Social influences, and attitudes and beliefs associated with smoking among border Latino youth

BACKGROUND: Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border. METHODS: A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior. RESULTS: The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups. CONCLUSIONS: These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.     

Meanings of smoking among adolescents in Chiang Mai, Thailand

The Meanings of Smoking Index-2 (MSI-2) was administered to 2516 Thai adolescents in an urban, suburban, rural, and vocational high school. Factor analysis identified six meanings of smoking factor domains: coping, social image, stimulation, weight, independence, and difficulty refusing smoking. Logistic regression analyses determined that the strongest positive association with smoking behavior and ever smoking was the coping domain, and coping was also positively associated with susceptibility to smoking. The individual meaning item which most differentiated current smokers from nonsmokers was "keeps from being bored" and the dimension of stimulation (gives more energy, helps to concentrate, helps to study, gives something to do) was positively associated with current smoking. Findings suggest that meanings of smoking is important because it can provide guidance to health educators and other health professionals in tailoring smoking prevention and cessation interventions by identifying and targeting meanings that are salient within specific adolescent populations.     

A randomized intervention of smoking for adolescents in urban Wuhan, China

BACKGROUND: Tobacco use is a significant public health problem in China. Culturally specific smoking prevention programs are needed for Chinese adolescents. This study evaluated a school-based smoking prevention curriculum with a social normative approach developed in the United States for adolescents in urban Wuhan, China. METHODS: As a randomized trial, the intervention was implemented in 1998 with 7th grade students in seven schools with seven matched control schools. Multilevel logistic regression models were used to compare ever and recent (past-month) smoking behaviors for the control and program conditions. RESULTS: At the 1-year follow-up, smoking had increased more rapidly in the control schools than in the program schools. The odds of baseline nonsmokers initiating smoking did not differ between the program and control groups (OR=1.08 with 95% CI=0.71, 1.64). The program prevented progression to recent smoking among boys who were baseline ever smokers. Among boys who were recent smokers at baseline, the prevention program significantly reduced risk of remaining recent smokers at follow-up (OR=0.45 with 95% CI=0.23, 0.88). CONCLUSIONS: This social normative smoking prevention curriculum did not demonstrate a significant primary prevention effect but showed potential for secondary prevention. Culturally specific smoking prevention programs are needed for Chinese adolescents.     

Electronic Cigarette Use Among Korean Adolescents: A Cross-Sectional Study of Market Penetration,Dual Use,and Relationship to Quit Attempts and Former Smoking

PurposeAs elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes.MethodsData from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13–18 years were analyzed with logistic regression.ResultsA total of 9.4% (8.0% ever–dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever–e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39–1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09–.12).ConclusionsSome Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.     

Adolescent smoking in Wuhan, China: baseline data from the Wuhan Smoking Prevention Trial

BACKGROUND: This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China. METHODS: Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke). RESULTS: Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05). CONCLUSIONS: Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.     

High school seniors' smoking initiation and progression 1 year after graduation

We explored cigarette smoking prevalence rates in former high school seniors 1 year after graduation and found that among 12th grade never smokers, 25% initiated smoking, and among 12th grade ever smokers, 39% increased their cigarette use. Alcohol use in 12th grade, along with not attending college, were both positively related to smoking progression. Risk for smoking initiation does not end at adolescence, and the public health community must continue tobacco control initiatives throughout adolescence and young adulthood.     

Are private school students more likely to smoke than public school students in China?

BACKGROUND: Tobacco use is prevalent among adolescents in China in general, however, little is known about tobacco use among students in private schools with an enrollment of 1.5 million. METHOD: In 2001, cross-sectional survey data from 2725 students in grades seven and eight (1307 sampled from private schools and 1418 sampled from public schools) were included. Smoking measures (risk of susceptibility to smoking, smoking onset, ever smoking, smoking in the past 7 days and past 30 days, established smoking) were compared between private and public school students using chi-square test, logistic regression, and survival analysis. RESULTS: Cigarette smoking was more prevalent among private school students than among public school students (private vs. public: 21.9% vs. 12.3% for susceptibility to smoking, 53.9% vs. 38.2% for ever smoking, 22% vs. 12.0% for 30-day smoking, 15.9% vs. 4.0% for 7-day smoking, 4.5% vs. 1.2% for established smoking). Students in private schools are 3.4 to 3.8 times more likely to smoke than students in public schools after the adjustment of important covariates (gender, grade, peer smoking, parental smoking, and parents' occupation). Risk of smoking onset by age was also greater for private school students than for public school students. CONCLUSIONS: Being in private schools was associated with three to four times increases in the likelihood of current cigarette smoking and heightened risk of smoking onset by age. Findings from this study suggest the urgent need to collect additional data on risk and protective factors as well as the willingness to participate in effective tobacco use intervention prevention among private school students.     

