Peer Smoking Research Articles

The Peer and Family Smoking Index: A Valid Measure of Secondhand Smoke Exposure in Adolescents

PurposeNearly half of all adolescents in the United States are exposed to secondhand smoke (SHS) daily, primarily at home, resulting in respiratory infections, asthma exacerbations, and reduced lung function. A concise self-report measure is needed to identity adolescents exposed to SHS. The purpose of this study was to test whether nonsmoking adolescents who reported exposure to peer and/or family smoking on the Peer and Family Smoking Index had higher salivary cotinine levels than those reporting no exposure to either peer or family smoking. MethodsA convenience sample of 135 English-speaking adolescents ages 15–18 years was recruited from two high schools. Those who reported use of nicotine replacement therapy, cigarette smoking (past 30 days), smokeless tobacco use (past 30 days), or who self-reported pregnancy were excluded. Salivary cotinine and self-report data from the Peer and Family Smoking Index were collected after obtaining parental consent and assent from the adolescent. ResultsMean salivary cotinine levels differed by exposure group (none, family, peer, or family and peer), F (3, 130) = 5.44, p = .001. The post hoc analysis identified a significantly higher mean cotinine level among those exposed to SHS from both family and peers than among those with no exposure (p = .001). ConclusionsKnown groups validity of the index was supported. Adolescents who reported family smoking or a combination of family and peer smoking had significantly higher salivary cotinine levels than unexposed adolescents. The Peer and Family Smoking Index is a concise and valid self-report measure for SHS exposure in adolescents.

Predictors of Cigarette Smoking among Young Adults in Mangalore, India.

The tobacco epidemic is a heralding health menace, particularly among college students. Tobacco usage among young can have an especially devastating effect as they can be exposed for longer periods. Data to estimate the prevalence of tobacco use in young adults will be a valuable addition to the existing resources. An analytical cross-sectional study was therefore carried out in Mangalore city using a pre-tested, self-administered questionnaire adapted from the Global Youth Tobacco Survey (GYTS) with a representative sample of 720 students aged 18-20 years selected from degree colleges by multi-stage random sampling. Prevalence of 'ever users' and 'current users' of smoking were 20.4% and 11.4%, respectively. The mean age at initiation of cigarette smoking was 16 years and the majority (31 %) smoked in public places. Interestingly, 84% of them knew about the harmful effects of cigarette smoking. About one half of smokers had some or most of their friends smoking. Multivariate analysis revealed gender (OR=8.585: CI-3.26-22.5), pocket money (OR=4.165; CI=1.76-9.82) and peer's smoking habit (OR= 5.15; CI-2.21-11.9) have higher odds as correlates of tobacco usage among college students. It is of prime importance to highlight the role of prevention of smoking initiation rather than subsequently trying to stop the habit. Comprehensive interventions embracing family, friends and social milieu are needed to reduce tobacco use among students in India.

The Effect Of Family And Social Environment On Smoking Behaviour In Adolescence

Background: Parental and peer smoking are considered major predictors of smoking in adolescence. We investigate the impact of family and social environment and parental anti-smoking socialization on the intensive and extensive margins of smoking for Greek adolescents. Method and Material: Information on 873 adolescents was collected through a self-reported survey and regression analysis examined associations with five different smoking outcomes (current/lifetime smoking status/intensity and onset). Subgroup analyses and interactions provided further insights. Results: Prevalence of adolescent smoking is high. Family and peer smoking habits and smoking restrictions at home reduce probability and intensity of smoking. Parental smoking increases probability of current smoking by 5% (95% CI: 0.01-0.09) as does having all your friends smoking by 30% (95% CI: 0.16-0.45). Parental anti-smoking advice delays onset of smoking by 0.76 years (95% CI: 0.15-1.39) but does not affect current smoking. Conclusion: Family and social environments play a significant role in preventing or promoting smoking and should be regarded as crucial factors when devising policy to curb adolescent smoking.

Peer beliefs and smoking in adolescence: a longitudinal social network analysis

ABSTRACTBackground: Peer smoking is one of the strongest predictors of adolescent cigarette use, but less is known about whether other peer characteristics also contribute to this behavior. Objectives: This study examined the links between adolescent cigarette use and peer beliefs about smoking. It tested whether peer beliefs about smoking are associated with changes in cigarette use, whether this association is a result of changes in individual beliefs about smoking, and how beliefs inform friendship choices. Methods: Analyses drew on data collected from 29 school-based networks, each measured at five occasions as students moved from 6th through 9th grade, as part of the study of the PROSPER partnership model. Longitudinal social network models provided estimates of friendship selection and behavior for an average of 6,200 students at each measurement point and more than 9,000 students overall. Results: Peer beliefs about smoking influenced cigarette use both directly and through their impact on individual beliefs. Respondents tended to name friends whose beliefs about smoking were similar to their own, and the likelihood of being named as a friend was higher for those who reported more positive beliefs about smoking. Conclusion: The results from this study suggest that peer beliefs about smoking, in addition to peer cigarette use itself, are associated with adolescent smoking through several mechanisms. Because beliefs favorable to cigarette use are present before adolescents actually smoke, these results underscore the importance of implementing smoking prevention programs in early adolescence.

