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.     

A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: evaluating a provincial tobacco control strategy

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrollment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrollment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.     

Symptoms of nicotine dependence and other predictors of student smoking at school: implications for school smoking policy

Students who violate school smoking policies present a difficult health and disciplinary issue for school officials. Professionals know little about the characteristics of students who smoke at school. In a prospective study of 679 students in two cities in central Massachusetts, researchers examined how nicotine dependence contributes to the problem of smoking at school. After three years of follow up, smoking at school was reported by 10.3% of students. Among subjects who admitted to smoking at school, 63% reported that symptoms of nicotine dependence preceded their smoking at school. After adjusting for other variables, student smokers with symptoms of nicotine dependence were nine times more likely to report smoking in school (OR 9.1, 95% CI 2.9-28.5) than were student smokers without symptoms. Smoking at school was more common among daily smokers and those who paid for their own cigarettes. Age, gender, race, and parental smoking status were not significantly associated with students' reports of smoking at school. These data suggest nicotine dependence as an important contributor to the problem of smoking at school, but not the only reason why students violate school smoking policies. Disciplinary action against students caught violating school smoking policies should be supplemented with an offer of treatment for nicotine dependence.     

A survey of smoking behavior among students of Himeji-Dokkyo University

PURPOSE: In 2000, a survey of smoking behavior among students of Himeji-Dokkyo University was conducted in order to provide a basis for no smoking movements in the university. METHOD: Anonymous questionnaires were distributed to students and then gathered it. The analysis examined the relationships among sex and age and the smoking status (smoker, previous smoker, non smoker). RESULTS: Of the smokers, 44.0% started before the age of seventeen years. Non-smokers were more critical of smoking than smokers, with previous smokers occupying an intermediate position. No clear reasons were given for starting smoking although the behaviour of elder students was of importance. Smokers thought that it was desirable to reduce the smoking rate in Japan and that information should be available regarding effects on the body. A small proportion also were in favour of banning cigarette vending machines. CONCLUSIONS: Most answer to the question about starting his/her smoking were no positive reason. However, the effect of circumstances is important, because smoking of friends, senior students and family members had a strong influence. It was suggested that many smoking students know smoking is not good for their health, and would like to quit.     

中学生吸烟与健康的知识和态度及行为的关系

目的探讨中学生有关吸烟与健康的知识和态度及其与吸烟行为的关系。方法采用自填式结构问卷对广州市黄埔区初一至初三年级中学生进行调查。结果8656名初中生,在满分为10分的吸烟所致疾病知识和满分为4分的烟草有害成分知识平均得分为4.87和2.13分。吸烟与健康的态度平均得分,吸烟的作用为25.88分(满分30分)、吸烟的形象认同21.33分(满分25分)、吸烟的交际认同32.07分(满分40分)、控烟措施的认同32.69分(满分40分)。初中生的尝试吸烟率为16.6%(男生25.6%,女生6.3%),偶尔吸烟率为12.0%(男18.0%,女5.1%),规律吸烟率为4.7%(男7.6%,女1.1%)。在男生中,吸烟与健康的知识得分和态度得分,均为:不吸烟者>偶尔吸烟者>规律吸烟者,且差异有统计学意义。在女生中,知识得分在不同吸烟行为者间差异无统计学意义,态度得分为:不吸烟者>偶尔吸烟者>规律吸烟者,差异有统计学意义。结论本组初中生吸烟与知识的认知水平较低,态度得分较高。中学生有关吸烟与健康的知识和态度与不同吸烟行为有关联,且男女有别。     

Perceived smoking prevalence at school-level and children's smoking initiation: a multi-level analysis of a cross-sectional data in Taiwan

OBJECTIVES: Literature on the influence of smoking prevalence at school-level on the smoking initiation among elementary school children is scarce. The aim of the current study was to explore this in school clusters stratified according to student's perceived smoking prevalence in the school while adjusting for social impact of individual students. METHOD: The data was obtained from a survey administered to 13 elementary schools in Taoyuan County, a final sample of 1585 3rd and 4th grade students. Multi-level logistic regression analysis (MLRA) was used to examine the influence variable at school-level as well as individual socio-environment level had on smoking status of elementary schools students. RESULTS: Attending a school where the students reported a perception of high smoking prevalence had a greater effect on smoking behavior in boys than girls when compared with students attending a lower smoking prevalence school, after adjustment for student-level characteristics. CONCLUSIONS: Our study confirmed that a broader school environment with a high student perception of smoking prevalence is associated with children's smoking behavior in boys. The findings further indicate the need for enforcement of anti-smoking policies within schools with higher smoking rates to reduce visibility of smoking among school children.     

