Determinants of smoking status: cross-sectional data on smoking initiation and cessation

BACKGROUND: Cigarette smoking is known to increase the risk of chronic disease. Improved understanding of factors that contribute to smoking initiation and cessation may help to underpin strategies that lead to smoking behavior change. METHODS: Cross-sectional data obtained from 11,967 men and women, aged 20-65 years, were used to study associations with smoking initiation and smoking cessation within the general population. Information on smoking habits, socio-demographic factors and psychosocial factors were collected through self-administered questionnaires. Multiple logistic regression analyses were undertaken by gender. RESULTS: Adverse childhood experiences and personality characteristics (including extraversion, neuroticism and hostility) were found to be related to smoking initiation. Age, marital status and tobacco-related factors were consistently associated with smoking cessation. Older people, married persons and those who smoked more cigarettes per day had a higher likelihood of quitting, both for men and women. CONCLUSIONS: Smoking initiation was found to be associated with adverse childhood events and with measures of personality whereas smoking cessation was associated predominantly with socio-demographic and tobacco use-related factors.     

Attachment to parents, parental tobacco smoking and smoking among Year 10 students in the 2005 New Zealand national survey

AIMS: To assess whether low attachment to parents is a consistent risk factor for adolescent smoking or is modified by ethnicity and parental smoking. METHODS: A national, cross-sectional multi-ethnic 2005 survey of 28,395 Year 10 students aged 14 and 15 years (18,934 Europeans, 4,769 Maori, 2,795 Asians, 1,897 Pacific Islanders). Students answered an anonymous questionnaire including measures of attachment to parents from the Inventory of Parent and Peer Attachment. RESULTS: The prevalence of adolescent smoking > or = monthly, going from the lowest to the highest quartile of parent attachment score, was 28%, 16%, 12% and 10%. The relative risk of smoking > or = monthly for students in parent attachment quartile 1, compared to quartile 4, was increased in all ethnic groups, being 4.37 (95% confidence interval 3.00, 6.38) in Asian, 3.12 (2.77, 3.51) in European, 1.97 (1.45, 2.67) in Pacific Island, and 1.36 (1.23, 1.51) in Maori students, adjusting for sex and school socioeconomic decile. The ethnic variation in relative risk was explained mostly by a variable smoking prevalence in the reference category (quartile 4) which ranged from 3% in Asian students to 29% in Maori. A similar pattern was seen when students were categorised by parental smoking, with students in the lowest parent attachment quartile having a significantly (p<0.05) raised relative risk of smoking > or = monthly compared to the highest quartile, regardless of whether their parents smoked or not. CONCLUSIONS & IMPLICATIONS: Low parent attachment score is associated with an increased risk of adolescent smoking regardless of ethnicity and parental smoking.     

Factors associated with age of smoking initiation in adult populations from different ethnic backgrounds

BACKGROUND: The age at which the individual begins smoking may influence the health of smokers at an older age. Cultural and social factors effect the age of smoking initiation. METHODS: A cross-sectional national survey of a random sample of 6,021 Israeli residents over the age of 21 were interviewed by telephone. The sample consisted of 4248 Jews, 858 Arabs and 915 immigrants, 856 of them were from the former Soviet Union. RESULTS: Compared to the Jewish population the Jews who immigrated from the former Soviet Union began smoking at an earlier age and the Arabs started smoking at an older age. The young respondents in all ethnic groups reported starting to smoke at a younger age compared to the older respondents, and there was a decrease in smoking initiation at an older age. Father smoking during childhood predicted earlier age of smoking initiation but not mother or sibling smoking, significantly among Jews and immigrants and non-significantly among Arabs. CONCLUSIONS: Age of smoking initiation is dependent on the ethnic background in which the smokers grow up, however, the influence of the father smoking seems to be similar in all population groups. It seems that a higher percentage of young adults started smoking at an early age and there is a decrease in smoking initiation at older ages in all ethnic groups.     

