Cigarette Smoking by Adolescent Females

Cigarette smoking rates among teenage females have risen progressively since 1968 until surpassing teenage males in 1979. Psychosocial factors underlying the initiation of smoking include peer pressure, adult role modeling and prosmoking messages in advertising, with smoking potentially representing a desired set of personality characteristics. Regular smoking leads to the development of a dependence process, with cessation often difficult to achieve and maintain. Preventing smoking onset is a responsibility of health professionals and educators. Social psychological approaches teaching social skills and techniques for resisting smoking have been effective in reducing rates of initiation in JHS experimental programs.     

Participant- and Study-Related Characteristics Predicting Treatment Completion and Study Retention in an Adolescent Smoking Cessation Trial

Purpose

To determine which factors predict smoking cessation treatment completion and retention among adolescents.

Methods

In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14–18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention.

Results

In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention.

Conclusions

High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.     

Age at Smoking Initiation and Subsequent Smoking Among Korean Adolescent Smokers

Objectives:

The aim of this study was to investigate the relationship between age at cigarette smoking initiation and smoking level among adolescent current smokers.

Methods:

In 2007, students from one or two classes of the 10th or 11th grade were randomly selected using the probability proportional to size sampling method. In total, 743 current smokers were included. Multiple logistic regression was used to determine the association between age at smoking initiation and smoking level as either frequent, daily, or heavy smokers.

Results:

The adjusted odds ratios for each smoking level were significantly higher for younger ages of smoking initiation than those for older ages of initiation were (p for trend <0.001). Compared with the students who started smoking in grades 10 to 11, the adjusted odds ratios for frequent, daily, and heavy smokers increased from 2.24 (95% confidence interval [CI], 1.30 to 3.87) to 3.90 (95% CI, 2.02 to 7.56), from 1.56 (95% CI, 0.92 to 2.62) to 3.17 (95% CI, 1.70 to 5.92), and from 2.56 (95% CI, 1.21 to 5.42) to 5.67 (95% CI, 2.61 to 12.30) with younger ages of smoking initiation.

Conclusions:

Smoking frequency and amount were closely associated with age at smoking initiation. Therefore, smoking prevention programs should be initiated from the young adolescent period.     

Gender Differences in Psychosocial Determinants of Adolescent Smoking

Because of the social meaning smoking has acquired and because of different trends in male and female initiation rates, it is reasonable to suspect that different psychosocial factors predict smoking in teen-age boys and girls. A literature review revealed external pressures such as peer and parental smoking are important for both boys and girls though their influence may be moderated differentially by age and type of smoking behavior assessed. Some data support the hypothesis that female smoking is associated with self-confidence, social experience, and rebellion, whereas male smoking is associated with social insecurity. Overall, group differences such as gender and socioeconomic status are well-documented in terms of smoking prevalence but underexplored in the area of psychosocial predictors. In this review, gender differences have been documented with sufficient frequency to warrant further attention to develop gender specific components of smoking prevention programs.     

Peer Reviewed: Area-Level Variation in Adolescent Smoking

Introduction

The purpose of this study is to 1) examine the variability in the prevalence of adolescent smoking in 60 geographic areas of Minnesota and 2) assess how variability in area-level smoking prevalence is associated with area-level sociodemographic characteristics.

Methods

Smoking data were collected from 3,636 adolescents residing in 60 areas of the state of Minnesota. Area-level characteristics were obtained from the 2000 US Census. Coefficient of variation was calculated to assess variability in smoking prevalence across areas, and mean smoking prevalence was compared above and below the median for each area-level characteristic.

Results

Substantial variation was found in adolescent smoking prevalence rates. Across the 60 areas, the percentage of adolescents that ever smoked varied from 13% to 53%, and the percentage of adolescents that smoked in the past 30 days ranged from 3% to 19%. Mean lifetime smoking prevalence was higher in areas with a higher percentage of residents with less than a high school education, a lower percentage of residents living in an urban area, lower median housing value and a lower median household income, a higher percentage of residents aged 16 years or older who were unemployed, and a higher percentage of residents with an income-to-poverty ratio less than 1.5. Similar results were found for past 30-day smoking prevalence among girls; however, no area-level characteristics were significantly associated with past 30-day smoking prevalence among boys.

Conclusion

Results suggest that area-level characteristics may play an important role in adolescent smoking, particularly for girls.     

