Adolescent Smoking Behavior Research Articles

Identifying Principal Risk Factors for the Initiation of Adolescent Smoking Behaviors: The Significance of Psychological Reactance

An in-school youth survey for a major state antitobacco media campaign was conducted with 1,831 students (Grades 6-12) from 70 randomly selected classrooms throughout the state. Tobacco users accounted for nearly 25% of the sample. Pretest questionnaires assessed demographic variables, tobacco use, and various other risk factors. Several predictors of adolescents' susceptibility to tobacco use, including prior experimentation with tobacco, school performance, parental smoking status, parents' level of education, parental communication, parental relationship satisfaction, best friend's smoking status, prevalence of smokers in social environment, self-perceived potential to smoke related to peer pressure, and psychological reactance, were examined using discriminant analysis and logistic regression to identify the factors most useful in classifying adolescents as either high-risk or low-risk for smoking uptake. Results corroborate findings in the prevention literature indicating that age, prior experimentation, and having friends who smoke are among the principal predictors of smoking risk. New evidence is presented indicating that psychological reactance also should be considered as an important predictor of adolescent smoking initiation. The utility of producing antismoking messages informed by an awareness of the key risk factors–particularly psychological reactance–is discussed both in terms of the targeting and design of antitobacco campaigns.

Influences affecting adolescent smoking behavior in China

This study examined multiple influences on the use of tobacco by adolescents in China. Using the theory of triadic influences as a guide, we selected interpersonal, attitudinal/cultural, and intrapersonal constructs from baseline data to predict adolescent smoking 1 year later. We used prospective data from middle and high school students (N = 11,583) and their parents from the China Seven Cities Study, a longitudinal study that is evaluating the effects of changing economic and social factors on health behaviors including tobacco use. A multilevel regression analysis provided some support that each of the influences in the theory of triadic influences affects adolescent smoking in China. After adjusting for important confounders including age, gender, socioeconomic status, and smoking behaviors (lifetime and past 30-day) at baseline, we found significant risk factors within each of the three categories, including interpersonal influences (parental monitoring, good friend smoking, and peer smoking), attitudinal/cultural influences (school academic ranking, initial liking of smoking, and the meaning of smoking), and intrapersonal influences (susceptibility to smoking, and low self-confidence to quit smoking). Results suggest that the etiology of smoking among adolescents in China might be similar to that observed in western countries and that some of the techniques used successfully in prevention programs in those countries might be useful guides when developing prevention programs in China.

Challenges to the peer influence paradigm: results for 12–13 year olds from six European countries from the European Smoking Prevention Framework Approach study

Objective: To examine whether smoking onset in young adolescents is predicted by peer or parental smoking. Design: Longitudinal design with one pretest and one follow-up at 12 months. Setting: Schools...

School-based smoking prevention programs for adolescents in South Korea: a systematic review

The number of research papers evaluating programs designed to prevent adolescent smoking have increased in the last 13 years in Korea. The purpose of this study was to evaluate these programs, to review the features of the studies and to systemically assess the results on the knowledge about, and attitude to, smoking and smoking behavior. Database searched were national digital library (NDL) and the Research Information Service System, which are major literature search systems for all academic fields in South Korea, and the Research Information Center for Health, which is a database for health field. A total of 11 papers were included. Program contents are described under five categories and the mode of delivery is described. Methodological features were investigated and effect of the size of the study on variables investigated was computed. Knowledge was the main content of the program in most of the studies. Most studies delivered classroom-based instructions that were mainly didactic presentations. School-based smoking programs have not influenced adolescent smoking behavior as much as anticipated. Methodological problems were discussed. Several recommendations are made to improve effectiveness of smoking prevention programs and reduce methodological flaws in future studies.