Gender and educational differences in smoking initiation rates in Spain from 1948 to 1992

BACKGROUND: The pattern of smoking initiation is of importance in understanding the prevalence of smoking and future trends in tobacco-related diseases. OBJECTIVE: To analyse trends of cigarette smoking initiation rates by sex and educational level in Spain. METHODS: Pooled data from the 1993, 1995 and 1997 Spanish National Health Interview Surveys were used (16,365 males and 17,478 females aged >15 years). The age and smoking status of each subject were reconstructed for five calendar periods (1948-1952, 1958-1962, 1968-1972, 1978-1982, 1988-1992). Age-specific (10 to 24 years old) smoking initiation rates were calculated for males and females, and according to level of education (high education: university and secondary school; low education: primary and less than primary). RESULTS: Among males, there was a trend towards earlier age at start of smoking and higher initiation rates between 1958 and 1982, and a subsequent decline in initiation rates, more apparent in males with a higher level of education. Smoking initiation among females was rare until the 1960s, and from the period 1968-1972 onwards a converging pattern with that of males was observed. Women with a higher level of education started smoking before women with low education, but this pattern changed over the period 1978-1982, with higher initiation rates among less educated women during the last period studied. CONCLUSIONS: These results help to characterize the tobacco epidemic in Spain, now at the end of stage 3. The observations are in agreement with diffusion-of-innovations theory and the social and economic changes from the 1960s onwards in Spain.     

New Zealand adolescents’ discouragement of smoking among their peers

Objective: This study examines the extent to which young people are acting as ‘agents of change’ in discouraging smoking among their peers. Methods: This study used data from a survey of 2,919 New Zealand secondary school students who participated in the 2014 national Youth In‐depth Survey. Relevant questions were used to assess the extent to which students engaged in behaviours to discourage or promote smoking among their peers. Results: About half of all students reported some form of behaviour discouraging others from smoking, while only one in ten reported encouraging smoking. Discouragement was associated with non‐smoking or lower levels of smoking, having more friends who smoked, and exposure to more health promotion messages about not smoking. Māori and Pacific young people also reported more discouraging behaviours. Conclusions: The results highlight the positive impact that young people can have on discouraging smoking among their peers. Implications for public health: The findings of this study point to encouraging and training young people as ‘agents of change’ to spread the smokefree message.     

Change of the smoking behavior and related lifestyle variables among physicians in Fukuoka,Japan: a longitudinal study

Two cross-sectional surveys of the entire membership of the Fukuoka Prefecture Medical Association were conducted in 1983 and 1990 using a self-administered questionnaire, and respondents were registered as the study cohort. In this investigation the trend of the actual prevalence of smoking among physicians and the relationship between their smoking cessation and living habits were studied. A decline in the actual prevalence of smoking was demonstrated among the 2,656 subjects who responded to both surveys (2,543 men and 113 women). To examine any relationship between lifestyle variables and smoking cessation after 1983, those who were smokers in 1983 (1,099 men and 7 women, total 1,106) were divided into two groups, according to whether or not they still smoked in 1990. Subjects who quit smoking accounted for a larger proportion of those physicians with any of the following life-style variables: earlier bedtimes, unawareness of mental stress, greater consumption of fresh vegetables and fruit, and less coffee consumption. Further observation of the relationship between smoking cessation and changes in lifestyle variables showed that there were more who quit smoking among those who became employed physicians, had an increase of the body mass index (BMI) and began to be aware of mental stress. These results suggested that, for physicians who smoked, it is a possibility that smoking was an important way of coping with stress, and thus pointed to the need to take mental-health measures to help physicians to stop smoking.     

