Adolescent Smoking Behavior Research Articles

Predictors of Adolescent Cigarette Smoking Behavior: A Sociological Case Study in Ankara, Turkey

ABSTRACT This paper aims to discuss important predictors of adolescent cigarette smoking behavior, such as their sociodemographic characteristics (age, gender, socioeconomic status, mother's and father's educational level, and school type), health-promoting behavior (healthy nutrition, physical activities), risk behavior (cigarette smoking and alcohol use), school achievement, life satisfaction, future expectations, smoking patterns in the family, and school environment. This study is a part of a larger comparative youth research where 310 questionnaires were applied to students in grade 11 in Yenimahalle district in Ankara, Turkey, with characteristics of mean years of age = 16.99; st.d: 0.78; minimum 15 and maximum 20 years of age and 41.1% male and 51.9% female. Of the students in grade 11, 29.9% were smoking and it was reported that 14.0% had smoked often, 7.1% sometimes, 8.8% rarely, and 70.1% had never smoked. Age (19–20 older age group), gender (being male), and alcohol use were the most important predictors of adolescent smoking behavior. Prevention implications and recommendations are also discussed.

The association between leisure time physical activity and smoking in adolescence: An examination of potential mediating and moderating factors

Although physical activity has been associated negatively with smoking in adolescence, the association is not well understood. This study examines the relationship between adolescents' leisure time physical activity and smoking behavior, while considering BMI, weight concern, sense of coherence, and physically active self-concept as potential mediating and moderating variables. Data were obtained through a postal survey among 3,940 Danes aged 16 to 20. Bivariate and multivariate logistic regressions were performed to identify significant associations as well as mediating and moderating effects. In the bivariate model, leisure time physical activity was negatively associated with smoking; adolescents who were active at least one hour per week were up to half as likely to smoke as inactive adolescents. In the adjusted model, however, the association disappeared. Further analyses revealed that physically active self-concept acted both as a mediator and as a moderator of the studied relationship. The data suggest that participation in leisure time physical activity is indeed inversely associated with adolescent smoking, but only when physical activity is perceived as an important part of the self. Hence, interventions designed to promote physical activity among youth may also aim to boost physically active self-concepts.

Associations between parental smoking restrictions and adolescent smoking

The purpose of this study was to examine the cross-sectional relation between reported levels of parental smoking restriction and several behavioral and cognitive variables in a sample of 757 (363 males, 394 females) adolescent smokers. Experimenters administered surveys to students in the homerooms of three Florida high schools. After controlling for student age, gender, and parental smoking status, results revealed that more restrictive parental smoking policies were significantly associated with less smoking on weekdays and weekend days, greater latency to smoking the first cigarette of the day, greater motivation to quit smoking, greater confidence in ability to quit smoking, and higher estimated risk perception regarding the health consequences of smoking. Results also revealed that 44% of adolescent smokers reported that their parents or legal guardians did not know that they smoked tobacco. These findings suggest that parental smoking restrictions may have the potential to impede adolescent progression to adult smoking behavior by reducing smoking rates and nicotine dependence, and increasing motivation to quit, self-confidence to quit, and health risk perception. Parental restrictions on smoking may present obstacles and inconveniences to adolescent smoking behavior that make smoking cessation a more attractive option.

Gene–environment interactions: Peers’ alcohol use moderates genetic contribution to adolescent drinking behavior

Social context is increasingly recognized as essential for understanding complex human outcomes even among geneticists who focus on genetic influences. These outcomes typically involve multiple genes, multiple environmental factors, and the interactions between the two. In this paper, we propose a conceptual framework for gene–environment interaction and show how the interaction can be tested empirically using a sample of MZ twin, DZ twins, and full siblings. We test the hypothesis that the genetic contribution to adolescent drinking depends on the drinking behavior of their friends, using a sample of clusters of siblings and their friends from Add Health. Our analysis has yielded evidence supporting the gene–environment interaction hypothesis. High levels of alcohol use by one’s best friend or among one’s friends tend to bring about higher levels of genetic contribution to alcohol use. Lower levels of alcohol use by one’s best friend or among one’s friends tend to suppress the level of genetic contribution to alcohol use. Our findings suggest that friend behavior might be a particularly important environmental moderator of the expression of genetic disposition for adolescent drug use, smoking, dietary habits, and risky sexual behavior. Subsequent studies of these behaviors that use non-DNA twin samples or DNA measures of genetic variants should investigate peer influence as a significant environmental moderator.

