Early Smoking Initiation Research Articles

The effect of smoking on nontuberculous mycobacterial pulmonary disease and tuberculosis: a nationwide retrospective cohort study.

Although smoking is an established risk factor for Mycobacterial infection, the association between smoking and nontuberculous mycobacterial pulmonary disease (NTM-PD) remains unclear. We evaluated the association between smoking and NTM-PD and tuberculosis (TB) using a population-based South Korean nationwide cohort. Using the Korean National Health Insurance Database, we screened individuals over 20years of age who underwent the national health screening program in 2009. Out of 3,774,308 eligible populations, we identified 2,964 and 26,112 cases of newly developed NTM-PD and TB, respectively. We used multivariate Cox proportional hazards models to estimate the adjusted hazard ratios (aHRs) of risk factors for NTM-PD and TB. The incidence rates for developing NTM-PD and TB were 0.08 and 0.68 per 1,000 person-years, respectively. Current smokers (aHR 0.63, 95% confidence interval [CI] 0.56-0.71) and current heavy smokers (≥ 20 pack-years, aHR 0.74, 95% CI 0.63-0.86) were at lower risk for NTM-PD development than never smokers. On the contrary, current smokers (aHR 1.19, 95% CI 1.15-1.23) and current heavy smokers (aHR 1.27, 95% CI 1.22-1.33) had a higher risk for TB development than never smokers. These trends were augmented if individuals started smoking before age 20years. In subgroup analyses stratified by age, these trends were prominent in the 40-64years age range. Current smoking was associated with a decreased risk of NTM-PD and increased risk of TB. These risks were augmented by early smoking initiation and in the middle age population.

Predictor of smoking cessation among school-going adolescents in Indonesia: a secondary analysis based on the transtheoretical model of behavioral change.

This study elucidates the complex journey of adolescents toward smoking cessation, investigating the association of relevant demographic factors, advertising, promotion, anti-cigarette messages, and individual knowledge and attitudes with being in different smoking cessation stages. Utilizing data from the 2019 Indonesia Global Youth Tobacco Survey, this secondary analysis included adolescents who reported ever smoking. The Transtheoretical Model (TTM) guided the categorization of the outcome variable into three smoking cessation stages based on the responses to two questions related to the intention and timing of the smoking cessation. This included contemplation, action, and maintenance stages. Multinomial logistic regression analyzed the associations between each independent variable and being in each stage of smoking cessation. The study comprised 3596 Indonesian adolescents from grades 7-12, of which 2484 responded to two questions related to intention and timing of smoking cessation and were included in regression analysis. Findings indicate that males and those aged ≥16 were predominantly in contemplation phase. Early smoking initiation, usage of other tobacco products, and exposure to various forms of smoke increased the likelihood of being in contemplation and action phases. Parental smoking, school smoking exposure, and second-hand smoke were significant contemplation phase predictors. Exposure to tobacco advertising was linked to an increased likelihood of being in contemplation and action phases, whereas anti-cigarette messages showed no significant impact. Awareness of cigarette and second-hand smoke harms reduced the odds of being in the contemplation phase, while enjoying smoking and willingness to accept cigarettes from friends increased the odds of being in contemplation and action phases rather than in maintenance phase. Addressing age, gender, cultural influences, environmental factors, and attitudes towards smoking through tailored interventions is vital for aiding smoking cessation in Indonesian adolescents. Strengthened tobacco control in schools and public places is recommended to bolster these efforts. Longitudinal studies are required to explore the evolving patterns of smoking cessation behaviors over time, enhancing our understanding of the factors influencing sustained cessation.

Inequalities in Smoking and E-Cigarette Use in Young Adults With Mental Ill-Health, 20 years After Ireland's Smoking Ban.