Are the recommended taxonomies for the stages of youth smoking onset consistent with youth's perceptions of their smoking status?

BACKGROUND: To examine if the recommended taxonomies for the stages of youth smoking onset are aligned with the beliefs of smoking youth. METHODS: The SHAPES Tobacco Module was administered to 23,047 students (grades 9 to 13) in a convenience sample of 29 secondary schools during the 2000-2001 school year in the province of Ontario, Canada. Cross-tabs were used to compare a student's self-perceived smoking status to their smoking status as determined with the currently recommended stage taxonomies for smoking behaviour. RESULTS: The majority of students classified as regular smokers (52.4%) and experimental smokers (98.9%) did not actually consider themselves to be smokers. Self-reported smoking status appeared to be relatively consistent for the never smoker and established smoker categories. CONCLUSIONS: Additional research is required to develop stage taxonomies that are aligned with the self-perceptions of non-established youth smokers.     

Risk factors for cigarette smoking among high school students in Okinawa, Japan

The purpose of this study was to examine the relationships between risk factors and smoking status among high school students in Okinawa, Japan. We also examined if there is a dose-response relation between the number of risk factors and smoking status. Self-reported questionnaires including smoking status and potential risk factors were conducted using a sample of 1,029 students of a public senior high school in Okinawa. The percentage of smokers was 40.0% for males and 10.6% for females, and it was significantly higher for males than females. As a result of multivariate analysis, we identified four significant risk factors; peer smoking, attitude of peer toward subject smoking, intention to smoke at the age 20, and alcohol drinking. The number of these risk factors was linearly associated with increased percentage of smokers, and a linear trend was significant for both gender students. Additionally, magnitude of risk for smoking among females became considerably great compared with those of males as the number of risk factors increased. In conclusion, this study was the first study in Japan to indicate a significant dose-response relationship between the number of risk factors and smoking status among high school students. We also found that females with many risk factors had extremely increased vulnerability to smoking compared to male counterpart. These findings may be useful to identify high-risk students who need more intensive smoking prevention programs and to develop the content of effective interventions.     

School factors and smoking prevalence among high school students in Japan

The purpose of this study was to analyze the relationship between student smoking prevalence by school and school factors. Junior and senior high schools were selected from throughout Japan using a simple random sampling. One hundred junior high schools and 50 senior high schools were randomly selected. Of these 70 junior high schools (70%) and 33 senior high schools (66%) responded to this survey. Self-administered anonymous questionnaires were completed by all enrolled students in each school. The principal of each school completed a school questionnaire about school factors. The smoking rate of male teachers was significantly related to the student smoking rate in junior high schools. This factor was still associated with the student smoking rate after adjusting for family smoking status. Surprisingly, the smoking rates for junior high school boys in schools with a school policy against teachers smoking were higher than those of schools without one. The dropout rate and the proportion of students who went on to college were significantly related to the smoking rates among senior high school students of both sexes. The regular-smoker rate of boys in schools with health education on smoking was more likely to be low. It is important to take account of school factors in designing smoking control programs for junior and senior high schools.     

