Peer Smoking Research Articles

Adolescent nicotine dependence symptom profiles and risk for future daily smoking

Recent research on adolescent smokers suggests that there are important differences in the types of nicotine dependence (ND) symptoms that emerge and different patterns of ND symptoms. The purpose of this study was to use data from the longitudinal Social and Emotional Contexts of Adolescent Smoking Patterns Study to identify latent subgroups of adolescent experimental and nondaily smokers varying in number and types of endorsed ND symptoms. Profiles were identified using baseline level of smoking, individual patterns of ND symptoms and other ND risk factors. Discrete time survival analysis was used to examine profile differences in probability of becoming daily smokers 48months later. Four distinct subgroups of smokers with different patterns of smoking behavior, ND symptoms, and alcohol and other substance use emerged. Heavier smoking adolescents with high symptom endorsement, particularly the need to smoke in the morning, were most likely to become daily smokers 48months later. A subgroup of social smokers had high smoking exposure and symptom endorsement (except need to smoke in the morning), and high levels of other substance use. Despite lower rates of smoking frequency and quantity compared to the heavier smoking class, 36% of these adolescents smoked daily by 48months, with a steeper decline in survival rates compared to other lighter smoking classes. Morning smoking symptoms and symptoms prioritizing smoking (i.e., choosing to spend money on cigarettes instead of lunch or smoking when ill or where smoking is forbidden) might quickly identify adolescent non-daily smokers with more severe dependence and higher risk for daily smoking. A focus on skills for avoiding social situations involving use of alcohol and other drugs and reducing peer smoking influences may be an important focus for reducing smoking and other substance use among social smokers.

Multiple Peer Group Self-Identification and Adolescent Tobacco Use

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self-identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high-risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among ethnicity, gender, and group self-identification. Psychographic targeting based on group self-identification could be useful to design more relevant smoking prevention messages for adolescents who identify with high-risk peer groups.

Cross Country Estimates of Peer Effects in Adolescent Smoking Using IV and School Fixed Effects

This paper presents micro-econometric evidence on peer effects in adolescent smoking between classmates aged 15/16 years across 13 European countries. Both instrumental variables and school fixed effects are used for identification. Omitting school fixed effects, as in some existing IV studies of peer effects, is shown to lead to substantial overestimates consistent with endogenous sorting into schools. When fixed effects are included, estimated peer effects range from 0.04 to 0.34 depending on the instrument set. The preferred estimate uses the smoking behaviour of peers’ older siblings to instrument for peer smoking behaviour and suggests a statistically insignificant peer effect of 0.16. This estimate is robust to restricting the sample by dropping schools that non-randomly sort pupils into classes. Ultimately, we cannot rule out zero peer effects in smoking between adolescent classmates in Europe.

Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: Results from a randomized clinical trial

BackgroundMotivational interviewing (MI) is widely used for adolescent smoking cessation but empirical support for this approach is mixed. MethodsAdolescent cigarette smokers 14–18years old (N=162) were recruited from medical, school, and community settings and randomly assigned to enhanced MI or brief advice (BA) for smoking cessation. MI comprised an in-person individual session, a telephone booster session one week later, and a brief telephone-based parent intervention. BA consisted of standardized brief advice to quit smoking. Assessments occurred at baseline, post-treatment and at 1-, 3-, and 6-month follow ups. ResultsBiochemically-confirmed 7-day point prevalence abstinence rates were low (e.g., 4.5% for MI; 1.4% for BA at 1month) and did not differ significantly by group at any follow up. Only those in MI reported significant decreases in cigarettes smoked per day (CPD) from baseline to 1month. At 3 and 6months, smokers in both groups reported significantly reduced CPD with no differences between groups. MI reduced perceived norms regarding peer and adult smoking rates, while BA had no effect on normative perceptions. No group differences emerged for self-reported motivation or self-efficacy to quit smoking. ConclusionsFindings support the efficacy of MI for addressing normative misperceptions regarding peer and adult smoking and for modestly reducing CPD in the short-term; however, these effects did not translate to greater smoking abstinence. MI may have more promise as a prelude to more intensive smoking intervention with adolescents than as a stand-alone intervention.