Background: Ireland's Smoking Ban reduced health inequalities known to be associated with smoking but some groups may not have benefitted. Mental ill-health and smoking are known to be associated with health inequalities. Whether similar patterns exist for e-cigarette use is less clear, as few data exist. Objectives: To examine: (1) self-reported doctor-diagnosed mental ill-health in Irish 20-year-olds; (2) smoking, e-cigarette, and dual use in those with and without mental ill-health; and (3) protective and risk factors for smoking and e-cigarette use in these groups. Methods: We use cross-sectional data from 20year-olds in Wave 4 of Growing Up in Ireland Child Cohort. They were asked to self-report mental ill-health which had been diagnosed by a clinician, and their smoking and e-cigarette use. All analyses were performed using SPSS v27. Results: 19.4% (n = 1008) of the total sample (n = 4729) reported a mental ill-health diagnosis. Comparing those with and without, those with mental ill-health had significantly higher prevalence of current smoking (47%, n = 419 vs 36%, n = 1361; OR 1.57, CI: 1.36, 1.82), e-cigarette use (17%, n = 152 vs 13%, n = 485; OR 1.40, CI:1.15, 1.70), and dual use (12%, n = 109 vs 9%, n = 328; OR 1.46, CI:1.16, 1.84). Risk factors for smoking and e-cigarette use were, earlier smoking initiation, peers or primary caregivers who smoked, being in paid employment, one-parent family background, and social media use. Being female was protective. Most risk factors were significantly higher in young adults with mental ill-health but, after adjusting for these variables, respondents with mental ill-health still have significantly higher adjusted higher odds of smoking (aOR 1.28, CI:1.05, 1.56). Conclusions: Inequalities in smoking and e-cigarette use in young adults with mental ill-health are evident 20years after Ireland's National Smoking Ban. Despite extensive Tobacco Control interventions in the past 20years, there is still need in Ireland for new targeted interventions to reduce health inequalities for left-behind young smokers with mental ill-health.

Youths' awareness and attitudes towards raising the minimum legal age of smoking and passive smoking in Singapore.

Early smoking initiation has been associated with a higher risk of developing long-term smoking habit. There is a growing global consensus that demands raising the minimum legal age (MLA) for smoking as an approach to address this problem. Singapore successfully raised the MLA from 18 to 21 years in 2021. This study aimed to evaluate the awareness and attitude of multi-ethnic Asian youth (aged 15-24) on raising MLA to 21 and passive smoking. A cross-sectional survey comprising of 23 items was circulated via a secure internet-based platform, FORMSG between September and November 2022. Data were analyzed for descriptive statistics. Categorical variables were compared for association with receptivity toward change in MLA using Chi-Squared test and multivariable logistic regression analysis using Rstudio. Post-hoc Bonferroni correction were further utilized for pairwise comparison. Majority (80.3%) of the 608 participants expressed their support for MLA 21 implementation. Participants' age was a significant variable as those aged 15-17 years old (OR = 2.1, 95%CI = 1.01-4.32, p = 0.048) showed a higher likelihood of supporting MLA implementation compared to those aged 21 and above. In addition, majority (89.8%) of them were also aware of the harmful effects of passive smoking. When it came to discouraging smoking among youth, family influence (64%) and school education (55.6%) emerged as the top strategies. Most of the youth express strong support for raising the MLA to 21, with over 80% in favor of such change, reflects a significant harmony among youth in favor of tobacco-free environment.

Do Determinants of Smoking Cessation and Relapse Differ between Men and Women? Data from a French National Study

Introduction: There is limited understanding of different predictors of smoking cessation success (SCS) among women and men, despite well-documented differences in smoking behavior. Methods: Using data from DePICT (Description des Perceptions, Images, et Comportements liés au Tabagisme), a national survey of French adults which recruited 2377 regular and former smokers we investigated whether major determinants of SCS differed by sex. Factors associated with unsuccessful vs. No successful quit attempt; vs. SCS were studied using multivariate multinomial logistic regression analyses stratified by sex. Results: Women and men share some determinants of SCS including no cannabis use, living in a nonsmoker household and importance giving to being a nonsmoker. However, no e-cigarette use, low-to-moderate alcohol consumption, early smoking initiation, and higher education were associated with SCS only among women. No use of nicotine replacement, having family members who smoke, family opinion on smoking and current employment, were associated with SCS only among men. Neutral or negative friends’ opinion on smoking or living with a smoker were associated with unsuccessful smoking attempts among men. Conclusions: Our results show differences between determinants of SCS according to sex, which highlights the importance of developing tailored interventions that account for sex/gender differences in smoking cessation.

