Psychosocial risk factors for tobacco use among adolescents with asthma

OBJECTIVE: To determine the prevalence of smoking among adolescents with asthma and smoking's psychosocial risk factors (environmental smoking exposure, autonomy, depression). METHOD: Participants were 2,039 adolescents with asthma and 2,039 matched controls from the Add Health study. RESULTS: The prevalence of ever smoking among adolescents with asthma was 56%. Among ever smokers with asthma, the prevalence of current smoking was 48%, and the prevalence of current smokers having made a recent attempt to stop smoking was 57%. Having parents who have smoked, exposure to friends who smoke, and depression were significant psychosocial risk factors for ever smoking. Asthma and exposure to friends who smoke were significantly associated with current smoking, and attempts to stop smoking were significantly associated with asthma and depression. CONCLUSIONS: Psychosocial risk factors for smoking among adolescents with and without asthma appear similar. Research on the role of illness in tobacco control is warranted.     

Predictors of intentions to use tobacco among adolescent survivors of cancer

OBJECTIVE: To examine the relationship between knowledge of tobacco-related health risks, perceptions of vulnerability to these health risks, and future intentions to use tobacco in a sample of adolescent survivors of cancer. METHODS: Written self-report questionnaires were administered to 46 survivors, 10-18 years of age (61% males, 93.5% Caucasian). RESULTS: Overall, survivors were generally knowledgeable about tobacco-related health risks, perceived themselves to be vulnerable to these health risks, and reported low future intentions to use tobacco. Regression analyses indicated that demographic factors, treatment-related variables, knowledge, and perceived vulnerability explained 28% of the variance in intentions scores, F:(6, 39) = 2.52, p <.05. Age and knowledge were significant predictors, indicating that older adolescent survivors and those with lower knowledge scores reported greater intentions to use tobacco. CONCLUSIONS: Young survivors will benefit from risk counseling interventions that educate them about their susceptibility to specific tobacco-related health risks secondary to their cancer treatment. Intensive tobacco prevention programs that target older adolescents should be developed.     

Predicting perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pediatric cancer survivors

OBJECTIVE: To examine predictors of perceived vulnerability to tobacco-related health risks and future intentions to use tobacco among pre-adolescents and adolescents previously treated for cancer. METHODS: Written self-report measures of tobacco knowledge, perceived vulnerability, perceived positive value of tobacco use, past and present tobacco use, and intentions to use tobacco were completed by 103 cancer survivors, 10-18 years of age (51.5% males, 78.6% Caucasians). Patient reports of peer and parent tobacco use were also obtained. RESULTS: Perceived vulnerability was influenced by demographic variables, knowledge, and gender-related past tobacco use. Fifty-seven percent of non-smoking survivors reported some intention to use tobacco. Survivors who perceived some positive value associated with tobacco use and who used tobacco in the past reported greater intentions for future tobacco use. CONCLUSION: Modifiable cognitive-motivational variables directly associate with smoking-related outcomes among pediatric survivors of childhood cancer. PRACTICE IMPLICATIONS: Preventive tobacco interventions with this vulnerable cohort are warranted and should inform about tobacco-related health risks and attempt to modify misperceptions of the positive value associated with tobacco use.     

Parenting style and smoking-specific parenting practices as predictors of adolescent smoking onset

OBJECTIVE: To test whether parenting style and smoking-specific parenting practices prospectively predicted adolescent smoking. METHODS: Three hundred eighty-two adolescents (age 10-17 years, initial nonsmokers, 98% non-Hispanic whites) and their parents were interviewed, with smoking also assessed 1-2 years later. RESULTS: Adolescents from disengaged families (low acceptance and low behavioral control) were most likely to initiate smoking. Adolescents' reports of parents' smoking-related discussion was related to lowered smoking risk for adolescents with nonsmoking parents, but unrelated to smoking onset for adolescents with smoking parents. Smoking-specific parenting practices did not account for the effects of general parenting styles. CONCLUSIONS: Both parenting style and smoking-specific parenting practices have unique effects on adolescent smoking, although effects were largely confined to adolescents' reports; and for smoking-specific parenting practices, effects were confined to families with nonsmoking parents. Interventions that focus only on smoking-specific parenting practices may be insufficient to deter adolescent smoking.     

