法]采取整群随机抽样方法，通过现场问卷的方式对两所中学4个高中班的221名学生进行调查。[结果]男生吸烟率14．1％，女生吸烟率3．7％。男生吸烟率高于女生（P〈0．05）。尝试吸第一口烟者占调查者总数的27．8％，半数以上小于10岁，尝试吸烟者成为当前吸烟者的比率为31．0％。说明尝试吸烟者近I／3成为当前吸烟者。[结论]个人认识与社会、家庭、学校影响成为影响青少年吸烟的主要因素，影响着青少年对控制吸烟的态度。应采取教育与行政干预相结合的办法，才能有效地改变学生的不健康行为，控制吸烟。     

Decrease in the prevalence of smoking among Japanese adolescents and its possible causes: periodic nationwide cross-sectional surveys

Objectives  To assess trends in smoking prevalence among Japanese adolescents and to analyze possible causal factors for the decrease in smoking prevalence observed in a 2004 survey. Methods  Nationwide cross-sectional surveys were conducted in 1996, 2000 and 2004. Survey schools, both junior and senior high schools, considered to be representative of the whole of Japan were sampled randomly. Enrolled students were asked to complete a self-reporting anonymous questionnaire on smoking behavior. The questionnaires were collected from 115,814 students in 1996, 106,297 in 2000, and 102,451 in 2004. School principals were asked about the policy of their respective school on smoking restrictions. Results  Cigarette smoking prevalence (lifetime, current, and daily smoking) in 2004, based on the completed questionaires, had decreased relative to previous years in both sexes and in all school grades. The most important trends were: a decrease in smoking prevalence among the fathers and older brothers of the students; an increase in the proportion of students who did not have friends; a decrease in the proportion of current smokers who usually bought cigarettes in stores decreased in 2004, in particular for the oldest boys. An association was found between a lower smoking rate at a school and a smoke-free school policy. Conclusions  Japan has experienced a decrease in the prevalence of smoking among adolescents. A decrease in smoking prevalence among the fathers and older brothers, limitations to minors’ access to tobacco, an increase in the proportion of students without friends, and a school policy restricting smoking may have contributed to this decreasing trend.     

Tobacco use amongst high school students in the Czech Republic

OBJECTIVE: We were interested in the prevalence of smoking amongst teen-age students, its possible causes, and their understanding of its associated health risks. METHODS: We constructed a questionnaire that was responded to by a total of 419 students from 5 high schools in Prague, Czech Republic. Students were classified as non-smokers, mild (1-10 cigarettes daily), moderate (11-20 cigarettes daily), and severe smokers (>20 cigarettes daily). The survey also contained questions about passive smoking, motivation for smoking, the understanding of its associated health risks, alcohol consumption, and drugs. RESULTS: We found that amongst 16-20 years old high school students there are 37.5% smokers (38.0% men, and 37.0% women). The majority are mild smokers (82.3%), 15.8% moderate smokers and 1.9% heavy smokers. 29.0% of non-smokers reported passive smoking; i.e. that 65.7% of students are exposed to harmful effect of tobacco smoke. The average onset of smoking is at 14 years of age. The youngest smoker started smoking at the age of 5 years. Parents of 52.0% of students smoke (69.4% of smokers and 41.6% of non-smokers). Most of students know about the risk of lung cancer and cardiovascular diseases (86-99%). CONCLUSIONS: The prevalence of active and passive smoking among high school students is high. Parents smoking is significantly more frequent in teen-age smokers than in non-smokers. We consider the "teen-age" population together with their parents to be the key target for a successful antismoking campaign.     

Changes in the use of tobacco among Australian secondary students: results of the 1999 prevalence study and comparisons with earlier years

OBJECTIVE: To estimate smoking prevalence among Australian secondary students in 1999 and to examine trends in smoking-related behaviours since 1984. METHOD: A randomly selected representative sample of 399 secondary schools from across Australia participated in the study. At each school, up to 80 randomly selected students completed a pencil-and-paper questionnaire anonymously. Data from 25,486 students aged between 12 and 17 years are reported. RESULTS: Current smoking (smoking in the week before the survey) was 6% in boys and girls aged 12, and rose to a peak prevalence among 17-year-olds of 33% for boys and 30% for girls. Comparisons across survey years showed that while fewer 12-to-15-year-olds were current smokers in 1999 than in 1996, among 16- and 17-year-olds, the proportion of current smokers in 1999 and 1996 was similar. Students who smoked were less likely to buy their cigarettes in 1999 than in previous surveys. Both older and younger secondary students were more likely to have received lessons about tobacco in the school year prior to the 1999 survey than were students in the 1996 survey. CONCLUSION: The rise in the prevalence of smoking among younger secondary students seen in the 1990s seems to have stopped and smoking prevalence has declined. Implications: Extrapolating from this survey, we estimate that nearly 269,000 12-to-17-year-old students were current smokers in 1999. If they all continue to smoke, 134,000 would die prematurely.     