Prevalence and Risk Factors of Early Initiation of Alcohol Consumption and Smoking in School-Aged Adolescents

Introduction: Despite a constant focus on prevention of health-risk behaviors among adolescents and young people in many countries and regions, teenagers still show interest and engage in smoking and alcohol consumption. Objective: To study the prevalence and risk factors of early initiation of alcohol consumption and smoking in schoolaged children in order to substantiate and develop appropriate preventive measures to be taken in secondary schools of Yekaterinburg. Materials and methods: In 2022, we conducted an anonymous questionnaire-based cross-sectional study of 742 secondary school students in grades 8 to 11 (aged 14–18 years) living in Yekaterinburg. We assessed associations between the use of psychoactive substances, behavioral risk factors, such as daily routine, physical activity, attitude to smoking and alcohol consumption, health literacy, disease prevention habits, and psychosocial factors, and health. The data were analyzed using Pearson’s chi-squared test and the Student’s t-test; odd ratios (OR) were calculated with the 95 % confidence interval. Results: The proportion of cigarette smokers and alcohol consumers among school-aged adolescents amounted to 21.3 % and 43.4 %. Among the risk factors contributing to early initiation of smoking and alcohol consumption, the most significant were bad relationships with adults (parents and teachers), lack of parental support, poor awareness of adverse effects of alcohol consumption and smoking, loyal attitude of parents and schoolchildren to the problem. The use of psychoactive substances correlated statistically with poor well-being of the school-aged youth. Conclusion: We observed lower prevalence rates of smoking and alcohol consumption in the adolescents compared with the 2000s. This problem, however, still requires preventive interventions. The established risk factors should be taken into account when developing school-based prevention programs.

In Utero and Childhood/Adolescence Exposure to Tobacco Smoke, Genetic Risk, and Cancer Incidence in Adulthood: A Prospective Cohort Study

ObjectiveTo evaluate the association of early-life tobacco smoke exposure, especially interacting with cancer genetic variants, with adult cancer. Participants and MethodsWe examined the associations of in utero tobacco smoke exposure, age of smoking initiation, and their interaction with genetic risk levels with cancer incidence in 393,081 participants from the UK Biobank. Information on tobacco exposure was obtained by self-reported questionnaires. A cancer polygenic risk score was constructed by weighting and integrating 702 genome-wide association studies–identified risk variants. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) for overall cancer and organ-specific cancer incidence. ResultsDuring 11.8 years of follow-up, 23,450 (5.97%) and 23,413 (6.03%) incident cancers were included in the analyses of in utero exposure and age of smoking initiation, respectively. The HR (95% CI) for incident cancer in participants with in utero exposure to tobacco smoke was 1.04 (1.01-1.07) for overall cancer, 1.59 (1.44-1.75) for respiratory cancer, and 1.09 (1.03-1.17) for gastrointestinal cancer. The relative risk of incident cancer increased with earlier smoking initiation (Ptrend<.001), with the HR (95% CI) of 1.44 (1.36-1.51) for overall cancer, 13.28 (11.39-15.48) for respiratory cancer, and 1.72 (1.54-1.91) for gastrointestinal cancer in smokers with initiation in childhood compared with never smokers. Importantly, a positive additive interaction between age of smoking initiation and genetic risk was observed for overall cancer (Padditive=.04) and respiratory cancer (Padditive=.003) incidence. ConclusionIn utero exposure and earlier smoking initiation are associated with overall and organ-specific cancer, and age of smoking initiation interaction with genetic risk is associated with respiratory cancer.

Factors associated with teenage pregnancy in the Scandinavian countries.

Teenage pregnancy may have negative consequences for the mother and the infant. The aim of the study was to examine whether selected individual factors occurring early in life were associated with teenage pregnancy. In a population-based, cross-sectional questionnaire study among 34,455 women from Denmark, Norway, and Sweden aged 20-45 years, who had first sexual intercourse (FSI) at age 13-19 years, we assessed the association between early smoking and drinking initiation (i.e., before the age of 13), contraceptive use at FSI, and teenage pregnancy. Log-linear binary regression models were fitted to estimate the relative risk (RR) with 95% confidence intervals (CIs) of teenage pregnancy according to the three exposure variables, overall and by age at FSI. Furthermore, the outcomes of the teenage pregnancies were examined according to age at FSI. Teenage pregnancy occurred in 11% of the population. Both early smoking initiation (RR: 1.6; 95% CI: 1.4-1.8), early drinking initiation (RR: 1.2; 95% CI: 1.0-1.4), and non-use of contraceptives at FSI (RR: 1.9; 95% CI: 1.8-2.0) were associated with teenage pregnancy. The associations for early smoking initiation and non-use of contraceptives remained when analyses were stratified by age at FSI. Almost 60% of all teenage pregnant women had an induced abortion and less than 30% gave birth. Individual factors, including early smoking and drinking initiation, and non-use of contraceptives at FSI, were associated with teenage pregnancy regardless of age at FSI. This emphasizes the necessity of focusing on early risk-taking behavior as a potential modifier to prevent teenage pregnancy.

