Adolescent Smoking Behavior Research Articles

Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours.

The tobacco industry denies that their marketing is targeted at young nonsmokers, but it seems more probable that tobacco advertising and promotion influences the attitudes of nonsmoking adolescents, and makes them more likely to try smoking. To assess the effects of tobacco advertising and promotion on nonsmoking adolescents' future smoking behaviour. We searched the Cochrane Tobacco Group specialized register, the Cochrane Central Register of Controlled Trials, MEDLINE, the Cochrane Library, Sociological Abstracts, PsycLIT, ERIC, WorldCat, Dissertation Abstracts, ABI Inform and Current Contents to August 2002. We selected longitudinal studies that assessed individuals' smoking behaviour and exposure to advertising, receptivity or attitudes to tobacco advertising, or brand awareness at baseline, and assessed smoking behaviour at follow-ups. Participants were adolescents aged 18 or younger who were not regular smokers at baseline. Studies were prescreened for relevance by one reviewer. Two reviewers independently assessed relevant studies for inclusion. Data were extracted by one reviewer and checked by a second. Nine longitudinal studies that followed up a total of over 12,000 baseline nonsmokers met inclusion criteria. The studies measured exposure or receptivity to advertising and promotion in a variety of ways, including having a favourite advertisement or an index of receptivity based on awareness of advertising and ownership of a promotional item. One study measured the number of tobacco advertisements in magazines read by participants. All studies assessed smoking behaviour change in participants who reported not smoking at baseline. In all studies the nonsmoking adolescents who were more aware of tobacco advertising or receptive to it, were more likely to have experimented with cigarettes or become smokers at follow-up. There was variation in the strength of association, and the degree to which potential confounders were controlled for. Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke. Based on the strength of this association, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke.

Adolescent smoking behavior: Measures of social norms

Background Relatively little research has focused on the social norms of teen smoking. This study examined social norms regarding adolescent smoking and their relationship with smoking behavior. Methods Data were collected in 1998 as part of the follow-up for a randomized trial in 14 rural Minnesota communities. Four aspects of perceived social norms of smoking were measured, and students were classified as nonsmokers, daily smokers, past-week smokers, or past-month smokers. Social norms were compared across four levels of smoking behavior, and multivariate models controlled for personal characteristics and family and peer smoking. Results The sample comprised a total of 3128 girls and 3146 boys in grades 8 to 10. For all four measures, nonsmokers had the most antismoking perceptions of social norms around smoking ( p <0.001). In multivariate models, noticing other teens smoking and the perception that adults care about and disapprove of teen smoking remained significantly related to past-month smoking. Using more frequent smoking as the dependent variable, noticing smoking remained significantly associated with smoking in the anticipated direction. Perceived prevalence of smoking did not perform consistently across models. Conclusions Noticing teens smoking is associated with smoking behavior across three different levels of smoking frequency. The perception that adults care about and disapprove of teen smoking was associated with past-month and past-week smoking. Although perceived prevalence is often used to measure social norms of teen smoking, this measure may have limited utility. Strategies for health promotion and intervention on the issue of youth smoking are discussed.

Both low and high activities of platelet monoamine oxidase increase the probability of becoming a smoker

Platelet monoamine oxidase (MAO) activity is a marker of personality and psychiatric vulnerability, but the direct inhibitory action of tobacco constituents on the enzyme distorts the association. In the present investigation, data from a prospective longitudinal study of smoking behaviour and platelet MAO activity in adolescents at ages 15 and 18 years were sequentially analysed using a second-order multiple logistic regression analysis. The odds of regular smoking at 18 years increased significantly with increasing absolute deviation of platelet MAO activity at 15 years from the mean. That is, both low and high platelet MAO activity at 15 years predicted a higher probability of becoming a smoker. These data suggest that smoking is associated with low platelet MAO activity not only because of the direct inhibitory effect of tobacco constituents on the enzyme, but also because subjects with low platelet MAO activity are more likely to become smokers. Furthermore, the possible association between above-average platelet MAO activity and behavioural phenotypes should be reexamined.

