Electronic-Cigarette Smoking Experience Among Adolescents

Objectives

To investigate the level of awareness and contact routes to electronic cigarette (e-cigarette), and to identify significant factors that may affect adolescent use of e-cigarettes; this study explores the experience of e-cigarettes among adolescents.

Methods

Using the data from the 2008 Health Promotion Fund Project in Korea, we used a hierarchical logistic regression analysis to evaluate gender, level of school, family smoking, perception of peer influence, satisfaction in school life, and cigarette smoking experience as predictors of trying e-cigarettes among adolescents in five schools in Korea.

Results

Overall, 444 (10.2%) students responded as having seen or heard of e-cigarettes. Twenty-two (.5%) students reported as having used an e-cigarette. The contact routes of information on e-cigarettes were the Internet (249, 46.4%), friends (150, 27.9%), television (59, 11.0%), books (50, 9.3%), and others (29, 5.4%). The following factors were determined to be statistically significant predictors of e-cigarette experience: male gender, perception of peer influence, satisfaction in school life, and cigarette smoking experience.

Conclusions

In light of this fact, continuous attention needs to be paid on the marketing of e-cigarettes on Internet sites to prevent adolescents from being exposed to unsupported claims about e-cigarettes and to provide appropriate information on health effects.     

Ethnic Differences in Smoking Rate, Nicotine Dependence, and Cessation-Related Variables Among Adult Smokers in Hawaii

This study tests hypotheses concerning ethnic disparities in daily cigarette smoking rates, nicotine dependence, cessation motivation, and knowledge and past use of cessation methods (e.g., counseling) and products (e.g., nicotine patch) in a multiethnic sample of smokers in Hawaii. Previous research has revealed significant differences in smoking prevalence among Native Hawaiians, Filipinos, Japanese, and Caucasians in Hawaii. However, no study has examined differences in dependence and cessation-related knowledge and practices among smokers representing these ethnic groups. Participants were recruited through newspaper advertisement as part of a larger smoking cessation intervention study. Participants (N?=?919; M age?=?45.6, SD?=?12.7; 48?% women) eligible to participate provided self-report data through mail and telephone. Participants included 271 self-identified Native Hawaiians, 63 Filipinos, 316 Caucasians, 145 “East Asians” (e.g., Japanese, Chinese), and 124 “other” (e.g., Hispanic, African-American). Pair-wise comparisons of means, controlling for age, gender, income, education, and marital status, indicated that Native Hawaiian smokers reported significantly higher daily smoking rates and higher levels of nicotine dependence compared to East Asians. Native Hawaiian smokers reported significantly lower motivation to quit smoking than Caucasians. Further, Filipino and Native Hawaiian smokers reported lesser knowledge of cessation methods and products, and less frequent use of these methods and products than Caucasians. The results suggest that Native Hawaiian and Filipino smokers could be underserved with regard to receiving cessation-related advice, and may lack adequate access to smoking cessation products and services. In addition, cessation interventions tailored for Native Hawaiian smokers could benefit from a motivational enhancement component.     

南宁市青少年吸烟行为流行现状

目的了解南宁市青少年的吸烟状况以及吸烟行为影响因素,为制定有效干预措施提供依据。方法采用分层整群抽样方法,对南宁市6所初中、6所高中、3所职业高中和2所大学共3 573名学生进行匿名自填问卷调查。结果南宁市青少年尝试吸烟报告率为37.8%,第一次吸完整支烟时≤13岁的报告率为14.3%;现在吸烟报告率为14.7%,被动尝试吸烟的报告率为50.9%。结论南宁市青少年对吸烟的成瘾性及危害认识不足。家庭环境和同伴压力是主要影响因素。加强对吸烟行为的早期预防教育和干预刻不容缓。     

Early-Emerging Nicotine Dependence Has Lasting and Time-Varying Effects on Adolescent Smoking Behavior