The Changing Role of Self-Efficacy in Adolescent Smoking Initiation

BackgroundRefusal self-efficacy is assumed to be linked to adolescent smoking. The aim of the present study was to examine the changing role of self-efficacy in adolescent smoking over time while controlling for parental, sibling, and friends' smoking.MethodsThis study used data from five annual waves of the “Family and Health” project. A total of 428 adolescents (mean age = 13.3 years; standard deviation = .48) and their parents participated at baseline. Only never smokers at baseline (n = 272) were included to measure smoking initiation. First, the effects of baseline self-efficacy, parental, sibling, and friends' smoking on adolescent smoking initiation at measurement five were examined. Second, with latent growth curves analyses, individual growth curve parameters of adolescent smoking, self-efficacy, parental, sibling, and friends' smoking were calculated. Subsequently, these growth parameters were used to predict growth of adolescent smoking.ResultsFindings showed that baseline self-efficacy, parental and friends' smoking did not predict adolescent smoking at wave five, but baseline sibling smoking did. However, growth curve parameters showed that a decrease in self-efficacy, an increase in proportion of smoking friends, and an increase in sibling smoking over time were related to an increase in adolescent smoking. Initial levels of sibling and friends' smoking moderated the link between self-efficacy and adolescent smoking over time.ConclusionA decrease in self-efficacy over time, rather than baseline self-efficacy, is associated with smoking initiation in adolescence. Findings emphasize the need for more fine-grained analyses when looking at self-efficacy or other individual characteristics that might fluctuate over time.     

A Longitudinal Analysis of Adolescent Smoking and its Correlates

ABSTRACT: When designing effective programs, it is important to identify factors associated with tobacco use at particular stages of adolescence, as well as factors associated with changes in tobacco use. This study examined cross-sectional correlates of smoking during early adolescence and during late adolescence in a longitudinal sample to compare the pattern of prediction of smoking at both stages. Changes in predictor variables related to changes in smoking also were examined. Results showed intentions to smoke was the strongest predictor of smoking during both early adolescence and during late adolescence; however, it was a much stronger predictor for the late adolescent stage. In addition, intentions to smoke was the strongest predictor of changes in smoking. However, the pattern of prediction at the two grade levels showed some differences as did predictors of changes in smoking. Implications for designing smoking prevention and cessation programs are addressed.     

Adolescent Caffeine Use,ADHD, and Cigarette Smoking

The purpose of this study was to describe the prevalence of adolescent caffeine use and its association with attention deficit hyperactivity disorder (ADHD) and cigarette smoking. A total of 448 adolescents between the ages of 13 and 21 years consecutively presenting for routine, well-child care were studied. Twenty-four percent had a pre-existing diagnosis of ADHD, and 47% reported a positive lifetime history of cigarette smoking. Eighty-five percent of participants reportedly consumed a caffeinated beverage within the past 30 days; 38% had consumed 1+ cups of caffeinated coffee, and 78% had consumed 1+ glasses of another caffeinated beverage other than coffee (e.g., tea or soft drinks). After controlling for sociodemographic and other potential confounding factors, an ADHD diagnosis and a positive lifetime smoking history were significantly associated with caffeine use: Adolescents with ADHD were nearly twice as likely to use more caffeine than were adolescents without ADHD (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.23, 3.50, p = .006); lifetime smokers were 80% more likely to use more caffeine than were adolescents who had never smoked (OR = 1.80; 95% CI = 1.16, 2.79, p = .009). Caffeine use is elevated among adolescents diagnosed with ADHD and those who have ever tried cigarette smoking. Although caffeine is a non-illicit psychostimulant, these findings add to the emerging data on substance use behaviors among adolescents with ADHD. Health care professionals who work with adolescents with ADHD should regularly screen for both cigarette and caffeine use among their patients.     

Understanding the Association Between Authoritative Parenting and Adolescent Smoking

Background: Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent–child relationship, such as parenting style. Methods: The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style—authoritative, permissive, autocratic, and unengaged—experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking. Results: Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents’ opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents’ opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents’ opinions about smoking are important. Discussion: Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.     

