Smoking Status Of Children Research Articles

Incentives for preventing smoking in children and adolescents.

Incentives for preventing smoking in children and adolescents.

Family-based programmes for preventing smoking by children and adolescents.

There is evidence that family and friends influence children's decisions to smoke. To assess the effectiveness of interventions to help families stop children starting smoking. We searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO, CINAHL unpublished material, and key articles' reference lists. We performed free-text internet searches and targeted searches of appropriate websites, and hand-searched key journals not available electronically. We consulted authors and experts in the field. The most recent search was 3 April 2014. There were no date or language limitations. Randomised controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and families to deter tobacco use. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention. We reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data for each RCT and assessed them for risk of bias. We pooled risk ratios using a Mantel-Haenszel fixed effect model. Twenty-seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow-up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty-three interventions were tested in the USA, two in Europe, one in Australia and one in India.The control conditions fell into two main groups: no intervention or usual care; or school-based interventions provided to all participants. These two groups of studies were considered separately.Most studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta-analysis.There was moderate quality evidence family-based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non-smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but confidence intervals were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17).Eight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta-analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n = 388).No studies identified any adverse effects of intervention. There is moderate quality evidence to suggest that family-based interventions can have a positive effect on preventing children and adolescents from starting to smoke. There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons. The evidence is therefore strongest for high intensity programmes used independently of school interventions. Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%. However, these findings should be interpreted cautiously because effect estimates could not include data from all studies. Our interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting.

Cochrane review: Family‐based programmes for preventing smoking by children and adolescents

AbstractBackgroundThere is evidence that children's decisions to smoke are influenced by family and friends.ObjectivesTo assess the effectiveness of interventions to help family members to strengthen non‐smoking attitudes and promote non‐smoking by children and other family members.Search strategyWe searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO and CINAHL. We also searched unpublished material, and the reference lists of key articles. We performed both free‐text Internet searches and targeted searches of appropriate web sites, and we hand‐searched key journals not available electronically. We also consulted authors and experts in the field. The most recent search was performed in November 2007.Selection criteriaRandomized controlled trials (RCTs) of interventions with children (aged 5‐12) or adolescents (aged 13‐18) and family members to deter the use of tobacco. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention.Data collection and analysisWe reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data and assessed them for methodological quality. The studies were too limited in number and quality to undertake a formal meta‐analysis, and we present a narrative synthesis.Main resultsWe identified 22 RCTs of family interventions to prevent smoking. We identified six RCTs in Category 1 (minimal risk of bias on all counts); ten in Category 2 (a risk of bias in one or more areas); and six in Category 3 (risks of bias in design and execution such that reliable conclusions cannot be drawn from the study).Considering the sixteen Category 1 and 2 studies together: (1) four of the nine that tested a family intervention against a control group had significant positive effects, but one showed significant negative effects; (2) one of the five RCTs that tested a family intervention against a school intervention had significant positive effects; (3) none of the seven that compared the incremental effects of a family plus a school programme to a school programme alone had significant positive effects; (4) the one RCT that tested a family tobacco intervention against a family non‐tobacco safety intervention showed no effects; and (5) the trial that used general risk reduction interventions found the group which received the parent and teen interventions had less smoking than the one that received only the teen intervention, and in the trial of CD‐ROMs to reduce alcohol use, both groups which received the alcohol reduction intervention had less smoking than the control. In neither trial was there a tobacco intervention, but tobacco outcomes were measured.For the included trials the amount of implementer training and the fidelity of implementation are related to positive outcomes, but the number of sessions is not.Authors' conclusionsSome well‐executed RCTs show family interventions may prevent adolescent smoking, but RCTs which were less well executed had mostly neutral or negative results. There is thus a need for well‐designed and executed RCTs in this area.Plain Language SummaryDoes preventing children from starting to smoke reduce the number of people damaging their health by smokingChildren and adolescents' likelihood of starting to smoke may be influenced by the behaviour of their families, and it may be possible to help family members strengthen non‐smoking attitudes and promote non‐smoking in children and other family members. Some high quality studies show that family interventions may help to prevent adolescent smoking, but less well‐conducted trials had mostly neutral or negative findings. How well the programme staff are trained and how well they deliver the programme may be related to effectiveness, but the number of sessions in the programme does not seem to make a difference.