The Importance of Smoking Definitions for the Study of Adolescent Smoking Behavior

Smoking is the leading cause of death and smoking initiation rarely occurs after adolescence. Thus research on adolescent smoking is crucial. A consistent definition of smoking is important because inconsistent definitions make comparisons across studies an arduous task. Thus, the aim of the study was to suggest future research directions for smoking definitions after examining pitfalls in the literature. In this study the literature on adolescent smoking in the U.S. and South Korea was examined, and three types of smoking definitions were identified. Limitations in the studies are identified and future research directions are suggested. In the U.S. literature, smoking definitions can be categorized into three groups: definitions based on stage models, smoking trajectories, and definitions derived from specific data. In the South Korean literature, various levels of smoking have not been differentiated. While the literature does not provide a definitive answer regarding the definition of smoking, it suggests three issues to consider for future research. First, multiple measures of smoking are more desirable than a one-time measure. Second, theory- or trajectory-based smoking definitions are more desirable than definitions derived from available data. Finally, regularity and amount of cigarette use should be incorporated in defining smoking behavior.

Insufficient Smoking Restrictions in Restaurants Around Junior High Schools in Japan

Controls for second hand smoke (SHS) and adolescent smoking have been still sociomedical concerns in Japan. Restaurant smoking restrictions are associated with community social norms affecting adolescent smoking behavior, and the status in areas around Junior high schools (JHSs) in the community could be a sign of community practices on regulating SHS for adolescents. To examine whether restaurant smoking restrictions are seen especially in areas around JHSs in Japan, a survey using the direct inspection of a total of 163 restaurants (64 restaurants within and 99 outside a 1-km radius from the nearest JHSs) was conducted in May 2003 in Yonago city, Japan. We assessed smoking restriction status in each restaurant and classified them into 2 groups according to the distance from the nearest JHSs. There were only 2 (3.1%) restaurants with 100% non-smoking and 11 (17.2%) with some partial restrictions among the restaurants within a 1-km radius of JHSs. There were 1 (1.0%) restaurant with 100% non-smoking, 3 (3.0%) with complete non-smoking sections and 17 (17.2%) with some partial restrictions among the restaurants outside a 1-km radius of JHSs. Among restaurants with some partial restrictions, restriction methods were considered insufficient. The smoking restriction status was not significantly different between the restaurant groups within and outside a 1-km radius of JHSs. These results suggest that the public awareness of and attitude toward adolescent smoking problems remains low in Japan. Further SHS control actions for adolescents are needed in Japan.

Recruitment and Retention of Adolescents in a Smoking Trajectory Study: Who Participates and Lessons Learned

Recruitment of adolescents into tobacco use research is often challenging. This study reports on the predictors of recruitment and retention in a longitudinal study of adolescent smoking behavior. In 2000, 8th and 10th grade students at 18 schools (N = 5,298) in the Chicago metropolitan area completed brief screening surveys; 1457 students (ranging from susceptible nonsmokers to regular smokers) were invited to participate in a longitudinal study, and 48.9% agreed. Chi-square analyses revealed that female and white students were more likely to participate than male and nonwhite students. Recruitment rates did not vary by parental smoking status, students' experience with smoking, or student grade. Multivariate analyses revealed that overall, gender and race were significant predictors of participation. Chi-square and multivariate analyses revealed no significant differences in retention on the demographic, smoking experience, or psychosocial variables measured. Implications of the results and study limitations are discussed.

Predictors of cigarette use among South African adolescents

This study assessed the interrelation among domains of ethnic factors; the individual's sense of well-being; personality, attitudes, and behaviors; sibling and peer smoking; and adolescent smoking behavior. The sample consisted of 1,468 South African adolescents selected from 4 ethnic groups self-identified as defined by current South African usage: Black (mainly Zulu and Xhosa), Indian, White, and Colored (mixed ancestry). In accordance with family interactional theory, there was a sequence of patterning from ethnic factors and the individual's sense of well-being to adolescent personality, attitudes, and behaviors and models of smoking. All of the 4 domains in the model also had a direct effect on adolescent smoking behavior. The findings suggest 4 possible targets of therapeutic or preventive intervention with regard to adolescent smoking: ethnic factors; the individual's sense of well-being; personality, attitudes, and behaviors; and smoking within the peer group.