Family characteristics and smoking among urban and rural adolescents living in China

BACKGROUND: Adolescent smoking is a public health concern in China. Although the family is an important social influence in China, few associations among family characteristics and adolescent smoking have been examined using Chinese samples. METHODS: Survey data on psychosocial variables and smoking were collected from a sample of 3629 7th grade adolescents (46% female; 54% male; mean age 12.7 years) in Wuhan, China. For adolescents, past 30-day smoking, family relationships, parents' negative sanctioning of smoking, parents' agreement with smoking, and parents' smoking behaviors are assessed. To account for the clustered data structure, hierarchical logistic regression analyses controlling for demographics (urbanization, age) examined the independent and multivariate effects of family characteristics for each gender. RESULTS: Girls are less likely than boys to report smoking and are more likely to report positive family relationships, and having parents with negative attitudes toward them smoking. Positive family relationships and age were strongly associated with smoking for both genders. No significant differences exist by gender. CONCLUSION: These findings suggest that the quality of family relationships are important for adolescent female and male smoking in China.     

Relationship Between Self-Esteem and Smoking Behavior Among Japanese Early Adolescents: Initial Results from a Three-Year Study

Researchers examined the relationship between self-esteem and smoking behavior among Japanese elementary and junior high school students. Students (2,090) in fourth to ninth grade from three elementary schools and two junior high schools in the Hyogo and Niigata prefectures completed an anonymous questionnaire. Self-esteem was measured using the Harter Perceived Competence Scale, the Pope Self-Esteem Scale, and the Rosenberg Self-Esteem Scale. Results indicated that never smokers had higher cognitive, family, and global self-esteem, but lower physical self-esteem than ever smokers. Grade and gender were significantly associated with self-esteem, showing a decrease of self-esteem with increases in grade and a higher level of self-esteem among boys than girls. The results suggest that effective smoking prevention programs for Japanese early adolescents should be integrated into more comprehensive health education or health promotion programs including self-esteem enhancement training.     

Attitudes of adolescents toward smoking cessation.

We surveyed 375 10th grade students on present behaviors regarding cigarette use and on attitudes concerning smoking cessation. Fourteen percent of students were daily smokers and 7% were occasional smokers. Of the daily smokers, 28% said their most important reason for continued smoking was because they were addicted, and 52% reported two or more prior cessation attempts. When asked the most important reasons for wanting to quit, 70% of occasional smokers and 43% of daily smokers listed health as the most important concern. Only daily smokers (22%) wanted to quit because they thought they were addicted. We conclude that daily smokers among adolescents have many characteristics of adult smokers and that intervention efforts among adolescent smokers may need to be tailored differently for such "adult pattern" smokers as compared to occasional smokers, particularly in regard to addressing the question of smoking as an addictive behavior.     

Weight concerns, postexperimental smoking, and perceived difficulty in quitting in Argentinean adolescents

PURPOSE: To assess the relationship among weight concerns, smoking, and perceived difficulty in quitting among Argentinean adolescents. METHODS: Logistic regression and profile analyses, stratified by sex, were used to estimate the associations among 8th and 11th grade students (n=2524). RESULTS: Weight concerns were associated with current smoking status and also with perceived quitting difficulty among female, but not male, Argentinean high school students. Profile analyses determined parallel profiles of weight concerns between female smokers and nonsmokers and between male smokers and nonsmokers. CONCLUSIONS: The presence of weight concerns among adolescent females may require special consideration in smoking prevention and cessation programs.     

Concurrent use of tobacco products by California adolescents

BACKGROUND: To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age. METHODS: Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use. RESULTS: Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use. CONCLUSIONS: Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.     