The moderating role of parental smoking on their children's attitudes toward smoking among a predominantly minority sample: a cross-sectional analysis

BackgroundIn general having a parent who smokes or smoked is a strong and consistent predictor of smoking initiation among their children while authoritative parenting style, open communication that demonstrates mutual respect between child and parent, and parental expectations not to smoke are protective. It has been hypothesized that parental smoking affects their children's smoking initiation through both imitation of the behavior and effects on attitudes toward smoking. The goals of the current analysis were to examine these two potential mechanisms.MethodsIn 2003, 1,417 high school students in Houston, Texas, completed a cross-sectional survey as part of the evaluation of an interactive smoking prevention and cessation program delivered via CD-ROM. To assess the relationship between number of parents who currently smoke and children's smoking status, we completed an unconditional logistic regression. To determine whether the attitudes that children of smokers hold toward smoking are significantly more positive than the attitudes of children of non-smokers we examined whether the parents smoking status moderated the relationship between children's attitudes toward smoking and their ever smoking using unconditional logistic regressions.ResultsCompared to participants whose parents did not currently smoke, participants who reported one or both parents currently smoke, had increased odds of ever smoking (OR = 1.31; 95% CI: 1.03–1.68; Wald χ2 = 4.78 (df = 1) p = 0.03 and OR = 2.16; 95% CI: 1.51–3.10; Wald χ2 = 17.80 (df = 1) p < 0.001, respectively). In addition, the relationship between attitudes and ever smoking was stronger among participants when at least one parent currently smokes (OR = 2.50; 95% CI: 1.96–3.19; Wald χ2 = 54.71 (df = 1) p < 0.001) than among participants whose parents did not smoke (OR = 1.72; 95% CI: 1.40–2.12; Wald χ2 = 26.45 (df = 1) p < 0.001).ConclusionChildren of smokers were more likely to smoke and reported more favorable attitudes toward smoking compared to children of non-smokers. One interpretation of our findings is that parental smoking not only directly influences behavior; it also moderates their children's attitudes towards smoking and thereby impacts their children's behavior. Our results demonstrate a continued need for primary prevention smoking interventions to be sensitive to the family context. They also underscore the importance of discussing parental smoking as a risk factor for smoking initiation, regardless of ethnicity, and of tailoring prevention messages to account for the influence that parental smoking status may have on the smoking attitudes and the associated normative beliefs.

Close friends', parents', and older siblings' smoking: Reevaluating their influence on children's smoking

A number of longitudinal studies have explored the role of friends', parents', and older siblings' smoking in children's smoking acquisition. A reasonable implication of this previous research is that intervention efforts could be beneficially directed toward countering the potential influence of friends' and possibly older siblings' smoking but not parents' smoking. However, methodological limitations of this previous research motivated our reevaluation of the role of friends', parents', and older siblings' smoking in children's smoking. Close friends' smoking status was assessed when children were in 5th grade, whereas parents' and older siblings' smoking status was assessed when children were in 3rd grade. The outcome, children's daily smoking status, was assessed in 12th grade. The setting was 40 Washington state school districts that participated in the long-term Hutchinson Smoking Prevention Project. Participants were the 4,576 families for whom close friends', parents', and older siblings' smoking status as well as children's smoking status were available. The probability that each close friend's smoking influenced the child to smoke daily was 9% (95% CI = 6%-12%), the probability that each parent's smoking influenced the child to smoke daily was 11% (95% CI = 9%-14%), and the probability that each older sibling's smoking influenced the child to smoke daily was 7% (95% CI = 1%-13%). These results suggest that close friends', parents', and siblings' smoking were similarly important influences on children's smoking. Family-focused interventions could be a valuable future direction of prevention research.

Parental smoking cessation and children's smoking: Mediation by antismoking actions

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.

The effects of work on the growth of Jordanian boys.