Tobacco Smoking Among School Children in Colombo District, Sri Lanka

Tobacco smoking is an important problem among schoolchildren. The authors studied the patterns of tobacco smoking among schoolchildren in Colombo, Sri Lanka, using a self-administered questionnaire. Multistaged stratified random sampling was used to select 6000 students. Response rate was 90.7% (5446), out of which 53.4% were males. Prevalence rates for males and females, respectively, were as follows: having smoked at least 1 complete cigarette: 27.0% and 13.3%, smoked more than 100 cigarettes: 2.3% and 0.3%, daily smoking: 1.8% and 0.2%. Mean age of starting to smoke was 14.16 years. The tobacco products most used were cigarettes (91.5%) and bidis (3.8%). In univariate analysis, male gender, parental smoking, studying non-science subjects, peer smoking, and participating in sports were significantly associated with smoking of at least 1 complete cigarette (P < .05). In multivariate analysis, the most significant correlates were having close friends (odds ratio = 3.29, confidence interval = 2.47-4.37) or parents who smoked (odds ratio = 1.86, confidence interval = 1.28-2.71). Female smoking has increased from previously reported values. These high-risk groups can be targets for preventive programs.

Social distance and homophily in adolescent smoking initiation

BackgroundStudies often demonstrate homophily in adolescent smoking behavior, but rarely investigate the extent to which this is due to the peer network processes of selection versus influence. Applying the concept of social distance, this study examines these two processes for smoking initiation. MethodsWe analyzed socio-centric network data from the National Longitudinal Study of Adolescent Health (N=2065; grades=7th–12th). Social distance (degrees of separation), combined with stability and change in friendship networks, was used to derive indicators of peer selection and influence on initiation. Multilevel modeling was used to predict initiation from these indicators, and propensity score modeling was used to determine whether these associations remained after adjusting for pre-existing differences between initiators and consistent non-smokers. ResultsWe found that both peer influence and selection effects increased the likelihood of initiation even after adjusting with propensity score weights and demographic controls. While the effect size for peer influence depended on the overall proportion of smokers at the school, the selection effect was independent of the school environment. De-selection and indirect influence effects were not significant after controlling for school norm interactions. ConclusionsThe association between peer smoking and adolescent smoking initiation appears to be due to both peer selection and direct influence. However, “friends of friends” effects are likely to be confounded with contextual factors. Given that smoking initiation is primarily associated with close personal interactions between the adolescent and his/her friends, prevention efforts should focus on the role of smoking in fostering personal relationships among adolescents.

Cancer risks and Native Americans: The ‘Healthy Living In Two Worlds’ study

Objective: This project collected data on cancer risk factors among urban Native American youth in the northeast to inform development of a prevention initiative. Design: Face to face interviews were conducted. Setting: Interviews were conducted in homes, at a social service agency, and in a private space at a Native American cultural event in Buffalo and Niagara Falls, New York. Methods: Forty-one youth (ages 9–13) and 17 caregivers were interviewed about their health behaviours. Results: Poor dietary choices and a sedentary lifestyle places these youth at risk for developing cancer later in life. Many of these youth’s family members and some of their peers smoke, thus exposing them to the temptation to initiate smoking and the effects of second hand smoke. Conclusion: This data informed development of a curriculum designed to reduce the cancer risk factors of poor diet, recreational tobacco use, and limited physical activity.

Effects of Media and Social Standing on Smoking Behaviors among Adolescents in China

Many studies have documented associations between peer influences and smoking among US and Chinese adolescents. Few studies, however, have shown how these influences occur in relation to adolescents' positions in their social networks. Social media channels such as online social networking and text messaging extend adolescents' networks and sphere of influence. This study examines the interplay between social media channels, peer influences, and smoking outcomes. Data were collected from 6,073 students from 24 high schools in Chengdu, China. Multilevel models suggest that mobile phone use (AOR = 1.45, p < .0001) and social Internet activity are risk factors for smoking (AOR = 1.18, p = .002), whereas informational Internet activity is protective (AOR = 0.87, p = .038). High social status was also positively associated with smoking (AOR = 1.16, p = .001), whereas the relationship with smoking intentions was moderated by mobile phone use (AOR = 1.11, p = .013). Findings suggest that media usage and social standing may have differential effects on smoking and other risky adolescent behaviors.