Estimating the impacts of cigarette taxes on youth smoking participation,initiation, and persistence: empirical evidence from Canada

In response to the widespread availability of illegal contraband, the federal and five provincial governments in Canada implemented a 40–60% reduction to cigarette excise taxes in February 1994. We exploit this unique and discrete policy shock by estimating the effects of cigarette taxes on youth smoking with data from the 1992–1996 Waterloo Smoking Prevention Program, 1991 General Social Survey, 1994 Youth Smoking Survey, 1996–1997 and 1998–1999 National population Health Surveys, and the 1999 Canadian Tobacco Use Monitoring Survey. Empirical estimates yield daily and occasional participation elasticities from ?0.10 to ?0.14, which is consistent with findings from recent U.S.‐based research. A key contribution of this research is in the analysis of lower taxes on a panel of 591 youths from the Waterloo Smoking Prevention Program, who did not smoke in 1993, but 43% of whom confirm smoking participation following the tax reduction. Employing these data reveals elasticities from ?0.2 to ?0.5, which suggest that even significant and discrete changes in taxes might have limited impacts on the initiation and persistence of youth smoking. Copyright © 2009 John Wiley & Sons, Ltd.     

Trends in smoking habits: a longitudinal population study

BACKGROUND: In 1998, the UK government published a White Paper in which it set long-term targets for reducing smoking in the population. This longitudinal study aimed to examine whether progress has been made in achieving these in two adult general practice populations over an 8-year period. METHODS: Postal respiratory questionnaires, based on the European Community Respiratory Health Questionnaire, were sent to all patients registered with two practices in North West England on four occasions between 1993 and 2001. Two analyses were carried out. The first (smaller cohort) included only those subjects answering the question concerning current smoking on all four occasions, the second (larger cohort) those answering at least twice. RESULTS: The smaller cohort included 2403 subjects (19.6% of all respondents). Almost one-quarter reported in all four surveys that they smoked, the highest proportion being in those aged 35-44 years. The proportion of smokers decreased from 34.2% (1993) to 30.3% (2001) (P < 0.001 for trend) and the prevalence of heavy smokers fell from 15.9 to 13.3% (P < 0.001 for trend) over the same period. There were, however, no reductions in those aged <45 years in 1993. These changes were confirmed in the larger cohort which included 7274 subjects (59.3% of respondents). CONCLUSIONS: If smoking-related disease is to be reduced, it is important that adults are targeted for smoking prevention and cessation before they reach middle age. Only when such initiatives show success will smoking prevention among their children become a practical proposition.     

Maternal smoking during pregnancy predicts nicotine disorder (dependence or withdrawal) in young adults – a birth cohort study

Objective: To investigate whether maternal smoking during pregnancy predicts offspring nicotine disorder (dependence or withdrawal) at 21 years.
Method: Participants comprised a prospective birth cohort involving 7,223 singleton children whose mothers were enrolled between 1981 and 1983 at the first antenatal visit to the Mater Mothers' Hospital, Brisbane, Queensland. The present sub-cohort consisted of 2,571 youth who completed the Composite International Diagnostic Interview-computerised version (CIDI-Auto) that assesses nicotine dependence and withdrawal according to DSM-IV diagnostic criteria at the 21-year follow-up.
Results: 12.8% of offspring met criteria for nicotine dependence and 8.5% met criteria for withdrawal. 16.6% met criteria for either dependence or withdrawal. Smoking during pregnancy resulted in offspring being more likely to have dependence or withdrawal at 21 years than offspring of mothers who never smoked (age adjusted odds ratio 1.53 (95% CI: 1.19-1.96).
Conclusions: Findings emphasise the long-term adverse effects of maternal smoking during pregnancy, including nicotine dependence in young adult offspring.
Implications: Public health approaches should strengthen arguments for mothers to cease smoking during pregnancy in view of the long-term health implications for offspring, and reinforce measures to help smokers among pregnant women and women of childbearing age to stop.     