Novice and light adolescent smokers can develop symptoms of nicotine dependence, which predicts smoking behavior several years into the future. However, little is known about how the association between these early - emerging symptoms and later smoker behaviors may change across time from early adolescence into young adulthood. Data were drawn from a 7-year longitudinal study of experimental (<100 cigarettes/lifetime; N?=?594) and light (100+ cigarettes/lifetime, but ≤5 cigarettes/day; N?=?152) adolescent smokers. Time-varying effect models were used to examine the relationship between baseline nicotine dependence (assessed at age 15?±?2 years) and future smoking frequency through age 24, after controlling for concurrent smoking heaviness. Baseline smoking status, race, and sex were examined as potential moderators of this relationship. Nicotine dependence symptoms assessed at approximately age 15 significantly predicted smoking frequency through age 24, over and above concurrent smoking heaviness, though it showed declining trends at older ages. Predictive validity was weaker among experimenters at young ages (<16), but stronger at older ages (20–23), relative to light smokers. Additionally, nicotine dependence was a stronger predictor of smoking frequency for white smokers around baseline (ages 14.5–16), relative to nonwhite smokers. Nicotine dependence assessed in mid-adolescence predicts smoking frequency well into early adulthood, over and above concurrent smoking heaviness, especially among novice smokers and nonwhite smokers. Early-emerging nicotine dependence is a promising marker for screening and interventions aimed at preventing smoking progression.     

Predicting Cigarette Smoking Among Adolescents Using Cross-Sectional and Longitudinal Approaches

ABSTRACT: The ability to identify groups of children at risk of initiating a smoking habit may prove useful in developing effective smoking prevention programs. This report includes data collected over a three-year period, and attempts to predict adolescents' smoking behavior using both cross-sectional and longitudinal analyses. In addition, predictor variables reflecting both interpersonal and intrapersonal domains were included. Results indicated the highest rates of accurate classification into smoking categories were achieved with cross-sectional analyses. In addition, interpersonal variables emerged as most important in all analyses. Implications for smoking prevention programming are discussed.     

新疆3城市青少年吸烟和饮酒行为调查

目的了解青少年吸烟和饮酒状况,为开展健康教育提供参考依据。方法采用多阶段随机抽样,从新疆3个城市选取不同学校类型的初中、高中和大学学生8869名进行问卷调查。结果35.2%的学生有吸烟行为,其中5.0%在7岁以前开始吸烟;58.3%的学生有饮酒行为,其中7.5%在7岁以前开始饮酒。结论随着年龄的增长,学生开始吸烟和饮酒的比例增高。应对学生加强健康教育,控制吸烟和限制饮酒。     

Tobacco Retailer Proximity and Density and Nicotine Dependence Among Smokers With Serious Mental Illness