P-27 - The association between personal, familial, school and peer factors and smoking behavior among chilean adolescents

Adolescent smoking remains as an important health problem in different countries. Understanding the factors involved in this behaviour may help to design and implement preventive programs. To study the association between personal, familial, school and peer factors and smoking behaviour among Chilean adolescents. To study the association between factors from four domains (personal, family, school and peers) and current smoking amongst adolescents performing secondary analyses of the Fifth Chilean School Population National Substance Use Survey (CHSS-2003) dataset. The CHSS-2003 is a stratified cross-sectional survey which gathers information about personal, familial, school and peer factors and cigarette use using a self-reported questionnaire. Complete data from 21,956 students for all variables of interest were used in the analyses. Theory-driven hierarchical stepwise multivariable logistic regression analyses were performed to study the association between personal, familial, school and peer factors and smoking. Results show that higher school commitment (OR = 0.46; 95%CI: 0.38–0.56), going home after school than not (OR = 0.69; 95%CI: 0.62–0.78), higher parental monitoring (OR = 0.62; 95%CI: 0.45–0.85), lower school aggressiveness (OR = 0.49; 95%CI: 0.33–0.73) and having a stronger negative opinion about drug use (OR = 0.40; 95%CI: 0.34–0.46) reduced the risk for smoking. However, the longer the time spent with friends the higher the risk for smoking (OR = 2.47; 95%CI: 2.08–2.94). Results confirmed the importance of some personal, familial, school and peer factors in Chile. Prevention programs in Chile should include interventions aimed to strengthen factors such as school commitment and parental monitoring in order to prevent smoking amongst adolescents.

Prevalence, Correlates and Perceptions Towards Cigarette Smoking Among Male and Female in School Adolescents (Aged 11–18 Years) in South Africa: Results from the 2008 GYTS Study

The aim of this study was to estimate the prevalence and identify correlates of current cigarette use among 8,470 school-going adolescents (aged 11 to 18 years) in South Africa. A cross-sectional study was carried out in 2008 in South Africa within the framework of the Global Youth Tobacco Survey (GYTS). Overall prevalence of current cigarette smoking was 16.5%. Significantly more males (22.8%) than females (10.5%) were current smokers (p < .001). Cigarette smoking among boys and girls was positively associated with parental and/or peer smoking and greater risk perception, and among girls smoking attitudes variables (having more friends among girls, greater attractiveness of boys and weight change) and various higher exposure to smoking advertising and promotion activities were positively associated with cigarette smoking. However, antismoking advertising and community and family education were positively associated with current smoking, while only having school or community special groups or classes for students who want to stop smoking was protective of smoking. Cigarette smoking and other tobacco use is a significant public health problem in South Africa. Public health efforts aimed at preventing adolescent cigarette/tobacco use should incorporate knowledge on the associated factors related to smoking.

Correlates of Chilean Adolescents' Negative Attitudes Toward Cigarettes: The Role of Gender, Peer, Parental, and Environmental Factors

We examined the association of peer, parental, and environmental factors with negative attitudes toward cigarettes among youth from Santiago, Chile. A total of 860 youth from Santiago, Chile, completed questions regarding their lifetime use of cigarettes, intentions to smoke, attitudes toward cigarettes, and questions that assessed peer, parental, and environmental factors. For both boys and girls, peer disapproval of smoking was associated with more negative attitudes toward cigarettes and peer smoking was associated with less negative attitudes toward cigarettes. Peer pressure was significantly associated with more negative attitudes toward cigarettes for girls only. Parental smoking was associated with less negative attitudes and parental control with more negative attitudes, but these associations were significant in the overall sample only. School prevention efforts and exposure to cigarette ads were not associated with cigarette attitudes. Difficulty in accessing cigarettes was positively associated with negative attitudes for boys and girls. Smoking prevention efforts focus on attitude change, but scant information is available about the experiences that influence Chilean youth's attitudes toward cigarettes. Results from the current study suggest that prevention efforts could benefit from gender-specific strategies. Girls' but not boys' attitudes were influenced by peer pressure. Moreover, negative attitudes toward cigarettes were associated with lower current smoking in girls only. Parental smoking was an important influence on youth's attitudes toward cigarettes. Efforts to reduce smoking among Chilean youth may benefit from concurrently reducing parental smoking.