Does smoking among friends explain apparent genetic effects on current smoking in adolescence and young adulthood?

We used data from a prospective cohort study of twins to investigate the influence of unmeasured genetic and measured and unmeasured environmental factors on the smoking behaviour of adolescents and young adults. Twins were surveyed in 1988 (aged 11–18 years), 1991, 1996 and 2004 with data from 1409, 1121, 732 and 758 pairs analysed from each survey wave, respectively. Questionnaires assessed the smoking behaviour of twins and the perceived smoking behaviour of friends and parents. Using a novel logistic regression analysis, we simultaneously modelled individual risk and excess concordance for current smoking as a function of zygosity, survey wave, parental smoking and peer smoking. Being concordant for having peers who smoked was a predictor of concordance for current smoking (P<0.001). After adjusting for peer smoking, monozygotic (MZ) pairs were no more alike than dizygotic pairs for current smoking at waves 2, 3 and 4. Genetic explanations are not needed to explain the greater concordance for current smoking among adult MZ pairs. However, if they are invoked, the role of genes may be due to indirect effects acting through the social environment. Smoking prevention efforts may benefit more by targeting social factors than attempting to identify genetic factors associated with smoking.

Can population-based tobacco-control policies change smoking behaviors of adolescents from all socio-economic groups? Findings from Australia: 1987–2005

To examine whether socio-economic status (SES) was associated with changes in smoking prevalence among Australian adolescents during three phases of tobacco-control activity between 1987 and 2005. Triennial cross-sectional national studies of representative random samples of secondary students aged 12-17 years have been conducted since 1987. Numbers range from 19,203 in 1987 to 29,853 in 1996. Self-report anonymous surveys assessed cigarette use in the past month, week (current), and on at least three of the previous seven days (committed). Students' residential postcode was collected and the Index of Relative Socio-Economic Disadvantage (IRSD) associated with each postcode determined SES quartiles. Between 1987 and 2005, smoking prevalence decreased in all SES groups. Tobacco-control activity level was associated with changes in smoking prevalence and whether changes were consistent across SES groups. In a period of low tobacco-control funding (1992-1996) and activity, smoking prevalence increased among 12- to 15-year-olds, the increase being greatest among low SES students. In a period of high tobacco-control activity (1997-2005) smoking decreased and reductions were generally consistent across SES groups. Well-funded, population-based tobacco-control programs can be effective in reducing smoking among students from all SES groups.

Does allowing adolescents to smoke at home affect their consumption and dependence?

Negative parental attitudes towards smoking decrease adolescent smoking initiation but limited research explores the relationship between parental attitudes and degree of adolescent smoking among established smokers. The aim of this study was to examine the relationship between parental allowance of smoking in the home and adolescent smoking behavior and level of dependence. Interviews from 408 youths seeking assistance to quit smoking showed that adolescents who were allowed to smoke at home smoked more cigarettes per day and had higher scores on the Fagerström Test of Nicotine Dependence than those not allowed to smoke at home. Studies that additionally evaluate parental smoking status and the temporal relationship of parental allowance of smoking with changes in adolescent smoking behavior are warranted to clarify public health implications of parental smoking interdictions.

Smoking Behavior in Asthmatic and Non-Asthmatic Adolescents: The Role of Smoking Models and Personality

Despite the particular health risks for asthmatics, recent international studies have reported that tobacco use among asthmatics is similar to, or even higher than, non-asthmatics. This study examined the role of personality and environment in smoking among asthmatic and non-asthmatic adolescents. In 2003 a random sample of 33 schools (first and second class of secondary education) was obtained in The Netherlands (N = 4,951). The mean age of the participants was 12.83 (SD =. 75), and 52.8% were females. Information about asthma, smoking, personality, and environmental smoking was assessed via self-reports on standard epidemiology survey items (asthma, smoking) and the Quick Big Five (personality). Both personality and environmental smoking were associated with smoking. Asthmatics were similarly or even more exposed to environmental smoke than non-asthmatic adolescents and asthmatic adolescents were less emotionally stable and extravert. Associations between personality and own smoking behavior, as well as between smoking models and own smoking behavior were similar for asthmatic and non-asthmatics. Limitations of the study are taken notice of, and implications of the results are briefly discussed.

