Outcome evaluation of a high school smoking reduction intervention based on extracurricular activities

BACKGROUND: An outcome evaluation of a high school tobacco control intervention using extracurricular activities developed by teachers and students is reported. METHODS: Eligible subjects (n = 3,028) had participated in a randomized trial of an elementary school smoking prevention curriculum. Their high schools were matched in pairs; one school in each pair was randomly assigned to the intervention condition, the second to a "usual-care" control condition. Data were collected at the end of Grades 9 and 10. RESULTS: For Grade 8 never smokers, regular smoking rates were significantly lower for males from intervention schools (9.8 vs 16.2%, P = 0.02) at the end of Grade 10. There were no significant differences among Grade 10 smoking rates for females, or for students of either gender with previous smoking experience in Grade 8. CONCLUSIONS: The extracurricular activities approach to tobacco control is practical to implement and has promise.     

Factors associated with Taiwanese junior high school personnel advising students to quit smoking

BACKGROUND: Most smokers in developing countries begin smoking before age 18, and smoking prevalence is rising among adolescents. School personnel represent a target group for tobacco‐control efforts because they interact daily with students, are role models for students, teach about tobacco‐use prevention in school curricula, and implement school tobacco‐control policies. The prevalence of teenage smoking has been examined in numerous studies, but few have focused on the influence of school personnel and the characteristics of school personnel who enforce school nonsmoking policy. The purpose of this study was to determine the factors associated with junior high school personnel advising students to quit smoking. METHODS: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self‐administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco‐related materials were more likely to advise students to quit smoking. Personnel who had received tobacco‐prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS: To reduce youth smoking prevalence, school tobacco‐control programs should support tobacco‐prevention training for school personnel.     

Can non-prosecutory enforcement of public health legislation reduce smoking amonq hiqh school students?

Background: Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents? access. Methods/Strategy: A prospective study evaluating the impact of non-prosecutory enforcement of public health legislation involving ‘beat police’ was conducted in the Northern Sydney Health region. Secondary students, aged 12 to 17 years, from both intervention and control regions were surveyed about cigarette smoking habits by means of a self-completed questionnaire administered pre- and post-intervention. Results: 12,502 anonymous questionnaires were completed. At baseline, 19.3% of male students and 21.2% of female students indicated they were current smokers. Age and sex stratified chi-squared analysis revealed significantly lower post-intervention smoking prevalence for year 8 and 10 females and year 7 males among the intervention group. Higher post-intervention smoking prevalences were demonstrated for year 7 and 9 females and year 8 males among the intervention group and in year 10 males and year 11 females among the control group. The analysis of combined baseline and follow-up data from coeducational schools with logistic regression techniques demonstrated that the intervention had a significant effect in reducing smoking prevalence among year 7 students only (OR=0.54). Conclusion: Our study demonstrates the difficulties in restricting high school students? access to cigarettes. Isolated non-prosecutory strategies are likely to only have a limited impact on reducing smoking prevalence among high school students.     

Tobacco smoking habits, beliefs, and attitudes among medical students in Tirana, Albania

BACKGROUND: Many surveys throughout the world have evaluated the smoking behaviors, beliefs, and attitudes of medical students, but no information is available from Albania. METHOD: A cross-sectional survey in classroom settings using a self-administered questionnaire was performed at the University of Tirana during October 2000. RESULTS: In the first and fifth years of medical school, 149 (68.5% women) and 185 (55% women) students, respectively, completed the questionnaire, with overall response rates of 82 and 92%. Tobacco smoking prevailed among males. The smoking rates among first-year medical students were 34% among men and 5% among women. Among fifth-year students, 55% of the men and 34% of the women smoked. The percentages of occasional smokers were 29 and 49%, respectively, among the first- and fifth-year students who smoked. Most medical students reported knowing the health hazards of tobacco. Most students in both groups believed that smoking should be restricted in hospitals. Slightly more than half of the students stated that they will regularly advise smokers against smoking in their future jobs. CONCLUSION: Tobacco smoking is common among medical students in Albania. Targeted antismoking training should be mandatory for medical students in Albania.     

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.     

Parental smoking and sociodemographic factors related to smoking among German medical students

Smoking among medical students has been found to vary strongly between European countries. Few studies have addressed factors associated with smoking among medical students within countries. In this study, we assessed the association of parental smoking and sociodemographic factors with smoking habits of medical students at the University of Ulm, Germany, Students who entered the 1st, 3rd and 5th year of medical school in fall 1992 were asked to complete a self-administered questionnaire. Questionnaires were returned by 696 (85.2%) of 817 eligible students. Overall, 23.7% of students were current smokers, and 11.9% were former smokers. Smoking habits were related to maternal smoking: Odds ratios for the association of maternal smoking with ever or current smoking of students were 2.11 (95% CI: 1.48–3.03) and 2.01 (95% CI: 1.35–3.01), respectively, after adjustment for potential confounders in multiple logistic regression. In contrast, no asso-ciation was found between paternal smoking and students' smoking status. Male students were more likely to smoke than female students, and living in a large city during secondary school was also associated with ever smoking. No association was found between students' smoking habits and educational achievement of their mothers and fathers. These results suggest a key role of maternal smoking for smoking among medical students in this society.     

