Past 30-day Smoking Research Articles

Deniers and Admitters: Examining Smoker Identities in a Changing Tobacco Landscape.

Smoking prevalence has declined considerably over the past 30 years. This decline has coincided with a growing stigma against smokers and a trend toward nondaily or occasional smoking. Some individuals now deny being a smoker despite current cigarette use-i.e., "deniers"; conversely, occasional smokers who admit to being a smoker are defined as "admitters." Although the "denier" phenomenon has been the focus of recent research, no studies have examined smoker identity in the context of emerging tobacco products and ongoing, statewide tobacco control programs. Recent data from the 2014 Minnesota Adult Tobacco Survey provided an opportunity to address these research gaps. Using the Minnesota Adult Tobacco Survey, participants were 242 adults who reported smoking 100 cigarettes lifetime, currently smoking "some days," and past 30-day smoking. Questions also assessed smoker identity, emerging product use and perceptions, and changes in smoking behavior in response to a recent statewide tobacco tax increase. Regression models revealed no difference in e-cigarette or hookah use between deniers and admitters, but deniers were more likely to perceive that hookah use was less harmful than smoking cigarettes. In response to the tax increase, we found that admitters were more likely than deniers to report thinking about quitting, reducing cigarette amount, and making a quit attempt. Findings suggest that deniers perceive lower harm from using tobacco products. Tax increases may be less effective at motivating quit attempts in deniers compared to admitters, implying that cessation programs tailored to specific smoking identities could usefully complement tax increases. Findings from this study suggest that tobacco tax increases should be coordinated with health promotion interventions to address occasional and social smoking. The denier phenomenon in particular is an important identity-based construct that population-level public health practice should consider in order to design effective tobacco control interventions. In addition, findings from our study and previous research suggest that occasional or social smokers who deny the smoker identity may be slowing progress in reducing smoking rates. Interventions targeting occasional smokers, and in particular, deniers, are needed to accelerate cessation efforts.

Phantom smoking among young adult bar patrons

ObjectiveTo explore the prevalence and sociodemographic makeup of smokers who do not self-identify as smokers (ie, phantom smokers) compared with self-identifying smokers in a sample of bar-going young adults aged...

Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later

BackgroundTo improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking. MethodsData from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12–21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30days. ResultsThree categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1–5, moderate: 6–60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; rτ=−0.2319, p<0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR=0.97, 95% CI=0.53–1.80 [daily as reference]). Low (1–5 cigs/mo.) and moderate (6–60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR=0.21, 95% CI=0.15–0.29 and OR=0.22, 95% CI=0.14–0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later. ConclusionsNon-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12–21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.

Smoke-Free Public Policies and Voluntary Policies in Personal Settings in Tbilisi, Georgia: A Qualitative Study.

Georgia has limited tobacco control policies, particularly in the area of smoke-free public policies, which may influence the adoption of smoke-free home rules. We qualitatively examined knowledge about and reactions to public and personal smoke-free policies among Tbilisi residents. In Spring 2014, we conducted six focus groups among 47 total participants—two among male smokers, one among male nonsmokers, two among female smokers, and one among female nonsmokers. Our sample was 48.9% male and 70.2% past 30-day smokers. Most believed that SHS was dangerous, with particular concern regarding the impact of SHS on children and pregnant women. Many had misconceptions about how to protect others from SHS and the effectiveness of some approaches. Many indicated that they had some type of home rules, but few reported a complete ban on smoking in the home. Even when some restrictions were in place, they rarely were effective or enforced. Common concerns about the partial smoke-free public policy in Georgia included its economic impact, perceived discrimination among smokers, and the policy being against the Georgian culture. These concerns were heightened when participants were asked about the possible implementation of a complete smoke-free policy. Educational programs are needed to promote smoke-free policies in Georgia.

Reactions to Cigarette Taxes and Related Messaging: Is the South Different?