A survey on smoking habits and attitudes among adolescents in Greece

The objective of the present study was to investigate smoking habits among 699 secondary school students, along with their attitudes toward smoking and their perceptions on the consequences of tobacco use in their health. Our results indicate that Greek adolescents begin to smoke mainly due to curiosity and for stress reasons. Furthermore, having friends who smoke is highly associated with smoking and intention for smoking. Likewise, paternal smoking seems to reinforce students' intention for smoking. On the contrary, parental disapproval of smoking leads to anti-smoking behavior. Adolescents' attitudes toward smoking are also related to a series of similar factors such as parental educational status, parental smoking, and parental disapproval of smoking, friends who smoke, and, finally, adolescents' age, smoking behavior, and intention for smoking. The impact of tobacco use in human health seems to be understood better by older students. All these factors must be taken into account for a successful implementation of an anti-smoking intervention program.

Do Current Government Policies Sufficiently Regulate the Interaction between Viewing Smoking in Movies and Adolescent Smoking Behavior?

Do Current Government Policies Sufficiently Regulate the Interaction between Viewing Smoking in Movies and Adolescent Smoking Behavior?

Bi-directional relations between anti-smoking parenting practices and adolescent smoking in a Dutch sample.

Parenting is generally regarded a determinant of adolescent behavior, whereas the reverse is seldom considered. Reported effects of anti-smoking parenting practices on adolescent smoking are inconsistent. Cross-sectional results may have been misinterpreted and child effects have been overlooked. The main goal of this study was to explain previous inconsistent effects of anti-smoking parenting practices, by examining bi-directional relations between parenting and adolescent smoking. Bi-directional relations were studied using a cross-lagged model where anti-smoking house rules, communication about smoking, and adolescent smoking were assessed at three subsequent years. The most prominent finding was that adolescent smoking behavior was a stronger predictor of parenting than vice versa. Anti-smoking house rules decreased as a result of adolescent smoking behavior, while communication increased. The reduction in house rules was more pronounced if parents smoked, while the increase in communication was greater for non-smoking parents. Results were independent of adolescent sex. Further research is needed to establish which aspects of parenting can be effective in deterring adolescent smoking. This study emphasizes the need for caution in interpreting cross-sectional research findings relating parenting to adolescent smoking.

Contextual consistency and adolescent smoking: Testing the indirect effect of home indoor smoking restrictions on adolescent smoking through peer smoking

The present study tested the indirect effect of home indoor smoking restrictions on adolescent smoking through peer smoking. Based on a bioecological perspective of development, we hypothesized that forbidding indoor smoking would reduce the likelihood of adolescent smoking by decreasing exposure to peer smoking, even when adolescents live with at least one household member who smokes. Participants were 163 adolescents (mean age = 16 years) from a suburban southeastern Pennsylvania community. Participants completed a self-report survey evaluating home indoor smoking restrictions, smoking behavior, peer smoking, alcohol use, and demographics. Structural equation modeling indicated that forbidding smoking indoors was associated with having fewer peers who smoke, which was associated with a lower level of smoking. The indirect effect was significant (beta = -.569, 95% CI -.90 to -.24), offering some preliminary ideas about why home indoor smoking restrictions reduce the risk of adolescent smoking. However, the nature and stability of these effects on adolescent smoking behavior remain to be investigated.

Changes in adolescent smoking behaviour and knowledge of health consequences of smoking

Strategies designed to prevent uptake or provoke cessation in adolescent smoking often include components educating adolescents on the health consequences of smoking. This paper assessed whether the level of knowledge an adolescent has about the health consequences of smoking (health literacy) covaried with changes in smoking behaviour over time. The data, derived from a 12-month longitudinal study of adolescent smoking, showed that smokers appeared to have a higher level of health literacy about smoking than non-smokers. The data suggested that health literacy was unrelated to uptake or cessation of smoking behaviour. Given the observed relationship between knowledge and change in behaviour (knowing smoking was bad for them had no effect on uptake or cessation) the assumed role of health education to prevent or provoke changes in adolescent smoking was challenged.