The association of current smoking behavior with the smoking behavior of parents, siblings, friends and spouses.

To examine the association of current smoking behavior of adolescents and young adults with the smoking behavior of their parents, siblings, friends and spouses. Using survey data from a large twin-family sample, the association between the smoking behavior of participants and that of their family members, friends and spouses was investigated by calculating the relative risk. To disentangle sex and age differences, calculations were carried out separately for males and females and for three different age groups: 12-15, 16-20 and 21-40 years old. The smoking behavior of the participants was significantly influenced by the smoking behavior of parents, siblings and friends, but all relative risks decreased with age. No differences in relative risk were found between having older or younger smoking siblings. Within each age group, the relative risk to smoke when having a smoking friend was comparable to the relative risk to smoke when having a smoking same-age and same-sex sibling. For the older participants, the relative risk to smoke was higher for monozygotic (MZ) twins with a smoking co-twin than for dizygotic (DZ) twins with a smoking co-twin. Most findings were sex-dependent: same-sex smoking family members influenced smoking behavior more than opposite-sex family members. The significant association of the smoking behavior of spouses decreased with age, which suggests that assortment for smoking is based on similarity at the time dating began. The results highlight the importance of both social and genetic influences on smoking behavior, with genetic influences increasing with the age of the participant.

Latent mixed Markov modelling of smoking transitions using Monte Carlo bootstrapping

It has been established that measures and reports of smoking behaviours are subject to substantial measurement errors. Thus, the manifest Markov model which does not consider measurement error in observed responses may not be adequate to mathematically model changes in adolescent smoking behaviour over time. For this purpose we fit several Mixed Markov Latent Class (MMLC) models using data sets from two longitudinal panel studies--the third Waterloo Smoking Prevention study and the UWO smoking study, which have varying numbers of measurements on adolescent smoking behaviour. However, the conventional statistics used for testing goodness of fit of these models do not follow the theoretical chi-square distribution when there is data sparsity. The two data sets analysed had varying degrees of sparsity. This problem can be solved by estimating the proper distribution of fit measures using Monte Carlo bootstrap simulation. In this study, we showed that incorporating response uncertainty in smoking behaviour significantly improved the fit of a single Markov chain model. However, the single chain latent Markov model did not adequately fit the two data sets indicating that the smoking process was heterogeneous with regard to latent Markov chains. It was found that a higher percentage of students (except for never smokers) changed their smoking behaviours over time at the manifest level compared to the latent or true level. The smoking process generally accelerated with time. The students had a tendency to underreport their smoking behaviours while response uncertainty was estimated to be considerably less for the Waterloo smoking study which adopted the 'bogus pipeline' method for reducing measurement error while the UWO study did not. For the two-chain latent mixed Markov models, incorporating a 'stayer' chain to an unrestricted Markov chain led to a significant improvement in model fit for the UWO study only. For both data sets, the assumption for the existence of an independence chain did not lead to significant improvement in model fit. The unrestricted two-chain latent mixed Markov model led to a significant improvement of model fit compared to a simple latent Markov model, but this model was overparameterized when the latent transition probabilities and/or response probabilities were assumed nonstationary. For the other models, the manifest/latent transition probabilities and response probabilities (for the four-wave Waterloo study only) were tested to be nonstationary for both data sets.

Ethnic differences in adolescent smoking behaviors, sources of tobacco, knowledge and attitudes toward restriction policies