Given the lag in tobacco control policies in the southeastern US, we examined differences in reactions to tobacco taxes and related messaging among Southeasterners vs. non-Southeasterners. In 2013, a cross-sectional online survey using quota-based sampling was conducted assessing tobacco use, attitudes/knowledge regarding tobacco taxation, and reactions to related messaging (health, youth prevention, economic impact, individual rights/responsibility, morality/religion, hospitality). Of 2501 participants, 36.7% were past 30-day smokers; 26.7% were Southeasterners. Compared to others, Southeasterners more likely believed that their state was in the bottom 20 states in tobacco taxes (p < .001) and less likely reported that their taxes were too high (p < .001). Regression analysis indicated that correlates of opposition to increased taxes included being older, having less education, being an infrequent church-attender, and being a current smoker (p's < .001); being a Southeasterner was not associated. Compared to others, Southeasterners were more likely to find pro-tobacco tax messages related to prevention and hospitality as more persuasive (p < .05) and anti-tobacco tax messaging related to the unfairness of tobacco taxes to smokers (p = .050) less persuasive. Given that Southeasterners are receptive to increased taxation, other factors must contribute to lagging policy and must be addressed.

The Effects of Antismoking Messages From Family, School, and Mass Media on Smoking Behavior and Smoking Intention Among Chinese Adolescents

The prevalence of adolescent smoking has been increasing rapidly in China. Expanding adolescent exposure to antismoking messages may be an effective approach to prevent tobacco use among this population. Using a cross-sectional sample of 8,444 high school students in four Chinese cities, this study assessed the relation between self-reported exposure to antismoking messages from families, schools, and mass media and the rate of past 30-day smoking and smoking intention among junior and senior high school students. Results from logistic regression suggested that antismoking messages delivered via school and media inhibited both tobacco use and the intention to smoke. The effects of familial warnings about harmful effects of smoking, in contrast, were at best insignificant.

E-cigarette and Traditional Cigarette Use Among Smokers During Hospitalization and 6 Months Later

Abstract Use of electronic nicotine delivery systems, most commonly called e-cigarettes (e-cigs,) has been rising over the past few years, with the greatest use among traditional cigarette smokers. The utility and harm of this group of emerging tobacco products are under debate. While some propose them as novel tobacco cessation tools, others decry their potential for sustained addiction and negative health effects. We examined smokers' e-cig use and smoking behaviors at hospitalization and 6 months later. Methods: 979 smokers hospitalized at a tertiary care medical center were recruited to a longitudinal observational study and provided baseline data during hospitalization and 6-months later. Past 30-day (current) e-cig use and smoking rates at both baseline and 6-month follow-up were examined with t-tests. Chi square test examined baseline e-cig use and 6-month smoking status. Results: 823 (84.1%) participants provided data at both time points: mean age was 46 years; 53.6% were White, 44.0% were Black, and 2.5% other; 22.5% had less than a high school degree, 38.8% had a high school diploma/GED, and 38.7% had some college or more; 30.8% were married/domestic partner and 53.6% were male. Current e-cig use was reported by 171 (20.7%) at baseline and 246 (29.9%) at 6-month follow- up, with 98 (11.9%) reporting current e-cig use at both time points. At 6-months follow- up, 12.2% of baseline current e-cig users vs. 13.4% of baseline non-users reported quitting smoking (P = 0.80), with 22% of baseline e-cig users who quit still using e-cigs at 6–months follow-up. Baseline current e-cig users reported higher daily cigarette consumption (14.1 vs. 11.9; P = 0.010) at baseline but not 6-months later (10.3 vs. 9.8; P = 0.619); whereas, continuing smokers with current e-cig use at 6 months follow-up reported fewer cigarettes per day (8.4 vs. 10.5; P = 0.008). Conclusions: Among adult smokers, current e-cig use at hospitalization was associated with higher cigarette consumption at baseline but was not predictive of quitting or consumption (among continuing smokers) at 6-months follow-up. Further, current e-cig use at 6 months was associated with a greater reduction in cigarettes smoked per day among continuing smokers at 6-months after hospitalization.

Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study.

BackgroundFor some adolescents feeling lonely can be a protracted and painful experience. It has been suggested that engaging in health risk behaviours such as substance use and sexual behaviour may be a way of coping with the distress arising from loneliness during adolescence. However, the association between loneliness and health risk behaviour has been little studied to date. To address this research gap, the current study examined this relation among Russian and U.S. adolescents.MethodsData were used from the Social and Health Assessment (SAHA), a school-based survey conducted in 2003. A total of 1995 Russian and 2050 U.S. students aged 13–15 years old were included in the analysis. Logistic regression was used to examine the association between loneliness and substance use, sexual risk behaviour, and violence.ResultsAfter adjusting for demographic characteristics and depressive symptoms, loneliness was associated with a significantly increased risk of adolescent substance use in both Russia and the United States. Lonely Russian girls were significantly more likely to have used marijuana (odds ratio [OR]: 2.28; confidence interval [CI]: 1.17–4.45), while lonely Russian boys had higher odds for past 30-day smoking (OR, 1.87; CI, 1.08–3.24). In the U.S. loneliness was associated with the lifetime use of illicit drugs (excepting marijuana) among boys (OR, 3.09; CI, 1.41–6.77) and with lifetime marijuana use (OR, 1.79; CI, 1.26–2.55), past 30-day alcohol consumption (OR, 1.80; CI, 1.18–2.75) and past 30-day binge drinking (OR, 2.40; CI, 1.56–3.70) among girls. The only relation between loneliness and sexual risk behaviour was among Russian girls, where loneliness was associated with significantly higher odds for ever having been pregnant (OR, 1.69; CI: 1.12–2.54). Loneliness was not associated with violent behaviour among boys or girls in either country.ConclusionLoneliness is associated with adolescent health risk behaviour among boys and girls in both Russia and the United States. Further research is now needed in both settings using quantitative and qualitative methods to better understand the association between loneliness and health risk behaviours so that effective interventions can be designed and implemented to mitigate loneliness and its effects on adolescent well-being.

Poster #M117 EVIDENCE THAT CHILDHOOD URBAN ENVIRONMENT IS ASSOCIATED WITH BLUNTED STRESS REACTIVITY ACROSS GROUPS OF PSYCHOTIC PATIENTS, RELATIVES AND CONTROLS

Background: This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China.Methods: Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke).Results: Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05).Conclusions: Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

Effectiveness of a school-based multi-component smoking prevention intervention: The LdP cluster randomized controlled trial

ObjectiveWe assessed the effectiveness of the Luoghi di Prevenzione-Prevention Grounds school-based smoking prevention programme. MethodsWe undertook a cluster randomized controlled trial of 989 students aged 14–15years in 13 secondary schools located in Reggio Emilia, Italy. The intervention consisted of the “Smoking Prevention Tour” (SPT) out-of-school workshop, one in-depth lesson on one Smoking Prevention Tour topic, a life-skills peer-led intervention, and enforcement surveillance of school antismoking policy. Self-reported past 30-day smoking of ≥20 or 1–19days of cigarette smoking (daily or frequent smoking, respectively) was recorded in 2 surveys administered immediately before and 18months after the beginning of the programme. Analysis was by intention to treat. The effect of the intervention was evaluated using random effects logistic regression and propensity score-matching analyses. ResultsPast 30-day smoking and daily cigarette use at eighteen months follow-up were 31% and 46% lower, respectively, for intervention students compared to control students. Taking into account non-smokers at baseline only, daily smoking at eighteen months follow-up was 59% lower in intervention students than in controls. Past 30-day smoking in school areas was 62% lower in intervention students compared to controls. ConclusionsThe Luoghi di Prevenzione-Prevention Grounds programme was effective in reducing daily smokers and in reducing smoking in school areas.