The influence of branding on adolescent smoking behaviour: exploring the mediating role of image and attitudes

Abstract This study investigates the continuing effects of tobacco marketing communications in a post advertising era, focusing on the constructs of brand awareness, brand image, attitude formation and intention to smoke by adolescents. A conceptual model is presented, based on 926 respondents from a UK wide study, to assess brand‐related interrelationships and influences of peers on adolescents' attitudes toward smoking and intention to smoke. Results show the strong influence of branding on both attitude and intention, and have implications for government anti‐smoking policies specifically in regard to generic packaging and point of sale displays. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Stressful life events and smoking behaviors in Chinese adolescents: A longitudinal analysis

The associations between stressful life events and smoking have been established among adolescents in the United States. However, whether these relationships are similar in adolescents from other non-Western cultures is unknown. Understanding these relationships in adolescents may help to provide opportunities to reduce the smoking rates in those cultures by providing positive coping methods that do not include smoking. In this longitudinal study, the associations between nine stressful life events scales and smoking behaviors were examined in a sample of Chinese adolescents. Six of these scales, positive school-related, negative school-related, positive family-related, positive peer-related, negative peer-related, and negative health-related had significantly different means among females and males. Among males, positive school-related stress was a protective factor for smoking susceptibility. Among females, positive school-related stress was a protective factor and negative school-related stress was a risk factor for lifetime smoking, and negative family-related stress was a risk factor for smoking susceptibility. Findings indicate that smoking among male adolescents in China may not be the result of stress; however, in females stress may contribute to the decision to smoke. Future directions are discussed.

Disentangling social selection and social influence effects on adolescent smoking: the importance of reciprocity in friendships

The goal of this study was to examine social selection and social influence within reciprocal and non-reciprocal friendships, and the role of parents and siblings, as factors explaining similarity of smoking behaviour among adolescent friends. A new social selection-social influence model is proposed. Longitudinal design with two measurements. Data were gathered among Dutch high school students in the control group of the European Smoking prevention Framework Approach (ESFA) study. The sample consisted of 1886 adolescents with a mean age of 12.7 years. The main outcome measures were the smoking behaviours of the respondents, best friends, parents and siblings. We tested the social selection-social influence model with structural equation modelling techniques. Social selection and social influence both played an important role in explaining similarity of smoking behaviour among friends. Within non-reciprocal friendships, only social selection explained similarity of smoking behaviour, whereas within reciprocal friendships, social influence and possibly also social selection explained similarity of smoking behaviour. Sibling smoking behaviour was a more important predictor of adolescent smoking behaviour than parental smoking behaviour. Social selection and social influence both promote similarity of smoking behaviour, and the impact of each process differs with the degree of reciprocity of friendships. These insights may contribute to further refinement of smoking prevention strategies.

Cognitions About Smoking and Not Smoking in Adolescence

The theory of planned behavior identifies important proximal determinants of behavior, including attitude toward the behavior, perception of subjective norms exerted by significant others, and perception of perceived control over performance of the behavior. Because research in the planned behavior tradition has focused on desirable target behaviors, it is not clear how these determinants can best be conceptualized to account for adolescents' acquisition of health risk behaviors such as smoking. This cross-sectional study compared the explanatory power of planned behavior constructs assessed in relation to "smoking" and "not smoking" in a sample of 248 Dutch secondary students (aged 12 to 17 years; 56% girls). The results indicated that four variables--attitude toward smoking, perceived subjective norm, and perceived behavioral control over both smoking and not smoking--best explained the adolescents' smoking intentions and smoking behavior. Methodological and practical implications for smoking interventions are discussed.