The French longitudinal study of growth and nutrition: data in adolescent males and females

Objectives To assess nutritional intake, growth parameters, physical activity and television viewing in French adolescents. Method A longitudinal study of dietary intake and anthropometric data recorded in the same children (n = 94) from 10 to 16 years of age is presented here. Results Energy intake increased from age 10–16 years in boys, whereas it decreased in girls from the age of 14. Height and weight increased in both males and females over the same period of time. Energy intake was positively associated with age at menarche. Nutritional intake, such as fat and calcium, did not meet recommendations for French adolescents. Height was higher than reference values, but the difference was not significant for girls between 14 and 16 years. Overweight (BMI > 97th percentile of the French reference) was found to be 13–14% between age 10 and 16 years. Time watching TV/computer increased with age from 1.4 to 2.2 h day^?1 from 10 to 16 years. Active children had nutritional intake closer to recommendations. Conclusion In conclusion, this study shows that during adolescence, some nutritional variations can be explained by normal individual growth processes. Low intake of calcium in girls and sedentary lifestyle are of particular concern.     

The long-term decline of adult tobacco use in Victoria: changes in smoking initiation and quitting over a quarter of a century of tobacco control

Objective: To examine changes in regular smoking prevalence among demographic and socioeconomic groups of Victorian adults from 1984 to 2008. Methods: Data were drawn from face‐to‐face and telephone surveys of randomly sampled Victorians conducted annually from 1984 to 2008. Results: Regular smoking in Victoria declined from 33.2% in 1984 to 15.5% in 2008, a relative decline of 53%. This change was largely accounted for by significant drops in ‘ever smoking’ among 18–29 year olds (from 59% to 35%, a relative decline of 41%) and by increased quitting among those aged 30 and older (from a quit proportion [% of those ever smoked who have quit] of 37% to 61% among 30–49 year olds, a relative increase of 64%; and from 53% to 79% among 50+ years, an increase of 48%). Over time, smoking prevalence became more similar between males and females. Regular smoking declined significantly across all socioeconomic status (SES) groups. Victorians living in low SES areas experienced the greatest relative increase in quit proportions of 75% (from 34% to 60%), helping to reduce the gap between low and higher SES groups in terms of smoking prevalence. Conclusions: Regular smoking in Victoria has declined substantially across all demographic groups. Victorians are taking up smoking at much lower levels than 25 years ago, while quit proportions have more than doubled. Implications: The continuation and extension of comprehensive, multi‐level approaches to tobacco control is likely to be required for the maintenance of the downward trend in smoking.     

中国控烟的过去、未来

  目的  了解湖北省成年居民吸烟与戒烟行为现状,为有效开展控烟工作提供参考依据。  方法  于2013年8月 — 2014年6月采用多阶段整群随机抽样方法在湖北省10个国家疾病监测点抽取6 000名≥18周岁成年居民进行面访调查,并应用湖北省2013年统计人口数据进行加权调整,分析不同特征成年居民的吸烟及戒烟行为。  结果  经加权调整后,湖北省成年居民吸烟率、现在吸烟率和现在每日吸烟率分别为32.7 %（95 % CI = 27.4 %～38.0 %）、27.6 %（95 % CI = 22.3 %～32.9 %）和24.7 %（95 % CI = 19.5 %～29.9 %）;湖北省不同特征成年居民比较,不同性别和年龄成年居民吸烟率、现在吸烟率和现在每日吸烟率不同,差异均有统计学意义（均P < 0.05）。经加权调整后,湖北省成年居民戒烟率、成功戒烟率和打算戒烟率分别为15.6 %（95 % CI = 12.6 %～18.7 %）、10.3 %（95 % CI = 8.4 %～12.2 %）和39.2 %（95 % CI = 32.2 %～46.3 %）;湖北省不同特征成年居民比较,不同性别和年龄成年居民戒烟率不同,不同性别、年龄和文化程度成年居民成功戒烟率不同,不同年龄和文化程度成年居民打算戒烟率不同,差异均有统计学意义（均P < 0.05）。  结论  湖北省成年居民吸烟率较高,但戒烟意识不强,应针对不同特征居民特点开展控烟工作。     

Adolescent smoking and health-related behaviours: interrelations in a Greek school-based sample