Smoking in the Movies Increases Adolescent Smoking: A Review

Despite voluntary restrictions prohibiting direct and indirect cigarette marketing to youth and paid product placement, tobacco use remains prevalent in movies. This article presents a systematic review of the evidence on the nature and effect of smoking in the movies on adolescents (and others). We performed a comprehensive literature review. We identified 40 studies. Smoking in the movies decreased from 1950 to approximately 1990 and then increased rapidly. In 2002, smoking in movies was as common as it was in 1950. Movies rarely depict the negative health outcomes associated with smoking and contribute to increased perceptions of smoking prevalence and the benefits of smoking. Movie smoking is presented as adult behavior. Exposure to movie smoking makes viewers' attitudes and beliefs about smoking and smokers more favorable and has a dose-response relationship with adolescent smoking behavior. Parental restrictions on R-rated movies significantly reduces youth exposure to movie smoking and subsequent smoking uptake. Beginning in 2002, the total amount of smoking in movies was greater in youth-rated (G/PG/PG-13) films than adult-rated (R) films, significantly increasing adolescent exposure to movie smoking. Viewing antismoking advertisements before viewing movie smoking seems to blunt the stimulating effects of movie smoking on adolescent smoking. Strong empirical evidence indicates that smoking in movies increases adolescent smoking initiation. Amending the movie-rating system to rate movies containing smoking as "R" should reduce adolescent exposure to smoking and subsequent smoking.

Personal Values, Advertising, and Smoking Motivation in Taiwanese Adolescents

ABSTRACT This article explores the role that personal values plays in motivating Taiwanese adolescents to smoke. In a nationwide survey of high school students, smokers attached greater importance to hedonic gratification values and less importance to idealism values than did nonsmokers. Hedonic gratification values were associated with favorable attitudes toward smoking, while idealism values were associated with unfavorable attitudes toward smoking. Attitudes toward smoking predicted adolescent smoking behavior. Evidence suggested that advertising plays an important role in motivating adolescents with hedonic gratification values to smoke. First, in the survey, hedonic gratification values were associated with paying attention to and expressing favorable attitudes toward cigarette advertising. Second, a content analysis of cigarette ads in magazines found hedonic gratification values to be the most commonly portrayed values, occurring in 62.7% of ads.

Normative processes and adolescents’ smoking behaviour in Norway: A multilevel analysis

Currently, smoking prevalence is still high among adolescents. This is of major concern for public health organizations. Factors that influence adolescent smoking behaviour need to be identified and addressed. Research in this area has identified attitudes, subjective norms and perceived behavioural control as some of the contributing factors, but subjective norms have often been the weakest predictor of smoking behaviour. This could be due to inadequate measurement. The current paper suggests that examining different types of norms and their relationship with smoking behaviour could help increase the contribution of norms. The paper set out to identify other normative concepts, such as the subjective estimate of smoking prevalence, and descriptive and desired societal norms that are not captured by subjective norms but that could be related to adolescents’ smoking behaviour. Data were collected from 15-year-old students from Norway ( n=1670 in 89 grade 10 school classes). Multilevel logistic regression analysis was used to determine how the various concepts of norms relate to each other and their relationship with adolescent smoking behaviour. The findings of the study showed that an individual's opinion of societal norms, and the expectations of significant others as well as their behaviour all seem significantly related to adolescent smoking behaviour, either as an individual or as a school class predictor. Hence, rather than playing down the role of norms, the addition of a subjective estimate of smoking prevalence, and descriptive and desired societal norms could extend the normative concept as well as increase its predictive power. Future intervention could address different types of norms as well as the effect of shared context to help prevent adolescents from smoking.

School connectedness and daily smoking among boys and girls: the influence of parental smoking norms

The objective was to test whether an association between school connectedness and smoking exists among Danish school children, and if so, to examine whether parental smoking attitude and parental smoking behaviour influenced this association. Data were collected by the Danish contribution to the cross-national study Health Behaviour in School-Aged Children (HBSC) 1998. Analyses were performed on questionnaire-based data from 1537 students at grade nine from a random sample of schools in Denmark. An independent inverse association was found between school connectedness and smoking among both boys and girls. Parents' attitude to their children's smoking significantly modified this association among boys. Among girls the modifying effect was less marked. Neither among boys nor girls did parental smoking behaviour significantly modify the association between school connectedness and smoking, although a modifying tendency was observed among girls. The smoking behaviour of Danish adolescents may be influenced by complicated interactions of varying sets of experienced smoking norms, and any research project or preventive programme focusing on the influence of school life on adolescent smoking behaviour needs to consider the family smoking norms. Additionally, the results stress the important role of gender by indicating that the smoking behaviour of girls may be more sensitive to restricting social influences than the smoking behaviour of boys.