Objectives. We examined the density and proximity of tobacco retailers and associations with smoking behavior and mental health in a diverse sample of 1061 smokers with serious mental illness (SMI) residing in the San Francisco Bay Area of California.Methods. Participants’ addresses were geocoded and linked with retailer licensing data to determine the distance between participants’ residence and the nearest retailer (proximity) and the number of retailers within 500-meter and 1-kilometer service areas (density).Results. More than half of the sample lived within 250 meters of a tobacco retailer. A median of 3 retailers were within 500 meters of participants’ residences, and a median of 12 were within 1 kilometer. Among smokers with SMI, tobacco retailer densities were 2-fold greater than for the general population and were associated with poorer mental health, greater nicotine dependence, and lower self-efficacy for quitting.Conclusions. Our findings provide further evidence of the tobacco retail environment as a potential vector contributing to tobacco-related disparities among individuals with SMI and suggest that this group may benefit from progressive environmental protections that restrict tobacco retail licenses and reduce aggressive point-of-sale marketing.Tobacco use among people with serious mental illness (SMI) is common and has serious health and financial costs.1 Nationally, individuals with psychiatric or addictive disorders consume 44% to 46% of cigarettes purchased and are more likely than those in the general population to be daily and heavy smokers.2,3 In one study, it was estimated that smokers with SMI spend, on average, 27% of their income on tobacco.4 Individuals with SMI suffer disproportionately from tobacco-related diseases and, as a group, have a 25-year premature mortality rate.5 Increasingly, researchers and practitioners highlight the need for more targeted prevention and intervention strategies to reduce the burden of smoking-related diseases in this vulnerable group.6,7Cigarette smoking among people with SMI reflects a complex interplay of genetic, neurobiological, cultural, and psychosocial factors.6 Studies have examined shared genetic effects between smoking and SMI,8–11 as well as associations with attention and cognition, stress and mood, and reductions in the side effects of psychotropic medications.6 In addition to individual-level risk factors, a complete understanding of smoking disparities among individuals with SMI requires examination of “upstream” social determinants of health, including social, political, and economic contexts. Accordingly, research on the etiology and maintenance of cigarette use in this disproportionately affected group has increasingly focused on systemic factors outside of an individual’s control, such as tobacco industry targeting, reduced access to smoking cessation services, and tobacco control policies.7,12 Notably, smokers with SMI are responsive to tobacco control policies that have been effective in the general population, such as smoking bans and cigarette tax increases.13–16The built environment is another important social determinant of health that has the potential to affect smoking among people with SMI. In the general population, retail availability of tobacco, which includes the number of retailers per area or population (i.e., density) and the distance to the nearest retailer (i.e., proximity) from one’s home or school, is associated with earlier smoking initiation,17,18 increased current smoking19–22 and cigarette purchases,23 and reduced smoking cessation over time.24,25 Smokers who live in neighborhoods with higher densities of tobacco retailers have greater exposure to retail advertisements and promotions, which can obstruct quit attempts by increasing cues to smoke, provoking cravings, and triggering impulse purchases.26–29 Smokers are price sensitive,30,31 and the financial costs of smoking are lower in communities with more convenient tobacco access and reduced travel time to purchase.22 Moreover, retailers and point-of-sale tobacco advertisements are more prevalent in socially and economically disadvantaged neighborhoods.19,22,32–36The effects of increased tobacco availability may be particularly strong among smokers with SMI given that factors such as unreliable transportation and limited resources37 in this population may lead to a greater reliance on readily obtainable consumer goods. Furthermore, people with SMI have been targeted by the tobacco industry,12,38 and they may be especially sensitive to aggressive tobacco advertisements and promotions. Surprisingly, in spite of the public health relevance, to our knowledge no studies of the retail availability of tobacco have involved clinical samples of individuals with SMI.Our goals in this study, which included a diverse sample of adults with SMI, were to characterize the proximity (roadway distance to the nearest retailer) and density (number of retailers per acre) of tobacco retailers within 500 meters and 1 kilometer of participants’ residences and to assess whether retail availability of tobacco is associated with severity of mental illness, nicotine dependence, and readiness to quit smoking. We also evaluated whether these associations vary according to gender.We hypothesized that smokers with SMI would reside in neighborhoods with greater than average tobacco retailer density for their county area and that this neighborhood characteristic would be associated with greater severity of mental illness. Furthermore, we predicted that increased retail availability of tobacco would be associated with greater nicotine dependence and lower readiness to quit, regardless of severity of mental illness. We also examined gender differences given calls to assess such differences in tobacco control research, policy, and practice39 and recent evidence that proximity to a tobacco retailer is associated with a lower likelihood of smoking cessation among men but not women who are moderate to heavy smokers.24     

Prospective Analysis of Peer and Parent Influences on Smoking Initiation Among Early Adolescents

The nature and relative importance of psychosocial influences on smoking initiation among early adolescents are topics of substantial research interest. Students (N = 1081) from four middle schools were surveyed at the beginning and end of the sixth grade. Baseline predictors were regressed on smoking initiation at end of sixth grade. In bivariate, logistic regression analyses association with problem behaving peers, perceived prevalence, and depression were positively associated and adjustment to school, perceived social competence, parent expectations, parental monitoring, and parental involvement were negatively associated with smoking initiation. In multivariate logistic regression analyses controlling for sex, race, and school, peer affiliation and perceived prevalence were positively associated, whereas social competence and parental monitoring were negatively associated with smoking initiation. A significant interaction between parental involvement and peer affiliation indicated that among teens with problem behaving friends only those with parents who were relatively uninvolved were are at increased risk for smoking initiation. This finding held for boys, girls, Whites, Blacks, and teens living in single parent families. These findings provide evidence that antecedent parenting behaviors may protect early adolescents against smoking even in the context of negative peer affiliation.     