Cross-talks between gut microbiota and tobacco smoking: a two-sample Mendelian randomization study

BackgroundConsiderable evidence has been reported that tobacco use could cause alterations in gut microbiota composition. The microbiota-gut–brain axis also in turn hinted at a possible contribution of the gut microbiota to smoking. However, population-level studies with a higher evidence level for causality are lacking.MethodsThis study utilized the summary-level data of respective genome-wide association study (GWAS) for 211 gut microbial taxa and five smoking phenotypes to reveal the causal association between the gut microbiota and tobacco smoking. Two-sample bidirectional Mendelian randomization (MR) design was deployed and comprehensively sensitive analyses were followed to validate the robustness of results. We further performed multivariable MR to evaluate the effect of neurotransmitter-associated metabolites on observed associations.ResultsOur univariable MR results confirmed the effects of smoking on three taxa (Intestinimonas, Catenibacterium, and Ruminococcaceae, observed from previous studies) with boosted evidence level and identified another 13 taxa which may be causally affected by tobacco smoking. As for the other direction, we revealed that smoking behaviors could be potential consequence of specific taxa abundance. Combining with existing observational evidence, we provided novel insights regarding a positive feedback loop of smoking through Actinobacteria and indicated a potential mechanism for the link between parental smoking and early smoking initiation of their children driven by Bifidobacterium. The multivariable MR results suggested that neurotransmitter-associated metabolites (tryptophan and tyrosine, also supported by previous studies) probably played a role in the action pathway from the gut microbiota to smoking, especially for Actinobacteria and Peptococcus.ConclusionsIn summary, the current study suggested the role of the specific gut microbes on the risk for cigarette smoking (likely involving alterations in metabolites) and in turn smoking on specific gut microbes. Our findings highlighted the hazards of tobacco use for gut flora dysbiosis and shed light on the potential role of specific gut microbiota for smoking behaviors.

EVALUATING THE ORAL HEALTH KNOWLEDGE ATTITUDE PRACTICE AND MENTAL STRESS LEVEL AMONG SOFTWARE PROFESSIONALS WITH SMOKING HABIT IN TAMIL NADU - A CROSS SECTIONAL SURVEY

Introduction: Adult tobacco use is a public health concern, and among software professionals, lifestyle choices and jobrelated stress are risk factors. The negative effects of smoking will be more pronounced in today's youth due to early smoking initiation, as well as in the long run for young individuals who develop a smoking habit and continue to smoke into adulthood. The purpose and goals of this study are to evaluate the oral health disparities and degree of mental stress among Tamil Nadu's software workers. Using an online survey site, a cross-sectional study of Materials And Methods: software professionals in Tamil Nadu was carried out. The sample size was calculated to be 550 based on the percentage of software workers that smoke. All potential human resources received the online survey. The findings of statistical analysis on the responses gathered were attained. : In this study, the response rate was 86%, and th Results e prevalence of smokers—including both men and women—was 78%. There are some substantial differences in oral health among software workers who smoke, including tooth discoloration and poor aesthetics. After smoking, stress levels are noticeably lower, which has an effect on the development of smoking as a habit. : It is crucial to f Conclusion ocus on this population since smoking's negative effects on dental health and the mental health of software professionals because of their line of work are ongoing challenges. Tobacco control and tobacco cessation programmes also remain crucial public and individual health issues

Abstract 6460: Smoking initiation at young age increases risk of gastric cancer among Korean men