Recent Findings on Peer Group Influences on Adolescent Smoking

This review addresses peer group influences on adolescent smoking with a particular focus on recently published longitudinal studies that have investigated the topic. Specifically, we examine the theoretical explanations for how social influence works with respect to adolescent smoking; discuss the association between peer and adolescent smoking; consider socialization and selection processes with respect to smoking; investigate the relative influence of best friends, close friends, and crowd affiliations; and examine parenting behaviors that could buffer the effects of peer influence. Our review indicates the following with respect to adolescent smoking: (a) substantial peer group homogeneity of smoking behavior; (b) support for both socialization and selection effects, although evidence is somewhat stronger for selection; (c) an interactive influence of best friends, peer groups, and crowd affiliation; and (d) an indirect protective effect of positive parenting practices against the uptake of adolescent smoking. We conclude with implications for research and prevention programs.     

Smoking Predicting Physical Activity in an Aging America

Objectives

Tobacco smoking and physical inactivity are among leading behavioral risk factors for ill health in older adults. This study considers how smoking is associated with physical activity.

Design

Using a Life-Course model, data are analyzed regarding this relationship, controlling for, and interacted with, lifecourse and other factors. Daily smokers and sometimes smokers were hypothesized to engage in less leisuretime physical activity than those who never smoked, while those who stopped smoking were expected to do more than never smokers. Analyses were performed using SAS-Callable SUDAAN.

Setting and Participants

Secondary data from ten years of a national sample of adults aged 18 and over of the National Health Interview Survey, 2001-2010, are used (N = 264,945, missing data excluded, of 282,313 total cases).

Measurements

Daily smokers, occasional smokers, and smoking quitters are compared to never smokers with regard to requisite physical activity (150 minutes per week of moderate, 100 of vigorous, and/or 50 of strengthening activity). Lifecourse measures include birth cohorts, age, and year of survey, as well as gender, race/ethnicity, and education.

Results

Overall, hypotheses are supported regarding daily smokers and quitters; but the hypothesis is strongly rejected among sometimes smokers, who are much more likely to do requisite physical activity. Findings differ by age, sometimes smokers age 65 and over being less likely to do physical activity. Findings among all men are similar to the overall findings, while those among all women are similar to those for older respondents. Associations of smoking status with physical activity vary greatly by race/ethnicity.

Conclusions

Daily smokers may be most in need of both smoking cessation and leisure-time physical activity interventions. Smokingcessation efforts may pay greater physical activity benefits among women and the aged, while smoking-reduction efforts may provide better outcomes among men. Smoking reduction efforts may pay more exercise benefits among African-Americans and Hispanics.

     

西安市青少年尝试吸烟行为与家庭因素的关系

目的了解西安市在校青少年吸烟状况,探讨西安市青少年吸烟行为与其家庭等因素的关系,为预防和减少青少年吸烟行为的发生提供依据。方法从西安市6个区分层抽取8所中学的初二、高一和高三年级学生1028名进行自编问卷调查,分析家庭因素与青少年吸烟的关系。采取χ2检验、独立样本t检验和多因素Logistic回归模型进行分析。结果西安市青少年吸烟行为在年级和性别上差异有统计学意义;父母情感温暖与理解与青少年吸烟行为有负向关系;父母监控、父母严厉惩罚和拒绝否认与青少年尝试吸烟行为有正向关系;家庭结构、父母吸烟和其他家庭成员吸烟与青少年尝试吸烟行为有关。性别、父母吸烟、母亲拒绝否认、其他家庭成员吸烟、父亲情感温暖与理解对西安市青少年开始吸烟行为有预测作用。结论青少年尝试吸烟行为与家庭中诸多因素有密切关系,营造良好的家庭环境、维护稳定的家庭结构和倡导科学的教养方式有利于预防和减少青少年吸烟行为。     

Longitudinal Associations Between Smoking and Depressive Symptoms Among Adolescent Girls

Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depressive symptoms, or both. Collectively, there have been mixed findings; however, studies have been limited by (1) cross-sectional or short-term longitudinal data or (2) the use of methods that test associations, or only one direction in the associations, rather than a fully-reciprocal model to examine directionality. This study examined the associations between smoking and depressive symptoms in a sample of adolescent girls using latent dual change scores to model (1) the effect of smoking on change in depressive symptoms, and simultaneously (2) the effect of depressive symptoms on change in smoking across ages 11–20. Data were from a cohort-sequential prospective longitudinal study (N?=?262). Girls were enrolled by age cohort (11, 13, 15, and 17 years) and were primarily White (61 %) or African American (31 %). Data were restructured by age. Every 6 months, girls reported depressive symptoms and cigarette use. Results indicated that controlling for sociodemographic characteristics, higher levels of smoking predicted a greater increase in depressive symptoms across adolescence. These findings suggest that a higher level of cigarette smoking does contribute to more depressive symptoms, which has implications for prevention of depression and for intervention and future research.     