The purpose of this study was to examine racial/ethnic differences in adolescent smoking behavior, sources of tobacco, knowledge of and attitudes toward youth tobacco restriction policies, and perceptions of tobacco availability by adolescents. The study is important as it will add to the growing body of literature regarding tobacco use by minors, and will help policymakers and public health professionals develop efficacious policies and interventions to prevent and reduce tobacco use among adolescents. Minors obtain tobacco from social and commercial sources. Previous studies have emphasized rural homogeneous populations and so the present study addresses the need to determine these sources of tobacco to youth in a large urban, heterogeneous population, such as Philadelphia. A stratified multistage purposive sampling procedure was used to ensure an ethnically/racially sample. A 68-item questionnaire was administered to 645 students in Grades 8–10 in five public and nonpublic funded schools in a culturally diverse part of Philadelphia. Correlations between selected independent variables and smoking behavior were determined. Results from this study indicate that rates of smoking are high among students, with 50% of students ever having smoked, 19% within the last month, 17% weekly, and 15% smoke daily. Further, there were differences in rates of smoking between ethnic/racial groups. Social sources were the most common sources of tobacco reported, with friends being the most frequent source. There were differences in social and commercial ever sources of cigarettes between ethnic/racial groups and in perceived school and parental sanctions for tobacco use. The results of this study suggest that more financial and educational resources should be committed to prevent and reduce smoking behaviors among adolescents. Educational prevention programs, especially parenting programs should be employed to reduce smoking.

Social Context and Adolescent Health Behavior: Does School-Level Smoking Prevalence Affect Students' Subsequent Smoking Behavior?

This paper examines the links between individual adolescent smoking behavior and actual and perceived smoking behavior in the individual's school cohort. We hypothesized that students enrolled in schools with higher smoking prevalence among students in their grade are more likely to smoke subsequently. We also expected perceived school-level prevalence of smoking to have a greater impact than actual prevalence because the former is a more direct measure of perceived norms. Adjusting for demographics, actual school-level prevalence at baseline (grade 7) was strongly associated with smoking frequency one year later. However, the association disappeared after adjusting for individual smoking frequency at baseline. School-level prevalence did not moderate the association between individual's baseline and subsequent smoking frequency. Perceived prevalence of smoking among grade 8 students and two measures tapping the behavior of smaller peer groups--cigarette offers and exposure to friends and other peers who smoke--were associated with increased risk of smoking.

Struggling to understand: the experience of nonsmoking parents with adolescents who smoke.

Smoking among adolescents is a major public health concern. Most parents would not want their children engaged in this risk-taking behavior. Although a majority of parents of smokers are themselves smokers, many are nonsmokers. The purpose of this grounded theory study was to understand what nonsmoking parents experience due to their adolescent children 's smoking behavior. The purposive sample consisted of 25 parents. The interview data generated the theory that nonsmoking parents struggle to understand their adolescents' smoking. They experienced four stages: discovering the smoking, facing the problem, reflecting, and waiting it out. Their experience can be examined from a stress paradigm. Programs are needed that provide parents with the knowledge and skills required for effective prevention and intervention strategies.

Adolescents' acquisition of cigarettes through noncommercial sources.

To examine the association between demographic and smoking behavior variables and the likelihood of acquiring cigarettes through noncommercial sources. The Robert Wood Johnson Foundation's 1996 National Study of Tobacco Price Sensitivity, Behavior, and Attitudes among Teenagers and Young Adults was the data source in this analysis. Respondents were high school students (grades 9 through 12) ages 13 to 19 years. The sample sizes, respondent selection procedures, and weighting procedures were designed to develop national estimates of adolescent smoking behaviors and attitudes. The questionnaire, modeled on previous surveys and input from leading tobacco control experts, was self-administered. Logistic regression was used to model the independent effects of each variable on the outcome while controlling for the influence of all other variables in the model. An inverse relationship was found between age and the likelihood of acquiring cigarettes through noncommercial sources. Females were 58% more likely to acquire cigarettes through noncommercial sources than were males. There were no differences among adolescents of different racial/ethnic groups in acquisition through noncommercial sources. Those who believed that cigarettes were difficult to acquire were more likely to obtain cigarettes by noncommercial means. Although point-of-sale restrictions have been a focal point of tobacco control legislation, these data suggest that younger smokers and those who view commercial purchase to be difficult are not using commercial sources. Therefore, more comprehensive approaches to limiting access may be required to address all sources of adolescents' acquisition. The proliferation of point-of-sale restrictions may have contributed to increases in noncommercial acquisition by creating the impression that cigarettes were more difficult to purchase. This reinforces the need for educational programs, interventions, and policies that more effectively target noncommercial sources of cigarettes.

Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark

Objective: To determine whether adolescent smoking behaviour is associated with their perceived exposure to teachers or other pupils smoking at school, after adjustment for exposure to smoking at home, in...

A comparison of predictors of the adolescent intention to smoke with adolescent current smoking using discriminant function analysis.

This paper explores one possible operationalization of smoking intention to assist development of adolescent smoking intervention programmes. Such programmes usually focus on predictors of current smoking, ignoring predictors of intentions to smoke, or how intentions relate to actual future smoking. Respondents took part in two stages of a repeated measures national survey on Australian adolescent smoking behaviour (12-month interval between administrations). A total of N=1419 adolescents provided matched data, measuring personal smoking habits, intentions of smoking behaviour, stress (seven subscales), self-esteem and response to the General Health Questionnaire (GHQ-12). A comparison of discriminant function predictors showed similarity between the current smoking and intention to smoke, with only one predictor differing between the functions. Non-smokers were more behaviourally consistent with their stated non-smoking intention over 12 months (i.e. remain non-smokers) than smokers (i.e. intention seemed unrelated to actual behaviour). While the predictors give no general indication of whether the processes behind the intention to smoke differ from current smoking, the intention to smoke may be a better focus for intervention with smokers given the apparent inconsistency with stated intention. Intervention for non-smokers may be usefully focused on maintaining non-smoking rather than preventing smoking.

The Incidence and Context of Tobacco Use in Popular Movies from 1988 to 1997

Objective. The aim of this study was to describe tobacco use in a large representative sample of movies.Methods. We analyzed the content of the top 25 box office hits per year from 1988 to 1997. Outcomes included the number of occurrences of tobacco use, the time tobacco use appeared on screen, the context in which tobacco use was portrayed, and characteristics of smokers compared with nonsmokers.Results. Eighty-seven percent of the movies portrayed tobacco use, with a median of 5 occurrences per film. Tobacco use was not related to year of release or box office success of the movie. R-rated movies had the greatest number of occurrences (median = 8.5; P < 0.05) and were most likely to feature major characters using tobacco (81%, P < 0.001). Among major characters, males were more likely to use tobacco than females (28% vs 17%, P < 0.001), but there was no difference in the prevalence of tobacco use by age, race, or socioeconomic status. Tobacco users were typically adults (96.3%) who were more likely to engage in a variety of other risk behaviors. Most tobacco use involved cigarettes or cigars (89.5%). Motivations for on-screen smoking included agitation (20.1%), sadness (5.1%), happiness (15.3%), and relaxation (17.1%). Characters were often shown smoking while confiding in others (30.7%) or in social/celebratory situations (18.0%). Negative reactions to tobacco use were rarely shown (5.9%) and negative consequences resulting from tobacco use were depicted for only 3.4% of the major characters who used tobacco.Conclusion. Despite increasing anti-smoking sentiments in our society, negative reactions to smoking are rare and there is no evidence that tobacco use in movies has declined over the past decade. Movies continue to model smoking as a socially acceptable behavior and portray it as both a way to relieve tension and something to do while socializing. By depicting positive images of tobacco use, movies have the potential to influence adolescent smoking behavior as much as any other environmental exposure, such as family or friend smoking.

Peer Influences and Access to Cigarettes as Correlates of Adolescent Smoking: A Cross-Cultural Comparison of Wuhan, China, and California