Parenting style and adolescent smoking cognitions and behaviour

Parenting style and smoking-related cognitions have both successfully predicted adolescent smoking behaviour. Data were collected among 482 Dutch adolescents to examine whether effects of parenting styles (authoritative, permissive, authoritarian, rejecting, neglecting, measured by underlying dimensions support, strict control, and psychological control) on adolescent lifetime smoking were mediated by cognitions (pro-smoking attitude, social norm, self-efficacy, intention) and to study the role of gender in this process. Support was not significantly associated with smoking behaviour. The inverse relation between strict control and smoking was partly mediated by attitude and intention, both associated with increased smoking. Psychological control related directly to increased lifetime smoking. Combinations of dimensions creating the specific styles were not associated with cognitions or behaviour. Maternal and paternal parenting were equally associated with smoking cognitions and behaviour; nor were effects moderated by adolescent gender. Interventions to prevent adolescent smoking initiation should aim at increasing strict control and reducing psychological control.

Antismoking Initiatives: Effects of Analysis Versus Production Media Literacy Interventions on Smoking-Related Attitude, Norm, and Behavioral Intention

This study developed inoculation-driven antismoking interventions aimed at changing attitudes, norms and intentions about smoking to influence smoking behavior in adolescents. This study explored the efficacy of 2 intervention approaches designed to help adolescents to refrain from smoking initiation. Participants were junior high students (6th, 7th, and 8th grade) from schools in the Northeast. Two kinds of experimental workshops and a control group were designed as stimulus material in a repeated measure nonequivalent group experimental design. The 2 intervention workshops developed included: analysis + analysis (where participants discussed and analyzed cigarette and antismoking ads) and analysis + production (where participants discussed, analyzed, and then created their own antismoking ads). The analysis + production workshop was generally more successful than the analysis + analysis workshop and control group in changing participants' behavioral intention to smoke and attitude toward smoking but not subjective norms over time. Implications and directions for future research are discussed.

Comment on “Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China”

Chen and colleagues describe social factors that are related with Chinese adolescent smoking behaviors [Chen, W., Wen, X., Muscat, J., et al., 2007-this issue. Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China. Prev. Med. doi:10.1016/j.ypmed.2007.02.009]. These types of studies in China are very much needed given the fact that smoking is a significant health problem in China. Environmental factors may be more important than sometimes thought, since some studies suggest that smoking onset may not be such a ‘reasoned’ process by youngsters (Kremers, S.P., Mudde, A.N., de Vries, N.K., Brug, J., de Vries, H., 2004. Unplanned smoking initiation: new insights and implications for interventions. Patient Educ. Couns. 55 (3), 345–52.). Studies indicate that a multitude of factors are related to smoking onset, and thus deserve attention in a smoking prevention approach (see, e.g., [Tyas, S., Pederson, L., 1998. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tob. Control 7, 409–420; Lantz, P., Jacobson, P., Warner, K., et al., 2000. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob. Control 9, 47–63]). The study conclusions were derived from a cross-sectional report. Consequently, one needs to be careful in making conclusions about causal pathways [Bauman, K., Fisher, L., 1986. On the measurement of friend behavior in research on friend influence and selection: findings from longitudinal studies of adolescent smoking and drinking. J. Youth Adolesc. 15 (4), 345–353]. Longitudinal studies also suggest the impact of selection mechanisms implying that adolescents were not pressured to start to smoke, but selected smoking friends. Chen, W., Wen, X., Muscat, J., et al.'s [2007-this issue. Modifiable family and school environmental factors associated with smoking status among adolescents in Guangzhou, China. Prev. Med. doi:10.1016/j.ypmed.2007.02.009.] work is important because it describes one of the many steps that are needed in China for realizing effective smoking prevention programs, a study that could be described as one of the first steps in the planning cycle of health promotion [Green, L., Kreuter, M., 1999. Health Promotion Planning: An Educational and Ecological Approach. Mayfield Publishing Company, Mountain View, CA]. Ultimately Chen and colleagues may want to develop smoking prevention interventions. These interventions should indeed incorporate the modifiable social factors, and – as the Chinese data suggest – should be gender sensitive. Consequently, the great challenge for Chen and several other Chinese colleagues will be to develop an integral long-term approach for their country to prevent smoking onset as effectively as possible using comprehensive approaches.