Perceived Social Acceptability and Longitudinal Trends in Adolescent Cigarette Smoking

Prevention Science - The current study uses methods from social network analysis to predict longitudinal trends in adolescent cigarette smoking based on perceived social acceptability from friends,...     

Peer Smoking, Other Peer Attributes, and Adolescent Cigarette Smoking: A Social Network Analysis

Peer attributes other than smoking have received little attention in the research on adolescent smoking, even though the developmental literature suggests the importance of multiple dimensions of adolescent friendships and peer relations. Social network analysis was used to measure the structure of peer relations (i.e., indicators of having friends, friendship quality, and status among peers) and peer smoking (i.e., friend and school smoking). We used three-level hierarchical growth models to examine the contribution of each time-varying peer variable to individual trajectories of smoking from age 11 to 17 while controlling for the other variables, and we tested interactions between the peer structure and peer smoking variables. Data were collected over five waves of assessment from a longitudinal sample of 6,579 students in three school districts. Findings suggest a greater complexity in the peer context of smoking than previously recognized.     

The Social Context of Adolescent Smoking: A Systems Perspective

We used a systems science perspective to examine adolescents'' personal networks, school networks, and neighborhoods as a system through which emotional support and peer influence flow, and we sought to determine whether these flows affected past-month smoking at 2 time points, 1994–1995 and 1996. To test relationships, we employed structural equation modeling and used public-use data from the National Longitudinal Study of Adolescent Health (n = 6504). Personal network properties affected past-month smoking at both time points via the flow of emotional support. We observed a feedback loop from personal network properties to emotional support and then to past-month smoking. Past-month smoking at time 1 fed back to positively affect in-degree centrality (i.e., popularity). Findings suggest that networks and neighborhoods in this system positively affected past-month smoking via flows of emotional support.Adolescent cigarette smoking remains a complex public health problem in the United States. Although lifetime smoking and current frequency of smoking among adolescents decreased between the late 1990s and 2003, prevalence remained unchanged from 2003 through 2005.¹ Smoking prevalence among adolescents is currently estimated to be around 23%,¹ posing ongoing challenges for tobacco-control efforts.Several streams of literature suggest that adolescent smoking is inextricably connected to the social context in which it occurs. Literature shows that an adolescent''s smoking behavior will tend to be similar to that of his or her peers.^2–6 There is a longstanding debate over why this similarity occurs; some studies suggest that it is caused by peer influence on an individual adolescent''s smoking,^7,8 whereas others suggest that it is caused by the individual''s selection of smoking peers,⁸ and still others attribute the cause to both influence and selection.² Some of the literature implicating adolescents’ social contexts in their smoking behavior examines youths’ social networks of friends and peers from a structural perspective. Such studies focus on how structural and positional characteristics of these networks relate to adolescent smoking. Structural characteristics reflect information about linkages among individuals, and positional characteristics indicate the significance of occupying different network positions. In general, studies find that isolated youths are likely to smoke, although some studies have found that popular youths are likely to smoke.^3–5,9–12 Implicit in each study is the notion that adolescents’ social context of friends and peers plays a critical role in their own smoking behavior.Given the relevance of adolescents’ social context to their smoking behavior, it is important to understand how to conceptualize and measure this context. Previous research has used ecological models to inform the theoretical specification of the context of adolescent smoking and other substance-use behaviors.¹³ Ecological models allow this context to be theoretically partitioned into levels of influence. Although there are valuable insights yet to be gained from such models, more theoretically informed research is necessary to elaborate the complexity of the social context of adolescent smoking. Moreover, because various theories are often integrated at different levels in such models, it is difficult to ensure that conceptual coherence is achieved across and within levels, given the possibility that the theories applied at each level make incongruous assumptions. Furthermore, such models do not provide specific guidance about mechanisms through which levels of influence relate to outcomes such as adolescent smoking. There is a need for theoretical models that more specifically and holistically elaborate features of the social context of adolescent smoking and how they act in concert.     