Background. Few studies have assessed the effects of access to cigarettes and peer influences on adolescent smoking in non-Western countries. Using samples characterized by two distinct cultural, social, and economic systems, this study evaluated the associations of friends' smoking and perceived access to cigarettes with adolescent smoking behavior in California and Wuhan, China.Methods. Survey data were obtained from 5870 eighth-grade students in the Independent Evaluation of the California Tobacco Control Program and 6992 seventh- to ninth-grade students in the Wuhan Smoking Prevention Trial. Odds ratios for lifetime and 30-day smoking, according to friends' smoking and perceived access to cigarettes, were calculated for boys and girls in both samples and compared.Results. California students were more likely than Wuhan students to have friends who smoked and to perceive easy access to cigarettes. The smoking prevalence was lower in Wuhan than in California, mainly due to the low smoking prevalence among Wuhan girls. Friends' smoking was strongly associated with smoking in both samples, and the strength of this association did not differ between the two cultures. Access to cigarettes was associated with a higher risk of lifetime smoking in both cultures and a higher risk of past 30-day smoking in California only.Conclusions. Despite divergent tobacco control policy enforcement, social structures, and cultural contexts, similarities exist between Wuhan and California. The findings suggest support for adapting a social-influences-based smoking prevention program developed in the United States to the culturally specific needs of youth in Wuhan, China.

“Kicking the Initiation”: Do Adolescent Ex-smokers Differ from Other Groups within the Initiation Continuum?

Background. Current research on the continuum of smoking initiation has largely focused on phases of progressing frequency of smoking. To gain more insight into reasons some adolescents do, and others do not, proceed to advanced levels of smoking behavior, a continuum in which two categories of ex-smoking are proposed is examined.Methods. Standardized scores on psychosocial predictors of smoking among adolescent nonsmoking deciders and quitters were compared cross-sectionally with those of the categories of never smokers, triers, experimenters, and regular smokers (n = 23,317).Results. Never smokers, triers, experimenters, and regular smokers had significantly different characteristics with regard to psychosocial predictors of smoking (P < 0.01), with scores of never smokers indicating that they were least at risk of smoking in the future and those of regular smokers indicating that they were most at risk. Scores of nonsmoking deciders showed that they were less at risk than triers and experimenters and more at risk than never smokers. Quitters seemed to have less risky psychosocial characteristics than experimenters and more risky characteristics than nonsmoking deciders.Conclusions. Studying transitions of smoking behavior based on six possible phases (i.e., never smoking, nonsmoking deciding, trying, experimenting, regular smoking, and quitting) might lead to more valid insights into predictors of adolescent smoking behavior.

The Effects of Group Smoking Cessation Program on the Smoking Cessation Behavior, Stress, Depression, Self-esteem, and Assertive Behavior

The major purpose of this study was to examine effects of the group smoking cessation program on the smoking cessation behavior. stress, depression, self-esteem, and assertive behavior.The study sample consisted of 25 high-school students, and they were exposed to the smoking cessation program. The major contents of the smoking cessation program included value perspectives auction game, group discussion and video on smoking hazards, positive reinforcement, learning and practicing stress reduction strategies, and assertive training etc., and they were given 9 sessions, twice a week.The instruments used for the study were Fagerstrom Tolerence Questionnaire (Fagerstrom. 1978), Lee's stress inventory, Center for Epidemiologic Studies Depressed Mood Scale (CES-D), Coopersmith's Self-esteem Inventory, and Rathus assertive behavior scale.The data were collected from October 25 to November 22, 1999, and were analysed by frequency, and paired t-test. The results were as follows.1. The scores of nicotine dependency(t=1.825. p=.080). stress(t=.564, p=.578), and depression (t=.374, p=.712) were decreased over time, however they were not statistically significant.2. The score of self-esteem(t=-.385. p= 704) and assertive behavior (t=-.107, p=.916) were increased over time, however they were not statistically significant.Although the effects of group smoking cessation program on nicotine dependency, stress, depression, self-esteem and assertive behaviors was not statistically significant, most students reported that they exerted to change smoking behaviors over time. and made effort to stop smoking. These findings are very meaningful, because they showed no intention to stop smoking at the early stage of the program.Therefore tailoring interventions to participants' motivation level must be developed to reduce adolescents smoking behavior.