Changes in the smoking behaviour, knowledge and opinion of medical students, 1972–1981

To examine changes in medical students' smoking behaviour, knowledge and opinion over the last decade, a survey first conducted at the University of Manchester Medical School in 1972 was repeated in 1981.A postal questionnaire was sent to 1163 students, of whom 1112 (96%) replied. A substantial decline in cigarette smoking among medical students has occurred. This largely follows trends in the general population, medical education itself having made little contribution to the change. In 1972, 29% of students were cigarette smokers compared with 17% in 1981. The fall in cigarette smoking was more marked among men students rather than women, older rather than younger students, clinical rather than pre-clinical students. Cigarette consumption had also decreased as had the use of cigars and pipes among male students. The decline was already evident prior to students beginning their medical studies. A smaller expansion of smoking experience at medical school had occurred among the 1981 students, but, as in 1972, those who took up smoking or increased their consumption exceeded those who gave up or cut down. In 1981 the likelihood of taking up smoking or becoming a regular smoker at medical school was somewhat greater for women students than for men, although the numbers concerned were small. The survey reconfirmed the importance of the social environment in smoking behaviour.Modest changes had occurred in knowledge and opinion about smoking. Both the accuracy and scope of knowledge of students about the health hazards increased between 1972 and 1981, particularly among clinical students, who remained considerably better informed than their pre-clinical colleagues. As in 1972, knowledge had little impact on smoking behaviour. By 1981 nine out of ten students regarded smoking as a major risk to health, both clinical students and smokers being more likely to take this view than in 1972. Almost all students, irrespective of their smoking behaviour, found the evidence linking smoking to serious illness to some extent convincing, and by 1981 a somewhat greater proportion, 60%, found it very convincing, the tendency to do so increasing as they progressed through their course.     

Self-comparison processes, prototypes, and smoking onset among early adolescents

BACKGROUND: Research has shown that social images or prototypes of smoking peers play a role in adolescents' decisions to start smoking. To devise effective prevention measures, specific information is needed about how adolescents evaluate characteristics associated with smoker prototypes. Such evaluation is assumed to occur through self-comparison processes, that is, 'self-consistency' and 'self-enhancement' motivations. This is one of the first studies to examine longitudinal relations between both these motivational processes and smoking behavior. METHODS: Self-reported data on motivational processes and smoking were gathered at two waves (with a 1-year interval) among Dutch adolescents (12-16 years). Relations between self-comparison processes and willingness to smoke or future smoking behavior were tested among a sample of 1938 respondents. RESULTS: Smoker prototypes predicted adolescents' smoking onset, particularly those images that referred to daily smoking peers as being "cool" or "rebellious." Furthermore, self-consistency and self-enhancement motivations predicted smoking onset for certain characteristics associated with smoker prototypes. CONCLUSION: Evidence for the role of self-consistency and self-enhancement motivations in adolescents' smoking onset suggests that smoking prevention projects should target both similar and aspiring features associated with the image of smoking peers.     

Cigarette smoking among Beijing (Peking) high schoolers

Students smoking at 2 key middle schools and 6 ordinary middle schools in Beijing, China were surveyed to determine the form in which high schoolers start smoking, and how long they have smoked. The patterns and causes of smoking were analyzed. The investigation was made from March to May 1981. 430 boys and 423 girls were selected from key schools and 1396 boys and 1394 girls from ordinary schools. Ages ranged from 13-17. All subjects completed a questionnaire in the classroom. To increase the reliability of the survey, names were kept secret. The students surveyed were classified into groups according to their smoking status: current regular smokers; occasional smokers; ex-smokers; and nonsmokers. In the key schools, there were only 4 smokers among 430 students, accounting for 0.9% of the total. Of these, 1 was Senior Class 2, 2 Senior Class 1, and 1 Junior Class 3. In the ordinary schools, 10% were smokers. 19.7% of the boys and 0.4% of the girls smoked. Among the boys, the higher the class, the more numerous the smokers. The smoking rate was 8.2% in the 1st year of junior high but rose to 34% in senior class 2; the difference was statistically significant. "Special occasion" smokers were few, only 5.5% of the students. In junior class, the number of regular smokers was about 2/3 to 4/5 that of occasional smokers. And by senior class 2 the number of regular smokers had risen to about 3 times that of the occasional smokers. In every grade, there were students who had given up smoking. Most had been occasional smokers. Some high schoolers had started to smoke in primary school and had a 4-5 year history of smoking, but most had only picked up smoking for 1-2 years after announcement of the Rules for High School Students prohibiting smoking. There were 3 smoking patterns: smoking without inhaling; inhaling the smoke deeply into the lungs, then expiring through the mouth or nostrils; and combining patterns 1 and 2. Of 265 students, 128 used the 1st pattern, 121 the second, and only 16 combined both patterns. The most common cause of smoking was curiosity. Next was lack of high ideals and dedication followed by boredom. The smoking rate in students whose parents were smokers was significantly higher than in those whose parents were nonsmokers. The difference was significant among all classes except junior class 1. To reduce smoking among high school students, it is necessary to go beyond the existing rules which prohibit smoking and emphasize political and ideologic education. Students must be taught about the dangers of smoking as early as possible, preferably in primary schools.     