Internet Chameleons: An Experimental Study on Imitating Smoking Peers Through Digital Interaction

Existing experimental studies indicate that young adults are more likely to smoke in the company of real-life smoking peers. However, it is still unclear whether imitation can explain these findings or whether alternatively the mere smell and not the smoking behavior may have been the trigger to smoke. One way to study this issue is by analyzing the exposure to real-life smoking peers without the possibility of smelling the smoker's cigarette, for example, during digital interaction on the Internet. Although many youngsters meet and interact with each other online, research on exposure to smoking peers through the Internet has not yet been investigated. This experiment was conducted among 36 daily smoking young people aged 16-24 years. Smoking behavior was observed during a 30-min joint music assignment. During this assignment, the confederate and participant sat in 2 separate rooms and interacted with each other online and via webcam. The findings show that young adults interacting with heavy-smoking peers on the Internet and via webcam smoked significantly more cigarettes than those who interacted with nonsmoking peers. Young adult smokers strongly imitate smoking in interaction with peers in online communication via webcam, without smelling the smoker's cigarette. Antismoking policies and smoking cessation programs should focus on (raising awareness of) avoiding smoking peers, even during digital interaction.

When Movies Matter: Exposure to Smoking in Movies and Changes in Smoking Behavior

The authors investigated the association between exposure to smoking in movies and the initiation and progression of adolescent smoking over time among 6,522 U.S. adolescents (between the ages of 10 and 14 years, at baseline) in a nationally representative, 4-wave random-digit-dial telephone survey. They conducted a hazard (survival) analysis testing whether exposure to movie smoking and demographic, personality, social, and structural factors predict (a) earlier smoking onset and (b) faster transition to experimental (1–99 cigarettes/lifetime) and established smoking (>100 cigarettes/lifetime). Results suggest that higher exposure to movie smoking is associated with less time to trying cigarettes for the first time (adjusted hazard ratio = 1.66; 95% CI [1.37, 2.01]) but not with faster escalation of smoking behavior following initiation (adjusted hazard ratio = 1.53; 95% CI [0.84, 2.79]). In contrast, age, peer smoking, parenting style, and availability of cigarettes in the home were predictors of earlier onset and faster transition to established smoking. Thus, the authors concluded that the effect of exposure to mass-mediated images of smoking in movies may decline once adolescents have started to smoke, whereas peers and access to tobacco remain influential.

The Association Between Smoking Depictions in Films and Tobacco use in British Adolescents: A Cross-Sectional Cohort Study

Background and aims: Research has shown that adolescents with high exposure to smoking depictions in films are two to three times more likely to start smoking compared to others, even after adjustment for confounders. We aimed to assess the association between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort. Methods: Data about exposure to smoking depictions in films and own smoking behaviour were collected from 5166 15 year olds in South-West England. Main outcome measures were smoking initiation (ever tried a cigarette?) and current smoking status (do you smoke every week?). Social, family and behavioural factors were adjusted for together with alcohol use and peer smoking behaviour as mediators. Results: Higher exposure to smoking depictions in films was associated with a dose response increase in risk of smoking initiation in adolescence even after adjusting for social, familial and behavioural confounders. Adolescents in the highest quartile of exposure were 1.73 (1.55 to 1.93) times more likely to initiate smoking compared with those in the lowest quartile. They were more likely to report being current smokers after adjusting for social and familial factors (RR 1.47 (1.07 to 2.02)) but the association attenuated after including behavioural factors in the model. Conclusions: This study provides evidence that adolescents in the UK exposed to smoking depictions in films are more likely to initiate smoking. Given the association between smoking and poor health outcomes these data justify a review of film ratings in the UK.

Parent, sibling and peer influences on smoking initiation, regular smoking and nicotine dependence. Results from a genetically informative design

We sought to determine whether parenting, sibling and peer influences are associated with offspring ever smoking, regular smoking and nicotine dependence (ND) after controlling for familial factors. We used a twin-family design and data from structured diagnostic surveys of 1919 biological offspring (ages 12–32 years), 1107 twin fathers, and 1023 mothers. Offspring were classified into one of four familial risk groups based on twin fathers' and their co-twins' history of DSM-III-R nicotine dependence. Multivariate multinomial logistic regression was used to model familial risk, paternal and maternal parenting behavior and substance use, sibling substance use, and friend and school peer smoking, alcohol and drug use. Ever smoking was associated with increasing offspring age, white race, high maternal pressure to succeed in school, sibling drug use, and friend smoking, alcohol and drug use. Offspring regular smoking was associated with these same factors with additional contribution from maternal ND. Offspring ND was associated with increasing offspring age, male gender, biological parents divorce, high genetic risk from father and mother ND, maternal problem drinking, maternal rule inconsistency and sibling drug use, and friend smoking, alcohol and drug use. Friend smoking had the largest magnitude of association with offspring smoking. This effect remains after accounting for familial liability and numerous parent and sibling level effects. Smoking interventions may have greatest impact by targeting smoking prevention among peer groups in adolescent and young adult populations.