Polytobacco use and multiple-product smoking among a random community sample of African-American adults

ObjectivesLittle is known about polytobacco use among African-American adults. This study is the first to explore this among a random, statewide, community sample of African-American adults.SettingCommunity-based sampling obtained a random,...

Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking.

As elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes. Data from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13-18 years were analyzed with logistic regression. A total of 9.4% (8.0% ever-dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever-e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39-1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09-.12). Some Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.

Parental Migration, Self-Efficacy and Cigarette Smoking among Rural Adolescents in South China

ObjectivesMillions of children and adolescents in rural China are left behind as their parents move away for work. Little is known about the impact of parental migration on their smoking and self-efficacy. This study explores the associations among parental migration, self-efficacy and smoking.MethodsA cross-sectional study was conducted among middle school students in Liangying Township, Guangdong, China. Socio-demographic and parental migration characteristics, as well as adolescent past 30-day smoking and self-efficacy level were collected using a self-administered questionnaire. Univariate and multivariate analyses were performed to estimate the risk of parental migration features for smoking and self-efficacy. Hierarchical regression was fitted to examine the relationship among parental migration, self-efficacy and smoking.Results2609 students (93.4%) participated into the study, 44% of who were with parents who had ever been or were currently migrating. Smoking prevalence was 9.7% in boys and 0.9% in girls. Paternal migration was protective for adolescent smoking, whilst maternal migration increased the risk. Both paternal and maternal migration had adverse effects on self-efficacy, a strong influencing factor for smoking. No significant relationship was found between other migration features and smoking and self-efficacy. The smoking risk of maternal migration was partly mediated by self-efficacy. There were no differences between boys and girls.ConclusionsOur findings suggest that adolescents whose mothers migrate from home to work elsewhere are at elevated risk for smoking. Improving self-efficacy may be an effective means to keep adolescents away from smoking, especially for those with maternal migration.

Psychosocial correlates of cigarette smoking among Asian American and Pacific Islander adolescents

Despite the growing body of research in adolescent cigarette smoking, there is a lack of research on Asian American and Pacific Islander (AAPI) adolescents. This study examined the prevalence and psychosocial correlates of the past 30-day cigarette smoking in Asian American (AA) and Pacific Islander (PI) adolescents by utilizing a multi-systemic theory—the problem behavior theory. Using the 2006–07 High School Questionnaire of California Healthy Kids Survey, variables such as cigarette smoking, individual characteristics and external influences were assessed. Chi-square tests and generalized estimating equations were used in the analyses. PIs had higher past 30-day cigarette smoking rates than AAs. In the whole AAPI population, significant correlates of cigarette smoking included: positive and negative attitudes toward cigarettes, perceived harm of cigarettes, perceived prevalence of peer cigarette smoking, friend disapproval of cigarette use, previous drug use, truancy, and academic performance. Interaction results showed that truancy increased the odds of cigarette use for AAs only. The study found differential prevalence and correlate of cigarette smoking in addition to common psychosocial correlates in AAs and PIs. It sheds light on the importance of studying AAs and PIs separately and further exploring other potential variables that contribute to the prevalence discrepancy.