Effects of a Saliva Pipeline Procedure on Adolescent Self-Reported Smoking Behavior and Youth Smoking Prevention Outcomes

Background. Two strategies to resolve the problem of under- or overreporting of tobaccouse among adolescents have been utilized: (a) objective measures for validating self-reports and (b) procedures for improving validity of self-reports, such as the pipeline procedure. The objectives of this article are to investigate the hypothesis that reporting biases may be related to intervention status and to examine what effect such biases would have on interpretation of treatment effects. Method. A two-by-two factorial design was used, with the first factor a pipeline manipulation consisting of pipeline versus control condition, and the second factor treatment status, consisting of treatment versus reference schools. Within each of the schools, half of the 9th-grade classrooms were randomly assigned to a pipeline condition and half served as controls. Analysis was conducted with school as the unit of analysis. Results. The main effect for pipeline condition and the significant interaction between treatment and pipeline conditions were not significant. However, the pipeline manipulation did have an effect on the difference detected between treatment and reference schools; 4.3% difference between treatment and reference schools in the control condition versus 9.9% difference in the pipeline condition, both in the direction of a treatment effect. Using saliva thiocyanate as an objective measure of smoking status suggested differential false negative reporting where students in the reference community falsely claimed to be nonsmokers more frequently than in the treatment community (10.04% versus 5.96%). Conclusions. The reporting bias assessed by the pipeline procedure alone appears to have masked treatment outcome effects. Adjusting the smoking-dependent variable for false negatives seems to have increased the treatment outcome effects even further. This result is contrary to the expectation that the treatment community would experience greater demand pressures to underreport their smoking behavior. Further investigation to address response biases in intervention studies is warranted.     

Gender Differences in the Association Between Perceived Discrimination and Adolescent Smoking

Objectives. We examined associations between perceived racial/ethnic discrimination, gender, and cigarette smoking among adolescents.Methods. We examined data on Black and Latino adolescents aged 12 to 19 years who participated in the Moving to Opportunity study (N = 2561). Perceived discrimination was assessed using survey items asking about unfair treatment because of race/ethnicity in the prior 6 months. We used logistic regression to investigate associations between discrimination and smoking, stratified by gender and controlling for covariates.Results. One fourth of adolescents reported that discrimination had occurred in at least 1 location. Discrimination was associated with increased odds of smoking among boys (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 1.2, 3.0) and decreased odds among girls (OR = 0.6; 95% CI = 0.3, 1.1). Discrimination at school or work contributed to associations for girls (OR = 0.3; 95% CI = 0.1, 0.9), and discrimination at shops (OR = 2.0; 95% CI = 1.1, 3.8) and by police (OR = 2.0; 95% CI = 1.2, 3.4) contributed to associations for boys.Conclusions. Associations between discrimination and smoking differ by gender. Girls’ decreased smoking in higher-discrimination settings may be a result of protective factors associated with where they spend time. Boys’ increased smoking in higher-discrimination settings may reflect increased stress from gender-specific targeting by police and businesses.Several studies have found perceived racial/ethnic discrimination to be associated with adolescent and young adult smoking.^1–7 Smoking as a response to the stress of discrimination is a possible reason for this association, but mediating factors are not well understood.¹A mediating factor that merits attention is the intersection of gender with smoking and the context of discrimination. Gender is relevant, as boys are more likely to smoke cigarettes than girls, and gender differences in smoking prevalence are more pronounced among Blacks.⁸ In addition, adolescents may make different choices about where to spend time based on gender,⁹ and these “gendered” contexts may relate to smoking behavior. For example, the Moving to Opportunity study showed that gender plays a significant role in both smoking behavior and where adolescents spend time. Girls in the Moving to Opportunity intervention groups, whose families used a study voucher to relocate to a neighborhood of their own choice or to a low-poverty neighborhood, were less likely to smoke than girls in the control group (whose families were not offered the means to move from public housing). However, boys in the intervention groups were more likely to smoke than boys in the control group.¹⁰A follow-up study found that girls and boys spent time in different locales.¹¹ Girls in intervention groups were more likely to spend time closer to home. Boys in intervention groups were more likely to return to their public housing community and congregate at street corners, parks, vacant lots, and other places without adult supervision. These gender differences in context may influence adolescents’ situational exposure to discrimination. In other words, the experience of discrimination may be caused by gender-specific use of place, which may then differentially relate to smoking behaviors.The primary purpose of this study was to examine the influence of gender on smoking''s association with discrimination and with context of discrimination among adolescents. We hypothesized that this association would be stronger among boys and that gender differences would be mediated by the context of discrimination. Analyses were adjusted for mediating factors that may contribute to smoking among individuals who perceive higher levels of discrimination, such as stress, depression, and anxiety.^3,4,6,12 Whether these factors differentially influence girls and boys in terms of the association between discrimination and smoking risk is unknown.