Interacting effects of depression and tobacco advertising receptivity on adolescent smoking

OBJECTIVE: To evaluate the independent effects of exposure to others who smoke and receptivity to tobacco advertising on adolescent smoking practices and the moderating influence of depression on these relationships. METHODS: Participants were 1,123 high school freshmen who completed a self-report survey as part of a longitudinal investigation of the biobehavioral predictors of adolescent smoking adoption. Sixty percent of freshmen reported that they were never smokers (i.e., never tried or experimented with smoking, even a few puffs), and 40% reported being ever smokers (i.e., ever smoked at least a partial or whole cigarette). RESULTS: In logistic regression models, the adjusted likelihood of ever smoking was greater for students reporting exposure to peer smoking. Further, a significant interaction was detected between receptivity to tobacco advertising and depression; specifically, adolescents with a high receptivity to tobacco advertising and clinically significant depressive symptoms were more likely to smoke than adolescents without these symptoms. CONCLUSIONS: Our data support the hypothesis that adolescents with both high advertising receptivity and depressed moods are most vulnerable to experiment with smoking. Tailoring prevention and intervention efforts to encompass tobacco advertising's effects and the role of depression could lead to a reduction in youth smoking.     

Brief report: social risk factors predict cigarette smoking progression among adolescents with asthma

OBJECTIVE: To compare smoking progression in adolescents with and without asthma and to compare their psychosocial risk factors. METHODS: Participants were 1,507 adolescents with asthma and 1,507 healthy matched controls from Waves I and II of the Add Health Project assessed at baseline and again 1 to 2 years later at follow-up. Three levels of smoking progression (defined as smoking more frequently and/or intensely over time) were identified: (a) Late Experimenters (never smokers at baseline, ever smokers at follow-up), (b) Early Experimenters (ever smokers at baseline, current/current frequent smokers at follow-up), and (c) Early Smokers (current smokers at baseline, current frequent smokers at follow-up). RESULTS: Twenty percent of adolescents experienced progression in their smoking behavior; those with and without asthma were equally likely to progress. Among adolescents who progressed, 37% were Late Experimenters, 42% were Early Experimenters, and 21% were Early Smokers. Exposure to friends who smoked was a consistent and powerful social risk factor for smoking progression among adolescents with asthma-more so than among adolescents without asthma. This effect was intensified among Late Experimenters by the presence of a positive history of parent smoking. CONCLUSIONS: Findings underscore the importance of addressing cigarette smoking behavior and its social risk factors among adolescents with asthma in both clinical and public health contexts, during early adolescence, and through research on this topic.     

Smoking and cancer: a review of public health and clinical implications

The cultivation of tobacco dates backwards to 6000 BC. Use of tobacco for spiritual, euphoric, and medicinal purposes, and its ultimate spread to the 4 corners of the globe, lay at the heart of the current pandemic of tobacco-related disease, including lung, head and neck, and many other forms of cancer. While evidence for the carcinogenic properties of tobacco was documented as early as the 1800s, it was not until the 20th century that the role of tobacco use and smoke exposure in the growing pandemic of lung and other cancers was fully appreciated. The evidence is now indisputable, and current research and intervention activities center on mechanisms by which tobacco use and smoke cause cancer, ways of stemming the worldwide pandemic of tobacco-related disease, and how to help people with cancer quit smoking. With respect to the latter, approaches to smoking cessation that are effective for the general population of smokers are equally applicable to cancer patients, thrusting physicians and other health professionals to the forefront of the antismoking arena. However, the scale of the tobacco pandemic has grown so large that it literally will take a village, complete with heads of nations, world-governing bodies, local leaders, physicians, and many others, to pass and enforce legislation and policies necessary to stem the worldwide tobacco pandemic and to implement cessation programs for smokers and users of other forms of tobacco across the globe.     

Individual differences in salivary cortisol and alpha-amylase in mothers and their infants: relation to tobacco smoke exposure