College Student Smokers: Former Versus Current and Nonsmokers

Little is known about how former smokers are different from nonsmokers and current smokers in the young adult population. Intra- and inter-personal factors associated with former smoking status were examined among a college student sample. Undergraduate students (N=8834) were contacted at a 2-year college and a 4-year university in 2008; 2700 completed the online survey (30.6% response rate). Current analyses, conducted in 2011, focused on 2589 students aged 18-30 years. Current (past 30-day) smoking prevalence was 35.3% (n=918); 9.2% (n=244) were former smokers. Multinomial logistic regression found that compared to former smokers, nonsmokers were younger (OR=0.91, CI=0.89, 0.92); less frequently used other tobacco products (OR=0.97, CI=0.94, 0.99); less frequently limited their dietary fat intake (OR=0.98, CI=0.97, 0.99); had more negative attitudes regarding smoking (OR=1.03, CI=1.02, 1.04); had lower levels of hope (OR=0.97, CI=0.94, 0.99); and had fewer friends who smoked (OR=0.74, CI=0.67, 0.83). Compared to former smokers, current smokers were younger (OR=0.94, CI=0.92, 0.96); more frequently binge drank (OR=1.11, CI=1.05, 1.18); less frequently limited their dietary fat intake (OR=0.98, CI=0.96, 0.99); had less negative attitudes toward smoking (OR=0.97, CI=0.96, 0.98); had lower levels of hope (OR=0.96, CI=0.94, 0.99); were more likely to live with other smokers (OR=2.09, CI=1.45, 3.00); and had more friends who smoked (OR=1.20, CI=1.07, 1.34). Intrapersonal factors (hope, attitudes toward smoking); interpersonal factors (living with smokers, friends' smoking); and use of other substances (alcohol, alternative tobacco products) are associated with differing smoking behaviors.

A randomized trial of a brief smoking cessation intervention in a light and intermittent Hispanic sample.

This study assessed the efficacy of a brief smoking cessation intervention in a light and intermittent smoking Hispanic sample. Two hundred fifty light (≤10 cigarettes per day) and intermittent smokers (nondaily smokers) (LITS) were recruited from a family health clinic and a border-region university; data from Hispanic participants (n = 214; 52.8% female) were analyzed for the purposes of the present study. Participants completed baseline measures assessing demographics, tobacco use/history, stage of change (SOC), perceived competence to quit smoking, and expired carbon monoxide (CO). Participants were randomly assigned to an immediate (II) or delayed (DI) brief cessation intervention. Psychology graduate students provided the intervention, which primarily addressed motivation, self-efficacy, and trigger management; blinding to condition was not feasible at follow-up. At the 3-month follow-up, smoking status, SOC, and perceived competence score (PCS) were assessed and analyzed via logistic and linear regression models by intervention assignment. Results indicated that intervention assignment was not associated with past 30-day smoking cessation (5.6% immediate condition vs. 4.7% delayed condition) or PCS. Nevertheless, participants in the II were more likely to increase readiness to quit smoking relative to those in the DI. Future efforts should focus on capitalizing on motivation change to promote smoking cessation.

The role of cognitive attributions for smoking in subsequent smoking progression and regression among adolescents in China

Previous studies have documented that cognitive attributions are correlated with adolescent smoking. The present study further explored whether cognitive attributions for smoking influenced adolescents' future smoking behaviors, especially transitions to more advanced stages of smoking.Participants were 12,382 middle and high school students (48.5% males and 51.5% females) in seven large cities in China. They completed two waves of surveys one year apart. Cognitive attributions for smoking and three smoking behavior outcomes (lifetime smoking, past 30-day smoking, and daily smoking) were assessed. Changes in smoking, including progression from lower stages to higher stages and regression from higher stages to lower stages, over a one-year period, were defined longitudinally. Polychotomous logistic regression was used to examine associations between cognitive attributions for smoking and changes in smoking status over one year, adjusting for demographic characteristics and other plausible confounders.Seven out of eight cognitive attributions for smoking were associated with subsequent smoking behaviors (p<0.05). Curiosity, autonomy, social image, social belonging, and coping influenced earlier stages of smoking, whereas mental enhancement and engagement influenced later stages of smoking. Curiosity, autonomy, social image, and mental enhancement preceded smoking progression; social belonging prevented smoking regression; and coping and engagement both preceded smoking progression and prevented smoking regression.This study demonstrates that different cognitive attributions influence smoking at different stages in different ways. These findings could inform smoking prevention and cessation programs targeting Chinese adolescents.