Adolescents' smoking expectancies: Psychometric properties and prediction of behavior change

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered.

Are anti-smoking parenting practices related to adolescent smoking cognitions and behavior?

The aim of this study was to explain the effects of anti-smoking parenting practices on adolescent smoking cognitions and behavior by showing the mediating effects of cognitions. Data were gathered among Dutch high school students in the control condition of the European Smoking prevention Framework Approach (ESFA). Anti-smoking parenting practices were measured by parental reactions to smoking, house rules, and frequency and content of communication about smoking. Attitudes, perceived social influences and self-efficacy made up for smoking cognitions. Additionally, intention to smoke was measured. Relations between practices and cognitions were mostly significant. While some practices were associated with less smoking (communication about health risks of smoking, health risks of breathing in smoke, addictive qualities of smoking and attention for smoking in school), others were related to increased chances of smoking (rewards for not smoking, frequency of communication about smoking, communication about being allowed to smoke, price of cigarettes and friends smoking). The effects of parenting hardly varied by parental smoking status or adolescent gender. Several practices operated through cognitions, which was more pronounced in older adolescents. Counter-productive effects of practices and the few effects in the longitudinal analyses indicate that the order in which parents and adolescents influence each other should be examined more closely.

Television viewing and age at smoking initiation: Does a relationship exist between higher levels of television viewing and earlier onset of smoking?

This cross-sectional study of children assessed the association between television viewing and age at smoking initiation, using self-reports administered by research assistants in schools. Participants were 909 students in their first and fourth years of secondary education in a random sample of 15 secondary schools in Flanders, Belgium, who had smoked at least one cigarette. The main outcome measure was age at smoking initiation. The independent variable was weekly television viewing volume. Gender, educational level, parental smoking, and peer smoking were the control variables. The relationship between television viewing and age at smoking initiation was significant. Higher levels of television viewing were related to earlier onset of smoking behavior in adolescents. The relationship of television viewing with age at smoking initiation was stronger than that of peer smoking, parental smoking, and gender. For each hour of television viewing per day, the average smoking initiation age decreased by 60 days. Heavier television viewers start smoking at an earlier age. Two possible explanations for this relationship are suggested. Social learning theory suggests that actors and actresses serve as behavioral role models for heavy viewers. Cultivation theory suggests that exposure to positive messages influences smoking attitudes. Further research should examine whether the relationship is causal and whether television acts as a provider of smoking role models or whether it influences smoking attitudes.

Parental Smoking and Smoking Behavior in Asthmatic and Nonasthmatic Adolescents

Parental Smoking and Smoking Behavior in Asthmatic and Nonasthmatic Adolescents

An exploration of self-reported negative affect by adolescents as a reason for smoking: implications for tobacco prevention and intervention programs

Background Negative affect is related to initiation and maintenance of smoking among youth and understanding its role is important when developing effective prevention and cessation programs. This study investigates the relationship between adolescent negative affect and smoking dependence, behaviors, attitudes, and self-efficacy in order to shed light on differences in adolescent smoking maintenance and cessation. Methods 721 smoking youth participated in a cognitive-behavioral smoking cessation program. Reasons for smoking were categorized ( α = 0.87) and youth were placed into one of two groups based on presence or absence of negative affect. One-way repeated measures ANOVA determined if differences existed between the groups on smoking behaviors, attitudes, and self-efficacy. One-way ANOVA determined if differences existed on Fagerström Nicotine Tolerance Dependence (FTND) scores. Results Adolescents indicating negative affect for smoking were significantly more likely to have future smoking intentions and had significantly less self-efficacy to quit smoking than adolescent reporting other reasons. Conclusions This study supports the need to address negative affect among adolescents participating in prevention and cessation programs. An examination of negative affect will provide program developers and facilitators with information to improve their interventions, assist with cessation, and provide an avenue to access other needed health services.