The impact of active and passive peer influence on young adult smoking: An experimental study

BackgroundPeers influence adolescent and young adult smoking, but little is known about the underlying mechanisms. It is necessary to understand whether the current assumption of peer pressure is valid, or whether an alternative explanation as imitation is more appropriate. We examined whether passive (imitation) and/or active (pressure) peer influence affects young adult smoking. MethodsAn experiment was conducted among 68 daily-smoking students aged 16–24. The actual study aim was masked. Participants had to do a 30-min music task with a confederate. The experiment consisted of a 2 (smoking condition: confederate smokes or not) by 2 (pressure condition: confederate offers the participant a cigarette or not) factorial design, resulting in four conditions: (1) no smoking and no pressure (N=15); (2) smoking but no pressure (N=16); (3) pressure but no smoking (N=20); and (4) smoking and pressure (N=17). The primary outcome tested was the total number of cigarettes smoked during this music assignment. ResultsPeer smoking significantly predicted the total number of cigarettes smoked by young adults while peer pressure did not. The interaction effect of peer pressure and peer smoking was not significant. ConclusionsPeer pressure did not have a significant additional contribution, over and above smoking of the peer. Passive (imitation) peer influence affected young adult smoking rather than active (pressure) peer influence. Thus, smoking cessation efforts should aim at preventing interaction with smoking peers and raising awareness about its impact.

Psychological, peer, and family influences on smoking among an adolescent psychiatric sample

Although much is known about adolescent cigarette use and initiation in community samples, less is known about these factors among adolescents in clinic-referred populations or those with severe psychopathology. Data were collected from 106 adolescents aged 12 to 15 years (M = 13.6, SD = 0.74) recruited from a psychiatric inpatient facility. Hierarchical logistic regressions assessed the relationship among psychological, peer, and family environment factors and smoking at baseline and 18 months posthospitalization. Conduct problem symptoms, friends' cigarette use, and friends' marijuana use were associated with greater odds of lifetime and current smoking at baseline but not at follow-up. After accounting for the significant effect of baseline use, greater family conflict predicted decreased odds of having initiated smoking at the 18-month follow-up. The period following inpatient psychiatric hospitalization may represent an important window for smoking cessation and prevention efforts targeting peer and family factors, especially for youth with externalizing problems.

Actions Speak Louder than Words: An Experiment on the Impact of Peers Discouraging Young Adult Smoking

This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults’ likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16–24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants’ smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants’ carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher’s exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers.

Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study

ObjectiveTo assess associations between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort.MethodsData on exposure to smoking in films and smoking behaviour were collected...

Influence of family environment and social group on smoking among Brazilian youth aged 15 to 24 years

To estimate the prevalence of smoking among Brazilian youth, examining individual, family, and social group factors associated with this habit. Data from youth aged 15 to 24 years living in 17 Brazilian state capitals and the Federal District, obtained from the Household Survey on Risk Factors for Chronic Diseases and Reported Morbidity carried out in 2002 and 2003 by the National Cancer Institute was analyzed. Individual variables (sex, age, schooling, alcohol consumption, self-rated health, physical activity, current school attendance), family variables (age and education of head of household and father, mother, or sibling smoking), and social group variables (best friend smoking, most friends smoking, boyfriend/girlfriend smoking) were analyzed. Generalized estimating equations (GEE) approach to evaluate the factors associated with smoking were used. Considering the effect of the sampling design, smoking prevalence was 12.8%, ranging from 6.8% in Aracaju to 24.1% in Porto Alegre. The following factors were predictors of smoking: male sex, older age, less schooling, not attending school at the time of the survey, poorer health perception, and alcohol consumption. Peer smoking (friends or boyfriend/girlfriend) and smoking among family members (father/mother or sibling) were associated with smoking. There was an effect of parental birth cohort on smoking, with a higher prevalence of smoking among youth whose parents were born in the 1930s. Individual characteristics and the influence of peers and family were relevant for smoking by the youth. Increasing the dialogue among teenagers, school, schoolmates, friends, and parents could lead to a reduction of substance use among youth.