National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries

The paper examines the association between restrictions on teacher tobacco smoking at school and student exposure to teachers who smoke during school hours. The data are taken from a European Commission-funded study 'Control of Adolescent Smoking' (the CAS study) in seven European countries. Multilevel modelling analyses were applied to investigate associations between national legislation concerning tobacco smoking in school, local school smoking restrictions and students' exposure to teachers who smoke at school. The analyses integrate data from three levels: national (types of policy and how restrictive they are), school (survey among teachers, n = 455) and student (survey among 15-year-old students, n = 10890). The results suggest that both national- and school-level policies on restriction of smoking among teachers are associated with a decreased probability of students reporting that they are exposed to teachers who smoke indoors, but an increased probability of being exposed to teachers smoking outdoors.     

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.     

The relationship between school-based smoking policies and prevention programs on smoking behavior among grade 12 students in Prince Edward Island: a multilevel analysis

PURPOSE: To examine how school-based smoking policies and prevention programs are associated with occasional and regular smoking among a cohort of grade 12 students in Prince Edward Island, Canada, between 1999 and 2001. METHODS: Data from the Tobacco Module of the School Health Action, Planning and Evaluation System (SHAPES) collected from 3,965 grade 12 students in 10 high schools were examined using multi-level regression analysis. RESULTS: Attending a school with smoking prevention programming was associated with a decreased risk of being an occasional smoker (OR 0.42, 95% CI: 0.18, 0.97). School-based policies banning smoking on school property were associated with a small increased risk of occasional smoking (OR 1.06, 95% CI: 0.67, 1.68) among some students. The combination of both policies and programs was not associated with either occasional or regular smoking. CONCLUSION: This preliminary evidence suggests that tailored school-based prevention programming may be effective at reducing smoking uptake; however, school smoking policies and the combination of programs and policies were relatively ineffective. These findings suggest that a new approach to school-based tobacco use prevention may be required.     

The Association Among Adolescents' Tobacco Use,Their Beliefs and Attitudes,and Friends' and Parents' Opinions of Smoking

Objective: To examine adolescents' attitudes toward smoking, the presence of a false consensus effect, and the influence of peer and parental attitudes about smoking choices on being a susceptible, never smoker; an experimenter; and a current smoker. Methods: Data from The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes Among Teenagers and Young Adults (RWJF survey) were used to produce national estimates of the tobacco use behaviors and attitudes of adolescents enrolled in high school. Three logistic regression models were estimated to examine which psychosocial variables were associated with three different stages of smoking uptake. Results: Positive attitudes toward tobacco use were associated with a greater likelihood of being a susceptible, never smoker (OR = 1.50), an experimenter (OR = 1.27), and a current smoker (OR = 2.96). Those respondents who believed that 50% or more of all adolescents smoked were more likely to be current smokers (OR = 1.45). The importance of the opinions of one's friends and parents about his/her choice to smoke was also found to be associated with smoking behavior. Conclusions: Preventing the initiation and continuation of smoking among adolescents will require interventions that address individual attitudes with respect to tobacco and will also need to present a clear picture of adolescent smoking. In addition, prevention and intervention messages should emphasize the importance of parental opinions on youth tobacco use regardless of parental tobacco use behavior.     