Abstract Objective: Early initiation of smoking is associated with adverse health outcomes. This study aimed to investigate the association of various smoking-related factors with the risk of gastric cancer in a population with a high incidence rate of gastric cancer. Method: From 2004 to 2013, Korean adults 40-69 years of age were enrolled in the large-scale prospective cohort, the Health Examinees-Gem study. Incident gastric cancer cases were identified until December 31, 2017, through linkage to the Korea Central Cancer Registry. Participants’ information regarding socio-demographics, smoking-related factors, and other lifestyle factors was obtained via self-reported questionnaires. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for gastric cancer risk associated with smoking-related factors such as smoking duration, amount, pack-years, and age of smoking initiation. Results: Among 44,207 men included in the final analysis, 565 gastric cancer cases were identified during a mean (±SD) follow-up period of 8.6 (±2.0) years. Compared to non-smokers, current smokers who smoked for more than 35 years (HR 1.44, 95% CI 1.06-1.96) or with ≥30 pack-years of smoking (HR 1.40, 95% CI 1.05-1.87) were positively associated with gastric cancer. These associations were shown to be significant with increasing smoking years (p trend 0.019) and pack-years (0.016) as well. Compared to non-smokers, current smokers who initiated smoking at a younger age, before or at 20 years, were at a higher risk of gastric cancer (HR 1.46, 95% CI 1.10-1.93). No significant associations were observed among former smokers. When stratified by smoking duration, increased risk of gastric cancer was observed among those who smoked for more than 25 years in the younger smoking initiation age group (≤20 years; HR 1.50, 95% CI 1.15-1.94). In terms of smoking intensity, those who smoked less than 20 cigarettes or 1 pack a day showed an increased risk of gastric cancer in the younger smoking initiation age group that began smoking before or at 20 years of age (HR 1.78, 95% CI 1.30-2.44). Conclusion: Our findings suggest that earlier initiation of smoking is associated with a greater risk of gastric cancer. Among those who began smoking early, longer duration is an important factor, but increased gastric cancer risk was also observed among those who smoked moderate amount on a daily basis. Thus, measures to manage and control onset age of cigarette smoking among teenagers may be considered when taking actions against the health burden of gastric cancer. Citation Format: Hwi-Won Lee, Woo-Kyoung Shin, Dan Huang, Katherine De la Torre, Jae Jeong Yang, Minkyo Song, Aesun Shin, Kyoung-Mu Lee, Hyuk-Joon Lee, Jong-koo Lee, Daehee Kang. Smoking initiation at young age increases risk of gastric cancer among Korean men. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6460.

Monitoring of the population health and health risk factors (research methodology)

The article considers the dynamics of health indicators and health risk factors in Russia, including in comparison to the OECD countries. The study is based on the Russian statistical data, OECD data, and Russian Longitudinal Monitoring Survey (RLMS-HSE). The key public health indicator - the life expectancy (years of life at birth) - shows the negative dynamics in 2020 (71.54), while some other health indicators, on the contrary, show the positive dynamics, such as the self-rated health (the share of population aged 15+ in poor health deceased). 10.8 % of Russian adults consider themselves to be in poor health, which is higher than in the OECD countries. The share of people who assess their health as good and very good has increased over the 25 years of the study: the share of women has doubled (17.5 % in 1994 and 35.1 % in 2020); the share of men has increased by 13.2 % (34.4 % and 47.6 %). The share of people who drink alcohol and of men who smoke has decreased. However, there are negative trends that accompany risk factors: early initiation of smoking (8.5 % started smoking at 13 years and earlier, the majority (78.3 %) started smoking at puberty - at 18 and earlier; half of smokers smoke more than 15 cigarettes a day). The majority (66 %) of the RLMS participants at least occasionally drink alcoholic beverages, including beer (69.6 % of men and 55.3 % of women); never drink alcohol 34 % (30.4 % and 44.7 %). Every tenth respondent (11.9 %) tried an alcohol for the first time at the age of 14 or earlier; 77.9 % - at 18 and earlier. Over 25 years, the share of people with normal weight has decreased: 57.3 % of men and 43.4 % of women in 1994; 43.8 % and 40.5 % - in 2020. The share of overweight people has increased from 40 % of men and 51.9 % of women in 1994 to 53.5 % and 55.7 % in 2020.