To examine the effects of work on growth among boys aged 10-16 years in Jordan. Cross-sectional health survey comparing working and non-working boys. Height for age z-score; weight for age z-score. One hundred and thirty-five working and 405 non-working boys aged 10-16 years were studied in the Jordanian areas of Irbid, Jarash and North Jordan Valley. The boys and their mothers were interviewed and data collected on work status, child's smoking status, and family socio-economic characteristics including per capita income, family size, maternal and paternal education, area of the house in square metres and expenditure on household durables. Height and weight were obtained at the time of interview. Linear regression models were fitted on height for age z-score and weight for age z-score. In bivariate analysis, child's work status (r = -0.221), household per capita income (r = 0.104), family size (r = -0.102), house m2 per capita (r = 0.090) and monthly expenditure on durables (r = 0.086) were significantly correlated with height z-score. Work status (P < 0.0001) and household m2 per capita (P = 0.002) were retained in the regression model fitted on height z-score which explained 9.8% of the variance. The model fitted on weight z-score explained 6.5% of the variance and work status (P < 0.0001), household per capita income (P = 0.041) were retained. The results of this study suggest that, independent of a range of socio-economic factors, work has a negative effect on child growth. Given the extent of child labour internationally these findings have profound implications for global child well-being and for global social and economic policy.

Nine-year prospective relationship between parental smoking cessation and children's daily smoking.

The first prospective investigation of the extent to which parental smoking cessation predicts their children's daily smoking. Parental smoking status was assessed when children were aged 8/9 years and children's smoking status was assessed at age 17/18 years. Twenty Washington State school districts in the control group of the Hutchinson Smoking Prevention Project. Questionnaire data were gathered on 3012 children (49% female and 91% Caucasian) and both of their parents in a cohort with a 95% retention rate. When both parents quit smoking, children's odds of daily smoking were reduced by 39% (95% CI = 15%,56%) compared to when both parents were current smokers.Furthermore, when both parents never smoked then children's odds of daily smoking were reduced by 71% (95% CI = 62%,78%). Parental smoking cessation is associated with reduced risk of their children's daily smoking. Parents who quit still place children at substantially higher risk compared to parents who never smoked.

Anti-Smoking Socialization: Relationship to Parent and Child Smoking Status

Anti-smoking socialization is defined as the transmission of knowledge, attitudes, and skills that prepare children to resist smoking. Three types of anti-smoking socialization are studied: parents' communication with children regarding no-smoking rules at home, health risks associated with smoking, and the disciplinary consequences of smoking. Results from a survey of children in 3rd through 8th grades (N = 937) indicate that (a) children from households where one or both parents smoke perceive less anti-smoking socialization than their peers from nonsmoking households; (b) anti-smoking socialization is positively associated with authoritative parenting; (c) children have significantly lower rates of smoking intention and initiation when parents engage in anti-smoking socialization, even if parents currently smoke. The findings offer an encouraging message to all parents Communicating anti-smoking messages may effectively discourage children from smoking

Cigarette smoking and drug use in schoolchildren. II. Factors associated with smoking.

In 1979 as the first stage in the evaluation of an educational strategy to discourage children from smoking, we surveyed over 6000 10-12 year old primary school children in the Hunter Health Region (New South Wales, Australia) to assess the prevalence of smoking and to identify some of the social and personal factors associated with this phenomenon. Logistic regression was used to determine the relative importance of the key factors in relation to the proportion of smokers in the 'recent' and 'regular' smoking categories. Friends' smoking behaviour was the best predictor of the child's smoking status followed in order by approval of advertising, siblings' smoking behaviour, amount of money available to spend weekly, sex, age and finally parents' smoking habits. Other factors such as size of family, position of the child in the family, country of birth of parents, father's occupation, having a single parent and urban or non-urban location of schools were all significantly associated with smoking prevalence in these children. Linear modelling techniques used in the analysis showed girls and non-smokers to have less favouring attitudes to smoking and tobacco advertising than boys and smokers. Significant differences in knowledge occurred between categories of smokers. Most children claiming not to smoke disapproved of advertising and did not intend to smoke in the future. Among current smokers, some with neutral or favouring attitudes were ambivalent about future smoking. Our data suggest that intervention in the field of cigarette advertising may be the most direct and effective means of reducing prevalence of smoking in children.