Exposure to smoking in popular contemporary movies and youth smoking in Germany

BACKGROUND: Studies have linked exposure to movie smoking and smoking initiation among adolescents in the United States, but there has been only one published study of adolescents outside the U.S. METHOD: A cross-sectional survey of 5586 schoolchildren aged 10-17 with a mean of 12.8 (SD=1.2) years from randomly selected secondary schools in Schleswig-Holstein, Germany, was taken in October/November 2005. In August 2006, using previously validated methods, exposure to movie smoking was estimated from 398 internationally distributed films (98% produced and distributed by U.S. studios) released in Germany and examined its relationship with ever and current (30-day) smoking. RESULTS: Overall, 40.7% of the sample had tried smoking, and 12.3% were current smokers. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.17 of adolescents in Q1 had tried smoking; 0.35 in Q2; 0.47 in Q3; and 0.64 in Q4. Movie smoking exposure was significantly associated with the prevalence of current smoking: 0.03 for adolescents in Q1; 0.08 in Q2; 0.14 in Q3; and 0.25 in Q4. After controlling for sociodemographics, parent/friend/sibling smoking, school performance, personality characteristics, TV consumption, receptivity to tobacco marketing, and parenting style, the adjusted odds ratios for having tried smoking were 1.7 (95% confidence interval [CI]=1.4-2.1) for Q2, 1.8 (95% CI=1.5-2.3) for Q3, and 2.2 (95% CI=1.8-2.8) for Q4 compared with adolescents in Q1. The adjusted odds ratios for current smoking were 1.4 (95% CI=0.9-2.2) for Q2, 1.7 (95% CI=1.1-2.6) for Q3, and 2.0 (95% CI=1.3-3.1) for Q4 compared with adolescents in Q1. CONCLUSIONS: Smoking in internationally distributed movies is associated with ever and current smoking among German adolescents. This suggests the need for prospective studies of this association in countries other than the U.S. and research into the potential impact of countrywide policies that would limit exposure of young adolescents to movie smoking.     

Meanings of smoking and adolescent smoking across ethnicities.

PURPOSE: To develop insight into population-specific meanings of smoking in our highly multicultural middle schools in order to provide effective and appropriate tools for smoking prevention efforts. METHODS: We used focus group interviews to develop the Meanings of Smoking Index (MSI), a nine-item scale that uses a "mark all that apply" strategy to assess what smoking means to children who have tried smoking as well as to those who are susceptible to smoking. In 24 public and parochial middle schools in the greater Los Angeles area, 2336 7th graders (1483 Latino, 565 Asian/ Pacific Islander and 288 white, 55.2% of the sample was female) completed the MSI as part of a school-based trial of culturally-targeted smoking prevention strategies. Items were rank ordered according to salience (rate of endorsement) and relevance (strength of relationship with lifetime smoking) across the entire sample and separately for Hispanic/Latino, Asian/Asian-American and white respondents. Spearman correlation coefficient was used to compare results between ethnicities. RESULTS: The most frequently endorsed meanings were similar across ethnicities. Magnitude of associations between smoking behaviors and meanings were dissimilar across ethnicities. The meaning with the strongest relationship to lifetime smoking for whites and Latinos was "it helps me study" (OR 3.4 and 2.6 respectively), and for Asians was "don't want to make another smoke alone" (OR 5.4). CONCLUSIONS: We have shown previously that interventions on meanings of eating behaviors changed dietary behaviors in adolescents. The present findings suggest that meanings are powerful determinants of adolescent smoking in culturally diverse populations and could offer powerful intervention tools to prevent adolescent smoking.     

Trends in Tobacco Use Among High School Students in the United States, 1991-1995

ABSTRACT: This study examined demographic characteristics of tobacco-using high school students in the United States from 1991 through 1995. Data about cigarette smoking and smokeless tobacco use among adolescents were collected in 1991, 1993, and 1995 using the Youth Risk Behavior Survey, part of the Youth Risk Behavior Surveillance System implemented by the Centers for Disease Control and Prevention. Data indicated current smoking increased 26.5% from 1991 to 1995 with one-third [31.2% (± 1.7)] of ninth grade students and 38.2% (± 3.5) of 12th grade students reporting current smoking in 1995. Smokeless tobacco use remained stable with 11.4% (± 1.7) of all students and one-fourth [25.1% (± 3.0)] of White male students reporting smokeless tobacco use in 1995. Many students already have begun using tobacco before reaching high school. Thus, interventions should begin well before high school to prevent adolescents from using and becoming addicted to tobacco. (J Sch Health. 1998; 68(4): 137-140)     

Does parental smoking cessation discourage adolescent smoking?

BACKGROUND: We examined the relationship of smoking cessation in parents to smoking and uptake and cessation by their adolescent children. METHODS: We analyzed a cross-sectional sample of 4,502 adolescents, ages 15-17 years, who lived in two-parent households that were interviewed as part of the 1992-1993 Tobacco Supplement of the Current Population Survey, which questioned householders 15 years of age and older about their smoking history. Ever smokers reported smoking at least 100 cigarettes in their lifetime. Former smokers were ever smokers who had quit. RESULTS: Multivariate analyses, adjusted for demographic characteristics of adolescents, as well as father's age, education, and family income, found that adolescents whose parents had quit smoking were almost one-third less likely to be ever smokers than those with a parent who still smoked. Furthermore, adolescent ever smokers whose parents quit smoking were twice as likely to quit as those who had a parent who still smoked. Parental quitting is most effective in reducing initiation if it occurs before the child reaches 9 years of age. CONCLUSION: Encouraging parents to quit may be an effective method for reducing adolescent smoking, through decreased uptake and increased cessation. The earlier parents quit, the less likely their children will become smokers.     