Peers, schools, and adolescent cigarette smoking.

PURPOSE: To investigate the effects of popularity, best friend smoking, and cigarette smoking within the peer networks on current smoking of seventh- through 12th-grade students. These factors were examined for adolescents attending schools with varying rates of student cigarette smoking. METHODS: This study used data from the saturated school sample of National Longitudinal Study of Adolescent Health (Add Health), a nationally representative school-based sample. The sample for the present study was 2525 adolescents in Grades 7-12 who completed an in-school questionnaire and an in-home interview. Information from the in-school questionnaire was used to construct measures of school smoking prevalence and popularity. Using peer nominations from the in-home interview, best friend smoking, and peer network smoking exposure were constructed using the peers' own reports of their cigarette smoking. Multiple regression techniques were used to estimate the risk of current cigarette smoking as a function of popularity, best friend smoking, peer network smoking, and school smoking prevalence, and all first-order interactions between measures of peer and school smoking prevalence. RESULTS: Adjusting for age, gender, race/ethnicity, parent education, school, and availability of cigarettes in the home, the risk of current smoking was significantly associated with peer networks in which at least half of the members smoked [odds ratio (OR) = 1.91], one or two best friends smoked (OR = 2.00), and with increasing rates of school smoking prevalence (OR = 1.73). In addition, there was a significant interaction of popularity and school smoking prevalence such that risk of current smoking was somewhat greater among popular students in schools with high smoking prevalence than among popular students in schools with low smoking prevalence. CONCLUSION: Findings suggest that school environments are important contexts for understanding peer group influences on adolescent cigarette smoking.     

Comparison of smoking, drinking, and marijuana use between students present or absent on the day of a school-based survey

The aim of this population-based survey was to compare the prevalence of selected risk behaviors between students present or absent on the day of a school-based survey. The study population was a representative sample of all students of secondary schools in the Seychelles (Indian Ocean). Students absent on the day of the survey were traced and requested to complete the same self-administered questionnaire as did present students. Self-reported consumption of cigarettes, alcohol, and marijuana were measured. Of the sample of 1453 eligible students aged 11 to 17 years, 1321 "present students" completed the survey (90.9% participation), 11 refused to answer all questions, and 121 were not present at school. We could trace 105 of the 121 students not present at school on the survey day ("absent students"), and all of them completed the questionnaire over the next 4 weeks. The prevalence of risk behaviors was significantly higher in absent than present students for current smoking and drinking. Inclusion of data from the absent students resulted in a relative increase in the prevalence of the considered behaviors by 3% to 8% as compared to data based on present students only. In conclusion, the prevalence of risk behaviors was higher in absent than present students. Adjusting for data of absent students increased the prevalence estimates in the base population.     

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。     

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.     

江西省公共场所禁烟及人群被动吸烟状况调查

目的了解江西省公共场所吸烟状况，以及成年人和青少年吸烟和被动吸烟状况，为制定被动吸烟控烟对策提供依据。方法采用现场观察法对南昌市、景德镇市和井冈山市共44个公共场所吸烟状况进行调查，对600名成年人和800名学生进行问卷调查，问卷内容包括吸烟和被动吸烟情况、吸烟相关知识和态度、学校开展控烟健康教育状况等。结果公共场所控烟标识率为65．9％，吸烟发现率为37．1％，吸烟劝阻率为8．2％，交通工具等候室地面烟头数量较多，吸烟者较多。成年人吸烟率为32．7％，其中男性为61．8％，女性为2．4％，分别有76．0％、86．7％和64．8％的成年人在家庭、室内娱乐场所和室内工作场所中存在吸烟情况。学生尝试吸烟率为27．8％，其中男生为40．9％，女生为11．7％，分别有66．6％和20．5％在调查前7天内遭受过和每天遭受被动吸烟的危害，学校控烟健康教育活动开设率较低。结论江西省城市公共场所禁烟实施情况不理想，青少年和成年人被动吸烟情况严蕈。     

Factors associated with smoking among children and adolescents in Connecticut

Introduction: The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4–6), middle school (grades 7–8), and high school (grades 9–12) students in Connecticut.Methods: We have used data from 8 years (1988–1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test.Results: Fifteen percent (n = 4,884) of the total population (n = 31,861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4–6.Conclusions: Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.     

Initiation of cigarette smoking and subsequent smoking behavior among U.S. high school students

BACKGROUND: Most adult smokers report trying their first cigarette before age 18 years. Understanding the impact of smoking initiation at young ages may help public health policy makers and practitioners improve strategies to prevent or delay adolescent cigarette smoking. METHODS: This paper examined age of initiation of cigarette smoking and subsequent patterns of smoking among U.S. high school students 16 years of age and older (N = 13,858). We used data from the 1991-1997 national Youth Risk Behavior Surveys, conducted by the Centers for Disease Control and Prevention. RESULTS: The majority of students 16 years of age and older (60.4%) reported ever having smoked a whole cigarette, and 11.1% initiated smoking at age 10 years or younger. Age of smoking initiation was significantly related to current frequent smoking, daily smoking, and whether students had ever smoked daily. A younger age of smoking initiation was associated with smoking more cigarettes per day than was initiating at an older age. CONCLUSIONS: Delaying the onset of smoking may affect the likelihood of becoming addicted to nicotine and smoking heavily. For students who are already addicted to nicotine, smoking cessation programs are needed.     