The Social Context of Smoking Among African-American and White Adolescents in Baltimore City

Objective To describe and understand variations in social influences on smoking behavior among African-American and white male and female adolescents in Baltimore City, USA . Design A qualitative study where adolescents, both smokers and non-smokers, were interviewed individually (n = 21) and participated in focus groups (n = 18 focus groups, 3-10 participants per group). Results Social contexts emerged as most relevant and salient themes related to smoking behavior. White females perceived the most permissive parental messages around smoking, while males, especially African-American males, reported receiving the strictest parental sanctions. Females' need to fit in with peers contrasted with males' being coerced to smoke. Possible reasons for African-Americans' non-use of cigarettes include a desire not to disrespect parents and being turned off by parental addiction to nicotine. All adolescents cited the school's lax anti-smoking policy as a reason teens smoke at school. Conclusion Interventions targeted at schools and families offer promise for reducing adolescent cigarette use.     

Antipsychotic Treatment Patterns and Aggressive Behavior Among Adolescents in Residential Facilities

This study examined the association between acute aggressive behavior patterns of 145 adolescents in residential treatment facilities with use of and changes in antipsychotic medication for the chronic management of aggression. Seclusion/restraint (S/R) frequency over 12 months was used to categorize youth into none, low, moderate, and high S/R groups. Data were analyzed using longitudinal mixed effects logistic regression models that allowed for intra-subject variability over time. The high and moderate S/R groups were significantly more likely to receive antipsychotics, get higher doses, and have changes in medication compared with the none S/R group. Increases in antipsychotic dose were associated with a lower likelihood of changes in antipsychotic medication over time. Despite persistent antipsychotic use at higher doses, youth in the high and moderate S/R groups continued to be secluded/restrained frequently. The findings question the adequacy of these medications in managing aggressive behavior.     

Electronic Cigarette Use and Attempts to Quit Smoking Cigarettes Among Adolescents in Taiwan

Purpose

This study assessed the relationship between electronic cigarette (e-cigarette) use and attempts to quit smoking cigarettes by adolescent smokers in Taiwan.

The Effects of Asthma and Bullying on Suicidal Behaviors Among US Adolescents

BACKGROUND

Positive associations between suicidal behaviors and asthma have been established in previous adolescent studies. Few studies consider social risk factors, such as bullying. This study involved an analysis of suicidal behaviors and asthma, but also includes an assessment of whether these relationships were modified by the co‐occurrence of bullying.

METHODS

Data included 13,154 participants from the 2013 Youth Risk Behavior Survey (YRBS), collected by the US Centers for Disease Control and Prevention. Logistic regression models were constructed and summarized using odds ratios (ORs) and 95% confidence intervals (95% CIs).

RESULTS

When comparing adolescents with asthma who were bullied at school to those who were not bullied at school, the odds of contemplating suicide were increased by nearly 2‐fold (OR = 1.8, 95% CI = 1.5‐2.3), and the odds of creating a suicide plan were 2.3 times higher (OR = 2.3, 95% CI = 1.7‐3.1). The odds of a suicide attempt and incurring an injury from a suicide attempt were also substantially increased. Similarly, increased odds of suicidal behaviors were observed for adolescents with asthma who were bullied electronically.

CONCLUSION

Having asthma and being bullied are both associated with increased odds of suicidal behaviors.