Background   Although several studies have reported findings concerning the interrelationship between smoking and specific health behaviours, little research has investigated how smoking behaviour may be associated with a cluster of health-related behaviours. The present study was an effort to extend previous research through assessing smoking status, patterns of physical and sedentary activity, as well as eating behaviours and diet quality, in order to gain some insight regarding the relationship between cigarette smoking and a cluster of health behaviours in a Greek sample of adolescents.
Methods   A sample of 2008 students (1021 male and 987 female, 12–17 years of age, 7th–12th grade) was selected from all schools of a representative Athens suburb in Greece. All children completed a questionnaire that was developed for the purposes of the study which retrieved information about age, sex, school class, individual and family smoking status, dietary habits and physical activity. Various statistical tests were performed.
Results   Age, playtime, consumption of soft drinks and foods from school canteens were positively associated with smoking status while the consumption of fruit juice, dairy products for breakfast and the frequency of breakfasts were inversely associated the aforementioned dependent variable.
Conclusions   This study supports the interrelationships between multiple lifestyle behaviours and tobacco use in adolescents. Future research is needed in order to elaborate on the nature of these relations, especially for those at higher risk.     

Effect of workplace smoking policies on smoking cessation: results of a longitudinal study

Studies of worksite smoking bans often find that they fail to increase the rate of smoking cessation. To see whether duration of exposure to restrictive policies was an important element, we surveyed workers by phone to examine the effect of being continuously employed at a smokefree worksite for 3 years. Results showed that worksite policy was unrelated to smoking cessation. However, 12% of respondents at smokefree worksites reported that smoking had taken place in their work area, and over 20% reported at least 2 hours of worksite environmental tobacco smoke (ETS) exposure during the prior week. When minimal ETS exposure is used as an indicator of an effectively enforced smoking ban, logistic regression demonstrates that continuous employment at such a worksite strongly predicts smoking cessation. Failure to demonstrate a significant impact of worksite smoking bans on cessation in this and other studies may be due to poor enforcement of smoking policies.     

Household smoking bans and adolescent antismoking attitudes and smoking initiation: findings from a longitudinal study of a Massachusetts youth cohort