Standardization of definitions concerning smoking behavior among Japanese adolescents--results from the Japan Adolescent Smoking Survey (JASS)]

The aim of the Japan Adolescent Smoking Survey (JASS) is to standardize the definitions of smoking behavior among Japanese adolescents together with measurement methods and questionnaires concerned. A study of 9921 school children aged 9 to 18 years in 17 elementary schools, 16 junior high schools and 18 senior high schools in 9 prefectures, was conducted between June and July of 1989, to determine the relationship between actual smoking behavior during the past month or year and the "self-referent label" concerning their smoking status. The main results were as follows: 1) The percentage of those who smoked at least one cigarette during the past month showed a high degree of similarity to the percentage of those who referred to themselves as "regular smokers" or "occasional smokers". 2) Less than 10% of students who identified themselves as "never smokers" or "ex-smokers" smoked at least one cigarette during the past month, while more than 80% of students who referred to themselves as "regular smokers" or "occasional smokers" smoked during the past month. 3) On the whole, those who smoked 20 or more cigarettes during the past month referred to themselves as "regular smokers"; those who smoked between 2 and 19 cigarettes as "occasional smokers"; those who smoked 1 cigarette as "ex-smokers"; those who did not smoke during the past month as "never smokers". 4) The definition where students who smoked one cigarette during the past month are classified as a category of smoker, displayed a high level of sensitivity and specificity for all school-level groups and for both sexes.(ABSTRACT TRUNCATED AT 250 WORDS)     

College student reactions to smoking bans in public, on campus and at home

We examined college student reactions to a statewide public smoke-free policy, campus policies and private restrictions through an online survey among 2260 students at a 2-year college and a university and 12 focus groups among smokers. Among survey participants, 34.6% smoked in the past month (35.0% daily, 65.0% non-daily). Correlates of receptivity to public policies included attending the university, not living with smokers and non-smoker status (versus daily and non-daily smoking). Correlates of receptivity to outdoor campus policies included being a university student, unmarried, without children, from homes where parents banned indoor smoking and a non-smoker. Correlates of having home restrictions included not living with smokers, no children, parents banning indoor smoking and non-smoker status. Correlates of having car restrictions included attending the university, not living with smokers, having children, parents banning indoor smoking and non-smoker status. Qualitative findings indicated support for smoke-free policies in public (albeit greater support for those in restaurants versus bars) and on campus. Participants reported concern about smokers' and bar/restaurant owners' rights, while acknowledging several benefits. Overall, 2-year college students and smokers (non-daily and daily) were less supportive of smoke-free policies.     

Influence of smoking on markers of oxidative stress and serum mineral concentrations in teenage girls in Korea

OBJECTIVE: The purpose of this study was to examine the effect of cigarette smoking on serum oxidative damage, antioxidant status, and mineral concentrations in teenage girls. METHODS: Subjects were randomly chosen from female senior high school students (15-17 y) in a rural community in Korea. Smoker (n = 19) was defined as a person who had smoked 10 or more cigarettes/d continually for at least 1 y while non-smoker (n = 19) was a person who had no previous smoking experience. All individuals in smoker group had serum cotinine concentrations greater than 110 ng/mL, and those in non-smoker group had concentrations of less than 30 ng/mL. Serum oxidative defense enzyme activities, serum antioxidant nutrient concentrations, anthropometric data, and dietary nutrient intakes were evaluated. RESULTS: Serum selenium glutathione peroxidase, glutathione reductase, and extracellular superoxide dismutase activities were lower in smokers than in non-smokers. Serum ascorbic acid and folate concentrations were lower in smokers than in non-smokers, whereas serum thiobarbituric acid-reactive substances (TBARS) were higher. Serum copper, iron, and magnesium concentrations were similar in the two groups. Serum zinc concentrations were higher in smokers. CONCLUSIONS: Teenagers with a short smoking history can have evidence of oxidative stress (high serum TBARS and low serum ascorbic acid and folate concentrations) and an impaired oxidant defense system. However, in contrast to common findings in adult smokers, blood pressure was lower in teenage smokers, and hypozincemia and hypercupremia were not observed. Alterations observed in mineral metabolism in adult smokers are probably secondary to chronic diseases associated with long-term smoking.