The North Norwegian Youth Study: cigarette smoking among ethnically diverse adolescents

Objectives: To examine ethnic and gender differences in the prevalence of cigarette smoking among indigenous Sami, ethnocultural Kven and majority Norwegian adolescents, and ethnic-specific gender differences in smoking. Design: 'The North Norwegian Youth Study' was a longitudinal epidemiological study. It collected data at two time points at a three-year interval (1994/95 and 1997/98). It was based on student self-reports (10-12th grade) from 21 state schools in North Norway. The initial analysis included 2997 students aged 15-19 years (response rate (RR): 85%) and 1533 responders at follow-up (RR: 55%). The sample consisted of 12% Kvens, 23% Sami and 65% Norwegians. Results: Baseline (follow-up) smoking rates were; 38% (35%) never smokers, 29% (29%) current regular smokers, 11% (12%) current irregular smokers and 23% (24%) former smokers. Ethnic differences in cigarette smoking were minor and found at baseline only. Sami students reported a lower proportion of current irregular smokers (8%) and a higher rate of former smokers (26%). Gender differences were most pronounced at baseline with females more involved in cigarette smoking than their male peers. However, males were more likely to be heavy smokers at both time points. Conclusions: Cigarette smoking among adolescents and young people in North Norway was generally independent of the ethnicity of the respondents. There were no ethnic differences in smoking rates at follow-up. Sami youth were not at higher risk of cigarette smoking than their non-indigenous peers. This finding contrasts with findings among other Arctic indigenous youth.     

Who is using e-cigarettes in Canada? Nationally representative data on the prevalence of e-cigarette use among Canadians

The current study examined prevalence and correlates of electronic cigarette (e-cigarette) use in the Canadian population, using data from the nationally representative 2013 Canadian Tobacco, Alcohol and Drugs Survey (n = 14,565). Sociodemographic correlates of e-cigarette use (ever, and in the past 30 days) were examined using logistic regression models. Overall, 8.5% of Canadians aged 15 and older reported having ever tried an e-cigarette; 1.8% had used one in the past 30 days. E-cigarette use was particularly high among smokers and young people. Overall, prevalence did not differ between males and females, for ever (P = 0.24) or past 30-day use (P = 0.30). Smoking status was the strongest correlate of e-cigarette use (ever and in the past 30 days, P < 0.0001): 37.3% of current smokers had ever tried an e-cigarette (9.6% used in the past 30 days), compared to 3.0% of never-smokers (0.3% past 30-days), and 5.1% of former smokers (0.9% past 30-day). E-cigarette use also varied by age (P < 0.0001): prevalence was highest among youth aged 15–19 (19.8% ever; 2.6% past 30-day) and young adults aged 20–24 (20.1% ever; 3.9% past 30-day), and decreased with age. Among youth, the majority of e-cigarette users were never-smokers, while the majority of adult users were smokers. In Canada, e-cigarette use is particularly high among smokers and young people. Dual use with cigarettes was common, with most e-cigarette users also smoking conventional cigarettes. Continued monitoring of e-cigarette use and its relationship with smoking should be a priority, given the rapidly-evolving e-cigarette market and implementation of new policy measures.     

Cigarette smoking for weight loss or control among adolescents: gender and racial/ethnic differences.

PURPOSE: To describe gender and racial/ethnic differences in the prevalence of cigarette smoking for weight loss or control in an adolescent population-based sample, and relationships among heavy smoking, weight concerns and smoking to lose or control weight. METHODS: Anonymous questionnaires were administered to 81,247 9th and 12th grade public school students across the state of Minnesota in 1998. Variables of interest included smoking frequency, weight concerns, and smoking for weight loss or control. Logistic regression analyses were used to estimate the odds of smoking to lose or control weight by race/ethnicity and gender, and to evaluate the relationships between smoking to lose or control weight and heavy smoking, perceptions of overweight, and weight concerns by race/ethnicity and gender. RESULTS: With the exception of black females, female smokers of different racial/ethnic groups were as likely as white girls to smoke for weight loss or control. Compared to white male smokers, American Indian and Asian American male smokers were more likely to smoke for weight loss or control, and black, Hispanic, and mixed race male smokers were equally likely to smoke for weight loss or control. Heavy smokers, smokers who perceived themselves as overweight or were weight-concerned were significantly more likely to report smoking as a weight control method. CONCLUSIONS: Smoking for weight control is prevalent across many race/ethnic groups and both genders among adolescents.     

Characterization of the smoking habit among high school students in Syria

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