Cigarette smoking in multicultural, urban high school students.

PURPOSE: To profile patterns of cigarette use among a multiethnic population of high school students, and identify important factors associated with cigarette use by ethnicity, in order to plan effective health promotion strategies. METHODS: This cross-sectional study involved the completion of a lifestyle questionnaire by 1236 Grade 9-13 students (86% response rate) from 62 randomly selected classrooms in three urban high schools in Toronto. Chi-square analysis of the association between tobacco use and other variables took account of the clustered sample using CSAMPLE in Epi Info. RESULTS: The students self-identified their ethnicity as follows: 388 Canadian, 269 European, 171 East Indian, 137 Asian, 76 West Indian, and 194 "other." Students who identified themselves as Canadians were significantly more likely to be current smokers (29%) than students reporting other ethnicities (13%). There was no apparent increase in smoking rates for immigrants after 2 or more years in Canada. Current drinking, sexual activity, and especially friends smoking was most strongly associated with current smoking for most ethnic groups, although the relative importance of these variables was not identical for all groups. CONCLUSIONS: Prevention programs may benefit from a focus on the influence of peer smoking and on the grouping together of lifestyle factors associated with smoking for students in all ethnic groups in this multicultural city.     

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.     

Mass media and school interventions for cigarette smoking prevention: effects 2 years after completion.

The long-term cigarette smoking prevention effects of mass media and school interventions were assessed. Adolescents in two communities received both mass media and school interventions; those in two matching communities received only school interventions. Surveys of 5458 students were conducted at baseline in grades 4 through 6 and 2 years after the 4-year interventions were completed, when students were in grades 10 through 12. Students exposed to the media-plus-school interventions were found to be at lower risk for weekly smoking (odds ratio = 0.62, 95% confidence interval = 0.49, 0.78) than those receiving school interventions only, indicating that the effects of the combined interventions persisted 2 years after the interventions' completion.     

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.     

2007年上海市嘉定区中学生吸烟知识态度行为调查

目的了解嘉定区中学生吸烟状况及其影响因素,以及吸烟知识知晓情况。方法采用整群抽样方法,抽取嘉定区初中、高中、职校各1所,对各校一年级学生进行不记名问卷调查。结果嘉定区学生吸烟率为11.8%,男生17.2%,女生5.3%,职校生吸烟率为18.3%,高中生为12.5%,初中生为4.8%,不同性别、学校间学生吸烟率差异均有统计学意义(P<0.01)。学生认为吸烟与被动吸烟有害的比例分别为99.4%、99.2%,知晓率较高。在对吸烟与疾病关系的认知方面,认为肺癌、慢性支气管炎、肺气肿与吸烟有关的知晓率较高,分别占95.4%、91.4%、86.2%,但认为膀胱癌、中风及高血压与吸烟有关知晓率较低,分别占35.6%、38.0%、50.0%。结论职校生和男生应作为控烟健康教育的重点人群,学校、家庭和社会应加强吸烟危害健康知识宣传。     

Related effectiveness of continued, lapsed, and delayed smoking prevention intervention in senior high school students

The relative effectiveness of continued, lapsed, and delayed smoking prevention intervention was tested with senior high school students. The original intervention was conducted during Grades 7 through 9, with significantly fewer intervention students reporting smoking than control students. The intervention was reintroduced in the 11th grade to one-half of intervention students (continued intervention), was withdrawn from the other half (lapsed intervention), and was initiated with one-half control students (delayed intervention). The 11th-grade smoking rates of these groups were compared to those of a fourth group, a continued control group. Results showed that continued control students reported significantly less smoking than continued control students and lapsed intervention students. Additionally, the delayed intervention group exhibited smoking rates lower than the lapsed intervention and continued control groups. This finding underscores the importance of continuing smoking prevention activities, as well as initiating these activities, in senior high school years.     

The feasibility of a web-based surveillance system to collect health risk behavior data from college students.

This study examined the feasibility of collecting health risk behavior data from undergraduate students using a Web-based survey. Undergraduates were randomly selected and assigned randomly to a mail survey group and a Web survey group. There were no statistically significant differences between the two groups for demographics, response rates, item completion, and item completion errors. Yet differences were found for response time and sensitive item completion. This is the first study to demonstrate the feasibility of collecting health risk behavior data from undergraduates using the Web. Undergraduates are just as likely to respond to a Web survey compared with a mail survey and more likely to answer socially threatening items using this method. Also, the Web format and protocol required less time to administer. Researchers and practitioners conducting health survey research with college students or other homogeneous populations who have access to e-mail and the Web should consider using a Web-based survey design as an altemative to a mail, self-administered survey. In such a population, a Web-based survey should not discourage participation, particularly if participants are interested in the questionnaire content.