Tobacco smoke exposure affects the activity of both the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Statistics reveal 41 million children in the U.S. are regularly exposed to tobacco smoke, but we know little about the effects of environmental tobacco smoke exposure on HPA and SNS activity in early childhood. This study assayed cotinine (a metabolite of nicotine), cortisol, and alpha-amylase (sAA) in the saliva of mother-infant dyads from 197 low income and ethnically diverse families. The dyads were identified as tobacco smoke exposed (N = 82) or nonexposed (N = 115) based on maternal self-reports of smoking and salivary cotinine levels greater or less than 10 ng/ml. As expected, higher rates of maternal smoking behavior were associated with higher levels of cotinine in mothers' and their infants' saliva. On average, smoking mothers' salivary cotinine levels were 281 times higher compared to their nonsmoking counterparts, and 23 times higher compared to their own infant's salivary cotinine levels. Infants of smoking mothers had salivary cotinine levels that were four times higher than infants with nonsmoking mothers. Mothers who smoked had higher salivary cortisol levels and lower sAA activity compared to nonsmoking mothers. There were no associations between maternal smoking behavior, infant's salivary cotinine levels, or tobacco exposure group, and cortisol or sAA measured in infant's saliva. The findings are discussed in relation to the influence of smoking tobacco on the validity of salivary biomarkers of stress.     

Increased prevalence of asthma and allied diseases among active adolescent tobacco smokers after controlling for passive smoking exposure. A cause for concern?

BACKGROUND: Whereas effects on allergic and respiratory health have been established for passive tobacco smoking, contradictory results still exist for active tobacco smoking. OBJECTIVE: Whether adolescents with asthma and allied diseases have higher rates of active smoking compared with adolescents without asthma was assessed after controlling for environmental tobacco smoking exposure. METHODS: A population-based sample of 14,578 adolescents was enrolled in an epidemiological survey on allergies in France. RESULTS: After controlling for age, sex, geographic region, familial allergy and passive smoking, current (in the past year) wheezing (12.4%), current asthma (5.6%), lifetime asthma (12.3%), current rhinoconjunctivitis (13.9%), lifetime hayfever (14.4%) and current eczema (9.3%) but not lifetime eczema (22.5%) were all significantly related to active smoking (>1 cigarette/day) (9.3%). A higher risk of current wheezing, current and lifetime asthma or current eczema was seen in smokers exposed to passive smoking compared with smokers not exposed to it using a polychotomous logistic regression model, in which the different modalities of exposure to active and passive smoking constituted the response variable. Passive smoking was significantly associated only with current diseases. Active smoking was also highly related to both severe asthma (OR=4.02; 95% confidence interval: 1.37, 11.79) and severe rhinoconjunctivitis (OR=2.95; 1.58, 5.49). The highest rate of adolescents suffering from the co-morbidity of lifetime asthma and hayfever (3.6%) was also seen in active smokers compared with passive and non-smokers (5.5% vs. 3.6% and 3.1%, respectively; P=0.001). CONCLUSIONS: Being asthmatic or allergic does not seem to act as a deterrent towards starting active smoking or continuing to smoke in adolescence. Results suggest the need for considering individual allergic status in programming health educational activities aimed at reducing smoking among adolescents.     

Lung cancer and exposure to tobacco smoke in the household

BACKGROUND. The relation between passive smoking and lung cancer is of great public health importance. Some previous studies have suggested that exposure to environmental tobacco smoke in the household can cause lung cancer, but others have found no effect. Smoking by the spouse has been the most commonly used measure of this exposure. METHODS. In order to determine whether lung cancer is associated with exposure to tobacco smoke within the household, we conducted a population-based case--control study of 191 patients with histologically confirmed primary lung cancer who had never smoked and an equal number of persons without lung cancer who had never smoked. Lifetime residential histories including information on exposure to environmental tobacco smoke were compiled and analyzed. Exposure was measured in terms of "smoker-years," determined by multiplying the number of years in each residence by the number of smokers in the household. RESULTS. Household exposure to 25 or more smoker-years during childhood and adolescence doubled the risk of lung cancer (odds ratio, 2.07; 95 percent confidence interval, 1.16 to 3.68). Approximately 15 percent of the control subjects who had never smoked reported this level of exposure. Household exposure of less than 25 smoker-years during childhood and adolescence did not increase the risk of lung cancer. Exposure to a spouse's smoking, which constituted less than one third of total household exposure on average, was not associated with an increase in risk. CONCLUSIONS. The possibility of recall bias and other methodologic problems may influence the results of case-control studies of environmental tobacco smoke. Nonetheless, our findings regarding exposure during early life suggest that approximately 17 percent of lung cancers among nonsmokers can be attributed to high levels of exposure to cigarette smoke during childhood and adolescence.     