Adolescent cigarette smoking and health risk behavior

During the past 30 years, tobacco use among adolescents has substantially increased, resulting in major health problems associated with tobacco consumption. The purpose of this study was to identify adolescent smoking behaviors and to determine the relationship among smoking, specific demographic variables, and health risk behaviors. The sample consisted of 93 self-selecting adolescents. An ex post facto design was used for this study and data were analyzed by using nonparametric statistics. Findings included a statistically significant relationship between lifetime cigarette use and ethnicity. Statistically significant relationships were also found among current cigarette use and ethnicity, alcohol use, marijuana use, suicidal thoughts, and age at first sexual intercourse. Nurses and other providers must recognize that cigarette smoking may indicate other risk behaviors common among adolescents. Copyright © 2001 by W.B. Saunders Company

Hazard of Smoking Initiation by Age among Adolescents in Wuhan, China

Background. Knowledge about age of smoking initiation among adolescents in China is helpful for exploring cultural differences in adolescent smoking behavior and informative for global tobacco control. However, little has been documented on this issue.Method. Adolescents (6,473) attending grades 7, 8, and 9 completed the baseline survey of a longitudinal, randomized smoking prevention trial. Data were collected in classrooms with a paper-and-pencil questionnaire. A survival model was used in the statistical analysis.Results. The hazard of smoking initiation for boys showed a pattern previously observed in the United States: very low (<2%) before 7 years of age, increasing rapidly after age 10, and peaking at 14–15 years of age. The hazard for girls was below or around 1% until 12 years of age before it increased. The hazard levels were similar for adolescents both in urban and in rural areas, but higher for those in grade 7 than in grades 8 and 9.Conclusions. Chinese boys in Wuhan, China, experienced a hazard pattern of smoking initiation by age similar to those observed in the United States, while Chinese girls there experienced a rather low risk of smoking initiation. The hazard pattern suggests that the best time for smoking prevention is between 10 and 15 years of age. Adolescents in lower grades are at higher risk of early smoking initiation, suggesting a potential cohort effect in adolescent smoking initiation in Wuhan, China.

Self‐esteem, stress and cigarette smoking in adolescents

AbstractBoth high stress and low self‐esteem have been consistently, though independently, reported to relate to aspects of adolescent smoking behaviour. Recent work on self‐esteem, however, suggests that adequate provision of this attribute may protect the individual adolescent from unpleasant dysphoric or harmful behavioural states. In line with this suggestion, the present study sought to extend this to the area of adolescent smoking behaviour. While independent associations were confirmed there was not strong support for a protective effect of self‐esteem on adolescent smoking in the face of stressor exposure. A modest sex effect was evident but not of sufficient magnitude to allow firm conclusions. Nonetheless, the results were tempting enough to indicate further investigation. Copyright © 2001 John Wiley &amp; Sons, Ltd.

A cusp catastrophe analysis of changes to adolescent smoking behaviour in response to smoking prevention programs

The efficacy of smoking prevention programs aimed at adolescent smoking behaviour is widely debated in the health psychology literature. In general, however, these are not seen to be particularly effective in eliminating this acknowledged health risk behaviour. Even when positive results are presented, they frequently assume a linear association between exposure to some prevention or other and the dynamics of subsequent smoking behaviour change. Clair (1998) demonstrated that for alcohol consumption behaviour in adolescents, at least, this was not necessarily so. A nonlinear model, and in Clair's particular case, a Cusp Catastrophe Model (CCM) provided a better fit for the data than did any of a number of simple or interactive linear models. The present paper reports the use of precisely the same analysis for change in adolescent smoking behaviour following exposure to one or other of three smoking prevention programs of different orientations. While changes to adolescent smoking behaviour were evident following intervention, the reported analyses suggested that unlike alcohol consumption behaviour, CCM's were not necessarily the best nonlinear representation of the data.

Adolescents and smoking: evidence from France and Spain

Until recently detailed evidence on smoking and its reduction was found mainly in the U.S.A. and the U.K. Now there is active research in a much wider range of countries which increases the potential for international comparison and international learning. In this paper we focus on the recent evidence now available from France and Spain for the smoking behaviour of adolescents and young people.