Physician and Dentist Tobacco Use Counseling and Adolescent Smoking Behavior: Results From the 2000 National Youth Tobacco Survey

The present study describes patterns of tobacco use counseling among physicians and dentists as reported by adolescents and determines the association between provider advice to quit and cessation activities among current smokers. Data were analyzed from the 2000 National Youth Tobacco Survey, an anonymous, self-administered, school-based survey. The National Youth Tobacco Survey was administered to a nationally representative sample of 35828 students in grades 6 to 12 in 324 schools. Thirty-three percent of adolescents who visited a physician or a dentist in the past year reported that a physician counseled them about the dangers of tobacco use, and 20% reported that a dentist provided a similar message. Among students who smoked in the past year, 16.4% received advice to quit from a physician and 11.6% received advice to quit from a dentist. Physician or dentist advice to quit was correlated with 1 or more quit attempts in the past 12 months. On the basis of adolescent reports, physician and dentist practice patterns remain well below recommended guidelines. Results suggest that provider advice to quit is associated with cessation activity. Additional studies are needed to confirm whether the low prevalence of brief provider tobacco use counseling is a missed opportunity to affect adolescent smoking behavior.

Influence of known psychosocial smoking risk factors on Egyptian adolescents' cigarette smoking behavior

The morbidity and mortality associated with cigarette smoking is shifting from the developed world to developing countries, especially developing Arab countries. One such country is Egypt, which has the highest rate of tobacco consumption in the Arab world. To curb the rising smoking epidemic in Egypt, appropriate adolescent smoking prevention programs need to be developed. Most of the effective adolescent smoking prevention programs are based on the social influence approach, which targets the proximal psychosocial variables believed to promote adolescent smoking. However, most of our understanding of adolescents' psychosocial smoking risk factors is based mainly on Western studies. Whether these factors have the same influence on Egyptian adolescents' smoking behavior has not been investigated to date. An understanding of the psychosocial correlates of smoking behavior among Egyptian adolescents may help in designing the appropriate smoking prevention program aimed at this population. This study reports the results of a cross-sectional survey administered to a random sample of 1930 students in grades 7, 9 and 12 in the city of Alexandria, Egypt, in May 2003. Adolescent smoking behavior was positively associated with positive beliefs about smoking, sibling, parent and peer smoking, and social smoking norms, with sibling smoking and perceived adult smoking norms having a stronger influence on adolescents' smoking behavior than peer smoking and perceived peer smoking norms. Refusal self-efficacy was protective against smoking behavior, while knowledge of the short-term negative consequences of smoking was protective against susceptibility to future smoking among females only. The results suggest that adolescents from collective cultures, like Egypt, are more influenced by their family's smoking behavior and perceived adult smoking norms than their peers' smoking behavior and perceived peer smoking norms. Smoking prevention programs aimed at Egyptian adolescents should be accompanied by smoking cessation programs for the family and adult community members.

Validation of the timeline follow-back in the assessment of adolescent smoking

The timeline follow-back instrument (TLFB) is a valid and reliable method of quantifying alcohol use patterns. The use of this instrument has been expanded to assess other behaviors, such as drug use, sexual behavior, binge eating, and panic attacks. Some evidence for the validity and reliability of this assessment instrument has emerged in the area of adult smoking. However, to date, there is no published evidence of its reliability and validity in the assessment of adolescent smoking. The purpose of this study is to present early evidence of the utility of the TLFB to collect information on adolescent smoking behavior. Through secondary data analysis of four studies on adolescent smokers, we examined the associations between the TLFB and measures of dependence, smoking history, respiratory symptoms, and saliva cotinine. Moreover, we examined the stability of the TLFB data across two 15-day time periods. Results provide preliminary evidence of the validity and reliability of the TLFB in the assessment of adolescent smoking. In particular, the TLFB instrument offered important data on the heterogeneity of adolescent smoking patterns beyond a global measure of cigarettes per day, and the reduction of digit bias. Implications of these findings for the assessment of adolescent smoking are discussed.