Team sport participation and smoking: analysis with general growth mixture modeling

OBJECTIVE: To assess the likelihood of smoking among adolescents with different patterns of team sport participation, grades 9-11. METHODS: Adolescents (N = 1098) participating in a longitudinal study of the biobehavioral predictors of smoking adoption completed items assessing various health-related behaviors, including team sport participation and smoking practices. General growth mixture modeling (GGMM) was used to analyze the data. RESULTS: Four patterns of team sport participation were found. Adolescents with decreasing or erratic participation were nearly three times more likely than adolescents with high participation to be current smokers in eleventh grade. Nonwhites were at particular risk for decreasing and erratic patterns of participation, and later smoking. Females were at high risk for low team participation. CONCLUSION: Results suggest that multiple patterns of team sport participation can be identified with GGMM and that these patterns may be useful in characterizing individuals at particular risk for future smoking.     

Psychosocial Obstacles to Smoking Cessation Attempts Among Young Adult Sexual Minority Women Who Smoke

Sexual minority women (SMW; i.e., women who identify their sexuality as lesbian, bisexual, or something other than heterosexual) report greater smoking behaviors than their heterosexual counterparts across all ages. We conducted a multivariable regression to examine the correlates of prior smoking cessation attempts and smoking cessation intentions in a sample of young SMW who smoke (N = 338; aged 18–24 years). Covariates included sociodemographic characteristics (i.e., race/ethnicity, sexual identity, age, urbanity), general (i.e., perceived stress), and sexuality-specific (i.e., internalized homophobia) stressors, as well as smoking attitudes and subjective norms. Bisexual women (OR = 1.92, 95% CI: 1.11, 3.31) were more likely than lesbian counterparts to report a prior smoking cessation attempt. Prior cessation attempts were associated with less internalized homophobia (OR = 0.44, 95% CI: 0.27, 0.69) and positive attitudes toward smoking (OR = 2.17, 95% CI: 1.27, 3.70). Smoking cessation intentions in the next month were negatively associated with being a daily smoker (β = –0.14) and attitudes toward smoking (β = –0.19). Based on these findings, we underscore the need to address the risk correlates associated with SMW's quit attempts and include these in cessation interventions.     

Inequalities in smoking: Influence of social chain of risks from adolescence to young adulthood: A prospective population-based cohort study

Background: The pathway between socioeconomic disadvantages and smoking is a process that requires an understanding of life-course influence. Purpose: This study investigated pathways of social risks at different life stages that are linked to adolescent smoking and maintenance of smoking through to young adulthood. Method: A cohort consisting of all pupils (n = 1083) from one Swedish city were followed from age 16 to age 30 (1981 & #x2013;1995), with a 96.4% response rate. Result: Odds ratios of being a smoker at age 30 among low educated were 2.54 for men and 2.53 for women. Using structural equation model analysis for men and women, a strong chain of risks was found from age 16 linking to smoking at age 30: adolescents with adverse socioeconomic status (SES) were more likely from a divorced family. Being from a divorced family and having poor contact with their parents influenced their smoking directly and through peers. Adolescents with adverse SES were also likely to be unpopular in school, which affected their smoking behavior directly and through peers. These socially disadvantaged participants, who were smokers at age 16, continued smoking until age 30 years. The risk pathways were similar for both men and women. Conclusions: Adult smoking reflects the cumulative influence of multiple socioeconomic and psychosocial chains of risks experienced during upbringing. The programs that are addressed to reduce smoking among socially disadvantaged adolescents would have an impact in reducing smoking inequalities in adults. This study was financed by the Swedish Council for Working Life and Social Research and the National Institute of Public Health, Sweden. The authors would like to thank Hans Stenlund, University Lecturer in Statistics, for assistance with the data analysis.     

Black Light Smokers: How Nicotine Intake and Carcinogen Exposure Differ Across Various Biobehavioral Factors

ObjectiveThe study objective was to identify biobehavioral variables associated with greater intake of nicotine and a tobacco carcinogen among Black light smokers who smoke 1 to 10 cigarettes per day (CPD).MethodsWe analyzed baseline data collected from 426 Black light smokers enrolled in Kick It at Swope III (KIS III), a smoking cessation trial for Black smokers. We examined differences in concentrations of tobacco biomarkers, including urinary total nicotine equivalents (TNE) and total 4-(methylnitrosamino)-1-(3)pyridyl-1-butanonol (NNAL; a human carcinogen), across gender, age, plasma nicotine metabolite ratio (NMR), CPD, and measures of tobacco dependence, including time to first cigarette (TFC), using ANOVA.ResultsTobacco biomarker levels were significantly higher among those who smoked more CPD (6–10 vs 1–5 CPD) and those with greater reported physical dependence on tobacco. Concurrently, those who smoked 1–5 CPD smoked each cigarette more intensely than those who smoked 6–10 CPD. While we found no gender differences overall, among those who smoked 1–5 CPD, women had higher NNAL levels compared to men. The rate of nicotine metabolism, measured by the nicotine metabolite ratio, was not significantly related to TNE or NNAL levels.ConclusionAmong Black Light smokers, higher cigarette consumption and greater physical dependence—but not rate of nicotine metabolism, menthol use, or socioeconomic status—were associated with greater toxicant exposure and thus a likely increased risk of tobacco-related diseases. The lack of data on light smokers, and specifically on Blacks, make this observation important given the disproportionate burden of lung cancer in this population.     

Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents

BACKGROUND: Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization. METHODS: A cross-sectional study of present and former smoking habits in relation to atopic disorders from data on 6909 young and middle-aged adults (16-49 years) and their 4472 children (3-15 years) from the Swedish Survey of Living Conditions in 1996-97. RESULTS: The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose-response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. This pattern was little changed when potential confounders (sex, age, education, domicile, country of birth) were entered into a multivariate analysis: the adjusted odds ratio (OR) for allergic rhino-conjunctivitis was 0.5 (0.4-0.7) for those who smoked at least 20 cigarettes a day and OR 0.7 (0.6-0.9) for those smoking 10-19 cigarettes, compared with those who reported that they never had smoked Former smokers had a tendency for a slightly lower risk: OR 0.9 (0.8-1.0). In a multivariate analysis, children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7). Children of fathers who had smoked at least 15 cigarettes a day had a similar tendency (ORs 0.7-0.9). CONCLUSIONS: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.     

Smoking practices and risk awareness in parents regarding passive smoke exposure of their preschool children: a cross-sectional study in Tehran

Background: Young children living with parents who smoke are exposed to unacceptable health hazards. Aim: To determine patterns of parental smoking, the level of parental awareness about hazards of secondhand smoke, and the effect of risk awareness on smoking behavior. Setting: Health centers affiliated with two teaching hospitals in Tehran. Design: Cross-sectional. Materials and Methods: Data was collected from parents of preschool children visiting the health centers, through face-to-face interview, during a period of 18 months. Statistical Analysis: Data was analyzed by multiple logistic regression, and analysis of variance was done for comparison of means. Results: In a total of 647 families, prevalence of parental smoking was 35.7%, (231 families). In 97.8% of smoking families, only the fathers smoked; and in 5 (2.2%) families, both parents were regular smokers. Prevalence of smoking was higher in poor families as compared with families who were well-off (39% vs. 25%; P = 0.025), and also in families with lower educational level. There was no significant difference in risk awareness between smokers and nonsmokers (P > .05). Conclusion: Low socioeconomic status and low education were identified as risk factors for children's exposure to secondhand smoke; parental risk awareness had no apparent effect on the smoking behavior. Unlike western societies, fathers were the sole habitual smokers in most families. Since factors that influence smoking behavior vary in different cultures, interventional strategies that aim to protect children from the hazards of tobacco smoke need to target diverse issues in different ethnic backgrounds.     

Cigarette smoking and invasive pneumococcal disease. Active Bacterial Core Surveillance Team

BACKGROUND: Approximately half of otherwise healthy adults with invasive pneumococcal disease are cigarette smokers. We conducted a population-based case-control study to assess the importance of cigarette smoking and other factors as risk factors for pneumococcal infections. METHODS: We identified immunocompetent patients who were 18 to 64 years old and who had invasive pneumococcal disease (as defined by the isolation of Streptococcus pneumoniae from a normally sterile site) by active surveillance of laboratories in metropolitan Atlanta, Baltimore, and Toronto. Telephone interviews were conducted with 228 patients and 301 control subjects who were reached by random-digit dialing. RESULTS: Fifty-eight percent of the patients and 24 percent of the control subjects were current smokers. Invasive pneumococcal disease was associated with cigarette smoking (odds ratio, 4.1; 95 percent confidence interval, 2.4 to 7.3) and with passive smoking among nonsmokers (odds ratio, 2.5; 95 percent confidence interval, 1.2 to 5.1) after adjustment by logistic-regression analysis for age, study site, and independent risk factors such as male sex, black race, chronic illness, low level of education, and living with young children who were in day care. There were dose-response relations for the current number of cigarettes smoked per day, pack-years of smoking, and time since quitting. The adjusted population attributable risk was 51 percent for cigarette smoking, 17 percent for passive smoking, and 14 percent for chronic illness. CONCLUSIONS: Cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease among immunocompetent, nonelderly adults. Because of the high prevalence of smoking and the large population attributable risk, programs to reduce both smoking and exposure to environmental tobacco smoke have the potential to reduce the incidence of pneumococcal disease.     