Risk factors for smoking among school adolescents in Greece

Objective We conducted this study among school adolescents to identify factors, which influence schoolchildren to smoke. Methods We carried out a cross‐sectional study in a sample of 924 students of all classes (ages 12–18 years old) in 15 public high schools in a semi‐urban area in Crete, Greece, using a questionnaire. The questionnaire comprised of 46 questions covering children's lifestyle habits regarding daily activities and leisure time, frequency of risk‐taking behaviour, knowledge about the hazards and long‐term consequences of smoking. Results 23.9% of participants were experimental smokers and 18.6% were current smokers. 11.4% of the total population was daily smokers. There was a significant increase in the prevalence of experimental and current smokers with school grades, while peaks in last grades were observed. Boys started smoking earlier than girls, mean (standard error) age 13.4 (2.3) years vs. 14.1 (2.3) years, P = 0.01. Stepwise logistic regression analysis showed a positive relationship between current smoking and having brother or sister smoking [odds ratio (95% confidence interval) 2.7 (1.7–4.4) and 1.8 (1.1–3.3) respectively], having more than three friends who were smokers [2.6 (2–3.4)] and last school grade [1.4 (1.2–1.7)]. Students appeared to be informed about long‐term smoking hazards and had negative views on children who smoke especially in the lower grades. Conclusions Prevention programmes should be imposed early in elementary schools while cessation policies should target at all grades, in particular at critical grades depending on population‐specific characteristics.     

Tobacco use among high school students in Buenos Aires, Argentina

OBJECTIVES: This study assessed the prevalence and correlates of tobacco use among high school students in Buenos Aires, Argentina. METHODS: Anonymous, self-administered questionnaires were given to 3909 8th and 11th graders in a stratified random sample of 49 public and private schools. The instrument included items from American surveys, translated and validated among Argentinean teens. Multiple logistic regression analysis was used to estimate possible effects on smoking behavior of environment, students' personal characteristics, and their knowledge, beliefs, and attitudes regarding smoking. RESULTS: Of 8th and 11th graders, 20% and 43%, respectively, were classified as current smokers. Overall, 29% of males and 32% of females were current smokers. Students attending public schools were more likely to smoke than those in private schools (P < .05). Current smoking was associated with having a best friend who smokes, reporting that more than 50% of friends of the same sex smoke, having positive attitudes and beliefs toward smoking, and having a positive intention to smoke within the next year (all P < .001). CONCLUSIONS: Over 20% of the 8th graders in our sample were current smokers; prevention efforts must therefore start early.     

Compliance and support for smoke-free school policies

Our objective was to examine factors associated with compliance and support for a smoke-free campus before and after a 1995 campus-wide smoking ban for everyone, including teachers and visitors, in California. Adolescent (12-17 years) data from the 1993, 1996, 1999 and 2002 (N approximately 6000 each year) California Tobacco Surveys (population-based telephone surveys) were analyzed. Trends in compliance with smoke-free school policies and support for smoke-free campuses were examined among students in public and private schools. Perceived compliance with the no-smoking rule by most or all student smokers increased from 43.7 +/- 1.6% in 1993 to 71.5 +/- 1.4% in 2002. While non-smokers have overwhelmingly favored smoke-free school grounds since 1993 (more than 85% each survey year), support among current smokers increased from 55.8 +/- 4.7% in 1996 to 69.1 +/- 6.8% in 2002. Student smokers who saw teachers smoking in school were less likely to favor school smoking bans (odds ratio = 0.25, 95% confidence interval 0.12-0.49). The percentage of private school students seeing teachers smoke on school grounds has been at least twice that of public school students since 1996. Compliance with and support for smoke-free schools increased since smoking was banned on campus for everyone. Perceived compliance by teachers, much lower in private schools, appears to undermine student smokers' support of this policy. Increased efforts are necessary to communicate to teachers the importance of their modeling of policy compliance to students.     

Prevention of smoking in adolescents with lower education: a school based intervention study

OBJECTIVE: To assess the effect of an antismoking intervention focusing on adolescents in lower education. Students with lower education smoke more often and perceive more positive norms, and social pressure to smoke, than higher educated students. An intervention based on peer group pressure and social influence may therefore be useful to prevent smoking among these students. DESIGN: Group randomised controlled trial. SETTING: 26 Dutch schools that provided junior secondary education. SUBJECTS: 1444 students in the intervention and 1118 students in the control group, all in the first grade, average age 13 years. INTERVENTION: Three lessons on knowledge, attitudes, and social influence, followed by a class agreement not to start or to stop smoking for five months and a class based competition. MAIN OUTCOME MEASURES: Comparison of smoking status before and immediately after and one year after the intervention, using multilevel analysis. RESULTS: In the intervention group, 9.6% of non-smokers started to smoke, in the control group 14.2%. This leads to an odds ratio of 0.61 (95% CI= 0.41 to 0.90) to uptake smoking in the intervention group compared with the control group. One year after the intervention, the effect was no longer significant. CONCLUSIONS: In the short-term, an intervention based on peer pressure decreases the proportion of adolescents with lower education who start smoking. Influencing social norms and peer pressure would therefore be a promising strategy in terms of preventing smoking among adolescents. The results also suggest that additional interventions in later years are needed to maintain the effect.