     

Disposable Income With Tobacco Smoking Among Young Adolescents: A Multilevel Analysis

PurposePrior studies examining the connection between disposable income and adolescent smoking often yielded mixed results, partly due to the lack of consideration for contextual variables. In the present study, we sought to broaden understanding of disposable income on adolescent smoking behaviors via both absolute and relative perspectives in the school context.MethodsWe obtained data from the 2010 Global Youth Tobacco Survey (GYTS) in Taiwan. Information concerning sociodemographics, disposable income, smoking history, and contextual smoking exposure (e.g., school) were assessed via self-report. Recent-onset smokers were defined as those who had their first cigarette within two years of the survey. Complex survey and multilevel analyses were carried out to estimate association.ResultsAdolescents with higher monthly disposable income were 2～5 times more likely to start smoking and become regular smokers. Having the least disposable income in a class appeared linked with increased risk of tobacco initiation by 40% (95% confidence interval [CI]: 2%–91%). Pupils’ odds to start smoking were lowered to .70 when the majority of schoolmates had low disposable income (95% CI: .51–.99).ConclusionsAdolescent risk of smoking initiation may be differentially affected by individual- and contextual-level absolute and relative disposable income. Future research is needed to delineate possible mechanisms underlying unfavorable health behaviors associated with disposable incomes in early adolescence.     

Measuring Exposure to Pro- and Anti-tobacco Marketing Among Adolescents: Intercorrelations Among Measures and Associations With Smoking Status

Exposure to tobacco - related marketing has been implicated as one of the risk factors for tobacco use among adolescents. However, tobacco - related marketing exposure has been measured in different ways in different studies, including per ceived pervasiveness, receptivity, recognition, recall, and affect. It is not known whether these measures represent one or more underlying constructs and how these underlying constructs are associated with adolescent smoking status. This study analyzed data from 5, 870 eighth - grade students in California, collected in 1996- 1997 as part of the Independent Evaluation of the California Tobacco Control , Prevention, and Education Program . An exploratory factor analysis of multiple measures of tobacco - related marketing exposure revealed four distinct factors: per ceived pervasiveness of protobacco marketing, perceived pervasiveness of anti tobacco marketing, recognition of specific antitobacco advertisements, and receptivity to protobacco marketing. Receptivity to protobacco marketing showed the strongest association with smoking status; higher levels of receptivity were associated with higher levels of smoking. Two measures of exposure to antitobacco marketing (perceived pervasiveness of antitobacco marketing and recognition of spe cific antitobacco ads) were highest among established smokers and lowest among susceptible nonsmokers. The same pattern was evident for perceived pervasiveness of protobacco marketing. Results suggest that exposure to tobacco - related market ing is a multidimensional construct, and each dimension may have a unique contribution to the process of smoking initiation. Because adolescents are exposed to numerous pro - and antitobacco messages, it is important to develop antitobacco media campaigns that can successfully counter protobacco marketing efforts. Potential strategies include targeting the susceptible nonsmokers who are at high risk for smoking and developing messages to decrease receptivity.     

The Association Between Smoking and Unhealthy Behaviors Among a National Sample of Mexican-American Adolescents

ABSTRACT: This study examined the relationship between smoking and participation in unhealthy behaviors among Mexican-American adolescents through a secondary analysis of national data. Mexican-American adolescents (N=580), ages 10 through 18 years who were interviewed as part of the 1993 Teenage Attitudes and Practices Survey (TAPS II), were selected for analysis. Data collected included smoking status of the adolescent and participation in certain unhealthy behaviors. Among girls in the study, smokers were more likely to not wear a seat belt, be involved in physical fighting, not be involved in organized sports, perform poorly in school, say they like to do risky things, and ride in a car with a drunk or high driver. For boys, smoking was significantly associated with liking to do risky things, fighting, not attending church, and poor academic performance. These results suggest that Mexican-American adolescents who smoke may be at higher risk for engaging in behaviors that could compromise their health and safety, and for not being involved in activities that may exert a protective influence. (J Sch Health. 1998;68(9):376–380)