Cultural diversity in the predictors of adolescent cigarette smoking: The relative influence of peers

A culturally diverse sample of 4375 adolescents completed a self-report inventory assessing their current amount of smoking, and several psychosocial predictors of smoking (e.g., depression, anger, stress, smoking among peers, etc). Results revealed that Whites smoke more than Blacks, Asians, and less acculturated Latinos but not more than highly acculturated Latinos. Stepwise regression analyses of the predictors of smoking found significant ethnic and acculturation differences in the relative predictive power of 18 well-known risk factors. Smoking among peers was the best predictor of smoking for White adolescents (accounting for 23.5% of the variance) but accounted for only 15% of the variance for Latino youth, 9.6% of the variance for Asian youth, and none of the variance for Black youth. Results are discussed in terms of their implications for smoking prevention programs that focus on resisting peer influences.This research was supported by NIDA Grant R01DA6307 to Brian Flay.     

Effect of pre‐ and postnatal tobacco smoke exposure on specific sensitization to food and inhalant allergens during the first 3 years of life

BACKGROUND: The study aimed to assess the effect of pre- and postnatal tobacco smoke exposure on specific sensitization to food allergens and inhalant allergens during the first 3 years of life. METHODS: A total of 342 children of a prospective and observational birth cohort study on atopy (MAS) were included on the basis of a complete follow-up of specific IgE measurements at the ages of 1, 2, and 3 years with available questionnaire information about the parental smoking habit at birth, 18 months, and 3 years of age. Study children were grouped into four exposure categories representing in utero and postnatal environmental tobacco smoke (ETS) exposure, and according to the number of cigarettes smoked by the parents. The effect on the development of allergic sensitization to food, outdoor, and indoor allergens by 3 years of age was determined by multiple logistic regression analyses. RESULTS: At the age of 3, children who were pre- and postnatally exposed to tobacco smoke had a significantly higher risk of sensitization to food allergens (odds ratio: 2.3, 95% C.I.: 1.1-4.6) than unexposed children. Children who were only postnatally exposed by a smoking mother also had a 2.2 times higher risk (95% C.I.: 0.9-5.9) of sensitization than unexposed children. These two categories (pre- and/or postnatal exposure) contribute to the significant overall effect of the tobacco smoke exposure (P< or =0.02). No significant association between tobacco smoke exposure and specific sensitization to inhalant allergens was observed. The determining risk factors for this type of sensitization were atopic family history and mite- and cat-allergen exposure levels. CONCLUSIONS: During the first 3 years of life, both prenatal and postnatal tobacco smoke exposure has an adjuvant effect on allergic sensitization which seems to be restricted to allergens to which children are mainly exposed, in combination with the peak of the ETS exposure around the first birthday.     

Parental Smoking and Adolescent Smoking Stages: The Role of Parents’ Current and Former Smoking, and Family Structure

This study examined the role of parents’ current and former smoking in predicting adolescent smoking acquisition stages. Participants were 7,426 students from 33 schools in the Netherlands. Participants’ survey data were gathered at baseline and at two-year follow-up. Logistic regression models showed that parental smoking status was not only predictive of transitions from never smoking to trying smoking, monthly smoking, or daily smoking, but also of the progression from trying smoking to daily smoking. Further, although parental former smoking was weaker associated with progressive adolescent smoking transitions than current parental smoking, however absence of parental smoking history was most preventive. Compared to the situation in which both parents had never smoked, cessation of parental smoking after the child was born was associated with an increased risk for children to smoke. Adolescents living in a single-parent family were at greater risk of smoking than adolescents living in an intact family with both mother and father. In sum, the role of parental smoking is not restricted to smoking onset and is present throughout different phases of the acquisition process. Results support the delayed modeling hypothesis that parental smoking affects the likelihood for children to smoke even when parents quit many years before. Children living in single-parent families are only exposed to the behaviour of one parent; in two-parent families the behaviour from one parent may magnify or buffer the behaviour of the other parent.