Waterpipe tobacco and cigarette smoking among university students in Jordan

While waterpipe and cigarette smoking have been well studied in Syria and Lebanon, data from Jordan are limited. To characterize the relative prevalence of waterpipe tobacco and cigarette smoking among university students in Jordan, and to compare the demographic and environmental factors associated with each form of tobacco use. We surveyed 1845 students randomly recruited from four universities in Jordan. We used multivariable logistic regression controlling for clustering of individuals within universities to determine associations between demographic and environmental covariates and waterpipe tobacco and cigarette use. Waterpipe tobacco smoking rates were 30% in the past 30 days and 56% ever, while cigarette smoking rates were 29% in the past 30 days and 57% ever. Past 30-day waterpipe tobacco smoking rates were 59% for males and 13% for females. Females had substantially lower odds than males of being current waterpipe (OR 0.12, 95%CI 0.10-0.15) or cigarette (OR 0.08, 95%CI 0.05-0.14) smokers. Current cigarette smoking was more significantly associated with markers of high socio-economic status (SES) than waterpipe tobacco smoking. Waterpipe tobacco smoking is as common as cigarette smoking among Jordanian university students. While cigarette smoking is consistently associated with high SES, waterpipe tobacco smoking is more evenly distributed across various populations.

Exposure to school and community based prevention programs and reductions in cigarette smoking among adolescents in the United States, 2000–08

Smoking remains prevalent among US youth despite decades of antismoking efforts. Effects from exposure to prevention programs at national level may provide informative and compelling data supporting better planning and strategy for tobacco control.A national representative sample of youth 12–17 years of age from the National Survey on Drug Use and Health was analyzed. A 3-stage model was devised to estimate smoking behavior transitions using cross-sectional data and the Probabilistic Discrete Event System method. Cigarette smoking measures (prevalence rates and odds ratios) were compared between exposed and non-exposed youth.More than 95% of the sample was exposed to prevention programs. Exposure was negatively associated with lifetime smoking and past 30-day smoking with a dose–response relation. Reduction in smoking was related to increased quitting in 2000–02, to increased quitting and declined initiation in 2003–05, and to initiation, quitting and relapse in 2005–08.Findings of this analysis suggest that intervention programs in the United States can reduce cigarette smoking among youth. Quitting smoking was most responsive to program exposure and relapse was most sensitive to funding cuts since 2003. Health policy and decision makers should consider these factors in planning and revising tobacco control strategies.

Do cognitive attributions for smoking predict subsequent smoking development?

To develop more effective anti-smoking programs, it is important to understand the factors that influence people to smoke. Guided by attribution theory, a longitudinal study was conducted to investigate how individuals' cognitive attributions for smoking were associated with subsequent smoking development and through which pathways. Middle and high school students in seven large cities in China (N = 12,382; 48.5% boys and 51.5% girls) completed two annual surveys. Associations between cognitive attributions for smoking and subsequent smoking initiation and progression were tested with multilevel analysis, taking into account plausible moderation effects of gender and baseline smoking status. Mediation effects of susceptibility to smoking were investigated using statistical mediation analysis (MacKinnon, 2008). Six out of eight tested themes of cognitive attributions were associated with subsequent smoking development. Curiosity ( β = 0.11, p < 0.001) and autonomy ( β = 0.08, p = 0.019) were associated with smoking initiation among baseline non-smokers. Coping ( β = 0.07, p < 0.001) and social image ( β = 0.10, p = <.0001) were associated with smoking progression among baseline lifetime smokers. Social image ( β = 0.05, p = 0.043), engagement ( β = 0.07, p = 0.003), and mental enhancement ( β = 0.15, p < 0.001) were associated with smoking progression among baseline past 30-day smokers. More attributions were associated with smoking development among males than among females. Susceptibility to smoking partially mediated most of the associations, with the proportion of mediated effects ranging from 4.3% to 30.8%. This study identifies the roles that cognitive attributions for smoking play in subsequent smoking development. These attributions could be addressed in smoking prevention programs.