Smoking Frequency of Nursing Students and the Extent to Which They Are Affected by the Warning Labels on Cigarette Packs

Background: Determining the smoking frequency of young people and their exposure to cigarette pack warnings is important in terms of developing new policies for smoking cessation. Objectives: This study was conducted to determine the smoking frequency of nursing students, their nicotine dependence, the extent to which they were affected by textual/graphic warning labels on cigarette packs, and the factors affecting them. Methods: The research is cross-sectional type. According to the sample calculation formula in cases where the universe is known, the universe was accepted as 855, the sample was calculated with 95% confidence interval and 0.05 error, and the number of people to be sampled was found to be 195. A total of 240 people were selected for the study, considering that there may be data losses. The students to be sampled were determined by the stratified sampling method. The data were collected via the survey created by the researchers and the Fagerstrom Test for Nicotine Dependence (FTND). Chi-squared test were used for statistical analysis. Results: The average age of the students was 20.95 ± 1.70. 22.5% of the participants smoked. 68.5% of students had a low addiction level, while 57.1% were affected by warnings on a cigarette packs. It was observed that the effect of textual warnings on the cigarette packs did not differ by gender. Graphics showing a person in intensive care and a dead person's foot in the morgue evoked higher levels of negative affect on women than on men. When the written warnings on the cigarette package and some variables are compared; It was found that there was a statistically significant difference between smoking status, presence of smokers in the family, level of smoking addiction and smoking status. No statistically significant difference was found when being affected by written warnings and gender were compared. Conclusion: In order to prevent early youth smoking initiation, preventive studies should be carried out on young people from childhood. Particularly male students should be observed more carefully. Nurses; should develop strategies that can be effective in smoking-related youth and conduct qualitative research on them.

Trait Impulsivity as a Mediator Between Early Cigarette Smoking Initiation and Addiction Severity in Patients with Methamphetamine Use Disorder

Trait Impulsivity as a Mediator Between Early Cigarette Smoking Initiation and Addiction Severity in Patients with Methamphetamine Use Disorder

Age of Smoking Initiation in Relation to Multiple Health Risk Factors among US Adult Smokers: National Health Interview Survey (NHIS) Data (2006–2018)

The adverse effects of multiple health risk factors have been well-documented; however, still understudied are the effects of early smoking in the context of multiple health risk factors. This study aimed to examine the role of early smoking initiation in relation to several health risk factors, including heavy drinking, physical inactivity, and obesity in later life among ever smokers in the USA. The National Health Interview Survey (NHIS) data from 2006 through 2018 were analyzed. The primary dependent variables were presence of three other risk factors: heavy drinking, physical inactivity, and obesity. The independent variable was the age of smoking initiation. Logit regression models were constructed to evaluate the association between smoking initiation and multiple health risk factors. All analyses were done in 2022. Among US adult smokers, 18.2% started smoking before age 15 (early initiators), 55.9% at ages 15–18 (middle initiators), and 25.9% at age 20 or later (late initiators). Compared to late smoking initiators, the odds of engaging in additional health risk factors increased by 37.3% among early initiators (OR = 1.373, 95% CI = 1.316, 1.432) and 7.7% among middle initiators (OR = 1.077, 95% CI= 1.041, 1.116). Additionally, current smoking was associated with higher odds (OR = 1.369, 95% CI = 1.322, 1.417) of having additional health risk factors compared to former smoking, with one exception: current smokers had lower odds of obesity (OR = 0.566, 95% CI = 0.537, 0.597). Tobacco control programs to prevent adolescents from initiating smoking may have the potential to prevent other health risk factors in adulthood.

Predictors of smoking initiation among Thai adolescents from low-income backgrounds: A case study of Nakhon Pathom low-cost housing estates.

INTRODUCTIONGlobally, an estimated 1.3 billion people in the world smoke tobacco products, of which more than 8 million die annually. A disproportionate number of these deaths occur in low- and middle-income countries like Thailand. Over 19% (10.7 million) of the Thai population aged ≥15 years were estimated to be smokers; of these, 7.8% were aged 15–18 years. Nearly 1 in 10 Thai students is a current tobacco user; about 20% of these smokers had initiated smoking before their 10th birthday. This shows that early smoking initiation among Thai youths is indeed a public health problem. This study was conducted to examine the factors associated with smoking initiation among adolescents from low-income backgrounds.METHODSA cross-sectional study was conducted among youth aged 15–18 years living in low-cost housing estates in Nakhon Pathom province between 1 December 2019 and 30 July 2020. A total of 290 participants were recruited by stratified random sampling. A proprietary questionnaire was used to collect the data, which were analyzed by binary logistic regression.RESULTSRisk factors for smoking initiation were having one or both parents deceased (OR=2.28; 95% CI: 1.218–3.471, p=0.001), having divorced parents (OR=1.67; 95% CI: 1.158–2.509, p=0.013), and poor academic performance (OR=2.50; 95% CI: 0.133–3.551, p=0.032). Protective factors were having knowledge of cigarettes (OR=0.65; 95% CI: 0.179–0.895, p=0.004) and correct perception of legal public smoking places (OR=0.45; 95% CI: 0.140–0.850, p=0.025).CONCLUSIONSTo curb the risks of early smoking initiation among youths of low-income backgrounds, both education and health authorities need to collaboratively design interventions tailored to raise awareness of the negative health impacts of tobacco, improve the performance of underperforming students, and meet the social needs of students whose parents are either deceased or separated to improve their social ties.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2 [version 2; peer review: 1 approved

Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.

Associations of adverse childhood experiences with smoking initiation in adolescence and persistence in adulthood, and the role of the childhood environment: Findings from the 1958 British birth cohort

Adverse childhood experiences (ACEs) have been identified as a strong determinant of smoking. We aimed to examine the association between ACEs and early smoking initiation and subsequent persistence and the contribution of five pathways including family factors, parental involvement, material living conditions, social activities and conscientiousness.Data are from 7414 individuals born in 1958 in Great Britain included in the National Child Development Study. ACEs were measured at ages 7, 11, and 16. Smoking initiation was derived from smoking variables from ages 16 to 42 and persistent smoking was derived from smoking variables from ages 23 to 42. We modelled the relationship between ACEs and smoking, and further assessed the contribution of each pathway using multinomial logistic regressions.During childhood, 20.9% of respondents experienced one ACE and 6.4% two or more. Those who experienced ACEs had a higher risk of initiating smoking by age 16 and of persistent smoking (RRR initiation by 16y = 1.89 [1.62; 2.20] for one ACE; RRR initiation by 16y = 2.36 [1.81; 3.08] for two or more ACEs, and RRR persistent smoking = 2.07 [1.73; 2.47] for one ACE, RRR persistent smoking = 2.59 [1.92; 3.49] for two or more ACEs). The factors that contributed most to explaining these associations were parental smoking, sibling order and conscientiousness. ACEs remained associated with persistent smoking after further adjusting for young adulthood variables.Smoking prevention measures may need to be tailored when considering adolescents from communities where ACEs are more prevalent to curtail initiation, intensity and persistence. FundingThis work was supported by the Institut National du Cancer & the Institut de recherche en santé publique (grant agreement: No. [2019–204]).

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 & 2

Background: Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.

Trends and correlates of hardcore smoking in India: findings from the Global Adult Tobacco Surveys 1 &amp; 2

Background: Data on prevalence of hardcore smoking (HCS) among different socioeconomic status (SES) groups in low- and middle-income countries are limited. We looked at the prevalence and pattern of HCS in India with the following objectives: 1) to analyse the association between SES and HCS, 2) to find trends in HCS in different SES groups and 3) to find state-wide variations in hardcore smoking. Methods: Data of individuals aged ≥25 years from the Global Adult Tobacco Survey (GATS) India 2009-10 (N= 9223) and 2016-17 (N= 7647) were used for this study. If an individual met all the following criteria: (1) current smoker, (2) smokes 10 or more cigarettes/day, (3) smokes first puff within 30 minutes after waking up, (4) no quit attempt in last 12 months, (5) no intention to quit at all or in the next 12 months, (6) lack of knowledge of harmful effect of smoking, s/he was identified as a hardcore smoker. Multiple regression analysis was done to find the factors associated with HCS. Results: Prevalence of HCS deceased from 2.5% in GATS 1 to 1.9% in GATS 2: males from 6.2% to 3.9% and females from 0.3% to 0.2%. Compared to the richest group the poorest, poor and those who belonged to the middle-income group were more likely to report HCS in GATS 1 and 2. However, only in the poorest SES group there was an increase in the proportion of hardcore smokers in GATS 2 compared to GATS 1. Other factors that were significantly associated with HCS in both surveys were male gender, working adults, those with lower education, early initiation of smoking and households without any rules for smoking inside the home. Conclusions: Tobacco control and cessation efforts need to focus on individuals of poor SES groups particularly in the high prevalence Indian states.