Objectives. We sought to determine whether adolescents living in households in which smoking was banned were more likely to develop antismoking attitudes and less likely to progress to smoking compared with those living in households in which smoking was not banned.Methods. We completed a longitudinal 4-year, 3-wave study of a representative sample of 3834 Massachusetts youths aged 12 to 17 years at baseline; 2791 (72.8%) were reinterviewed after 2 years, and 2217 (57.8%) were reinterviewed after 4 years. We used a 3-level hierarchical linear model to analyze the effect of a household ban on antismoking attitudes and smoking behaviors.Results. The absence of a household smoking ban increased the odds that youths perceived a high prevalence of adult smoking, among both youths living with a smoker (odds ratio [OR] = 1.56; 95% confidence interval [CI] = 1.15, 2.13) and those living with nonsmokers (OR = 1.75; 95% CI = 1.29, 2.37). Among youths who lived with nonsmokers, those with no home ban were more likely to transition from nonsmoking to early experimentation (OR = 1.89; 95% CI = 1.30, 2.74) than were those with a ban.Conclusions. Home smoking bans may promote antismoking attitudes among youths and reduce progression to smoking experimentation among youths who live with nonsmokers.The proliferation of US smoke-free workplace policies and laws over the past decade has been accompanied by increased attention to private household smoking restrictions. The number of US households with comprehensive rules that make homes smoke free in all areas at all times has increased substantially.¹ The proportion of US households with smoke-free home rules increased from 43% in 1992 to 1993 to 72% in 2003.² Even smokers appear to be increasingly adopting such rules, particularly in homes in which they live with a nonsmoking adult.Although smoke-free home bans are typically implemented to reduce or eliminate environmental tobacco smoke exposure in the household, these bans may have the additional benefit of reducing the initiation of smoking among youths by changing norms about the prevalence and social acceptability of smoking. Very little is known about the specific effect of a household smoking ban on youth smoking behavior or on smoking-related attitudes and norms that may mediate an effect on smoking behavior. In particular, few studies have addressed the independent effect of bans on youths who live with smokers—those who are at the greatest risk for becoming smokers themselves.Recent studies showed that strong smoking regulations in local restaurants and bars were associated with more negative attitudes among youths toward the social acceptability of smoking in restaurants and bars.^3–6 Establishing household smoking bans conveys to youths living within these smoke-free home environments the message that smoking is unacceptable. Some supportive evidence, derived from cross-sectional data, indicates that a household smoking ban is associated with antismoking attitudes and norms. A recent cross-sectional study found that a household ban was associated with a lower perceived prevalence of adult smoking and more-negative attitudes about the social acceptability of smoking, 2 factors that affect the likelihood of smoking initiation.⁷Several cross-sectional studies have reported that a smoking ban in the household was associated with a lower likelihood of being in an earlier stage of smoking and a lower current smoking prevalence among adolescents.^8–11 Conversely, other studies found no statistically significant association between a household smoking ban and reduced adolescent smoking.^12–14 Several factors may account for these conflicting results, including varying sample sizes, age groups, and smoking measures used in these cross-sectional studies.A critical question is whether antismoking socialization occurs when parents themselves smoke. One study found that a household smoking ban was related to lower levels of smoking onset for children with nonsmoking parents but not for children with 1 or more parent who smoked.¹⁵ Another study reported that a household smoking ban was not associated with trying smoking among high school students who had 1 or more parents who were current or former smokers.¹⁶ Only 1 study reported an association between a household smoking ban and a reduced likelihood of smoking among 12th graders whose parents were smokers but not among those whose parents were nonsmokers.¹⁷ In summary, more evidence supports an association between home smoking bans and lower levels of smoking behaviors among youths who live with nonsmokers.Current research on household smoking bans has significant limitations. First, these studies rely on cross-sectional data that limit the ability to indicate causality in the relation between home smoking bans and trajectories of attitudes and smoking. Second, most studies have focused on individual-level predictors of attitudes and smoking behaviors, despite evidence that part of the explanation lies within the community context.¹⁸ Third, few studies have investigated the unique effects of a household smoking ban among adolescents living in home environments with parental smokers compared with those living with nonsmokers.In this study, our goal was to improve existing research by (1) using longitudinal data that followed up a cohort of youths and young adults who lived in parental homes over a 4-year period, with a total of 3 repeated observations for each participant; (2) using a multilevel model that simultaneously examined the effects of individual-level and town-level factors; and (3) investigating separately the effects of a household ban on youths who live with at least 1 smoker and youths who live with nonsmokers.     

Smoking after the age of 65 years: a qualitative exploration of older current and former smokers' views on smoking, stopping smoking, and smoking cessation resources and services

The aim of this study was to explore older current/former smokers' views on smoking, stopping smoking, and smoking cessation resources and services. Despite the fact that older smokers have been identified as a priority group, there is currently a dearth of age-related smoking cessation research to guide practice. The study adopted a qualitative approach and used the health belief model as a conceptual framework. Twenty current and former smokers aged>or=65 years were recruited through general practices and a forum for older adults in the West of Scotland. Data were collected using a semistructured interview schedule. The audio-taped interviews were transcribed and then analysed using content analysis procedures. Current smokers reported many positive associations with smoking, which often prevented a smoking cessation attempt. The majority were aware that smoking had damaged their health; however, some were not convinced of the association. A common view was that 'the damage was done', and therefore, there was little point in attempting to stop smoking. When suggesting a cessation attempt, while some health professionals provided good levels of support, others were reported as providing very little. Some of the participants reported that they had never been advised to stop smoking. Knowledge of local smoking cessation services was generally poor. Finally, concern was voiced regarding the perceived health risks of using nicotine replacement therapy. The main reasons why the former smokers had stopped smoking were health-related. Many had received little help and support from health professionals when attempting to stop smoking. Most of the former smokers believed that stopping smoking in later life had been beneficial to their health. In conclusion, members of the primary care team have a key role to play in encouraging older people to stop smoking. In order to function effectively, it is essential that they take account of older smokers' health beliefs and that issues, such as knowledge of smoking cessation resources, are addressed.