Use of electronic cigarettes and alternative tobacco products among Romanian adolescents.

To assess socio-demographic and smoking-related correlates of e-cigarette and alternative tobacco products (ATPs) use in a multi-ethnic group of adolescents in Tîrgu Mures, Romania. The cross-sectional study included 1835 high school students from Tirgu Mures, Romania. Socio-demographic variables and data about smoking and e-cigarettes and ATP use were collected using an online questionnaire. Chi-square tests or one-way ANOVA were applied to compare never smokers, non-current smokers, and current smokers. Multiple logistic regression was conducted to determine the correlates of e-cigarettes and ATP use. The most frequently tried non-cigarette nicotine and tobacco products were e-cigarette (38.5 %), cigar (31.4 %) and waterpipe (21.1 %). Ever trying and current use of cigarettes were the most important correlates of e-cigarette and ATPs use. Sex, ethnicity, sensation seeking and perceived peer smoking were correlates of several ATPs use. The results of this study may inform the development of tailored tobacco control programs.

The Effects of Peer Influences and Implicit and Explicit Attitudes on Smoking Initiation in Adolescence

Using participants from an 1½-year longitudinal study of smoking socialization ( N = 709), we examined peer smoking, and implicit and explicit attitudes on smoking initiation among initial nonsmoking adolescents. We also tested whether implicit and explicit attitudes mediated the effect of peer smoking on smoking initiation, and whether implicit and explicit attitudes moderated the effect of peer smoking. Results suggest that peer smoking prospectively influenced both implicit and explicit attitudes about smoking, which in turn affected risk for smoking initiation. Peer smoking and implicit and explicit attitudes exerted noninteracting effects on risk for smoking. These findings suggest that peer-focused prevention programs that target only countering explicit messages may not address the more subtle positive associations toward smoking that peer affiliations create. Additionally, prevention programs focusing only on altering these verbal messages that adolescents can report about smoking may be less effective than those addressing both explicit and implicit ideas.

The Effects of Peer Influences and Implicit and Explicit Attitudes on Smoking Initiation in Adolescence

Using participants from an 1½-year longitudinal study of smoking socialization (N = 709), we examined peer smoking, and implicit and explicit attitudes on smoking initiation among initial nonsmoking adolescents. We also tested whether implicit and explicit attitudes mediated the effect of peer smoking on smoking initiation, and whether implicit and explicit attitudes moderated the effect of peer smoking. Results suggest that peer smoking prospectively influenced both implicit and explicit attitudes about smoking, which in turn affected risk for smoking initiation. Peer smoking and implicit and explicit attitudes exerted noninteracting effects on risk for smoking. These findings suggest that peer-focused prevention programs that target only countering explicit messages may not address the more subtle positive associations toward smoking that peer affiliations create. Additionally, prevention programs focusing only on altering these verbal messages that adolescents can report about smoking may be less effective than those addressing both explicit and implicit ideas.

Factors Influencing Adolescent Lifetime Smoking and Current Smoking in South Korea: Using data from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey

The purpose of this study was to investigate factors influencing lifetime smoking and current smoking among adolescents in South Korea. Hierarchical logistic regression was conducted based on complex sample analysis using statistics from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey. The study sample comprised 72,060 adolescents aged 12 to 18. The significant factors influencing adolescent lifetime smoking were female gender, older age, higher stress, higher weekly allowance, lower economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school. The significant factors influencing adolescent current smoking were female gender, older age, higher stress, higher weekly allowance, both higher and lower economic status compared to middle economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school. Factors identified in this study need to be considered in programs directed at prevention of adolescent smoking and smoking cessation programs, as well as policies.

Exploring Support for 100% College Tobacco-Free Policies and Tobacco-Free Campuses Among College Tobacco Users.

Tobacco-free campus policy is identified as an effective means to address tobacco use on college campuses; however, the prevalence of tobacco-free policies (TFPs) in the United States remains low. This study explores college tobacco users' support for a university's TFP and tobacco-free campuses (TFCs) in general. A standardized and structured questionnaire was administered to 790 college tobacco users recruited in a university located in a tobacco-growing region of the United States, during April-May 2011, to collect information on support for TFPs and TFCs and sociodemographic-political characteristics. Descriptive and multivariable logistic regression analyses were conducted to identify key factors associated with support for TFPs and TFCs. Approximately 2 of 5 tobacco users favored TFPs and TFCs. Multivariable logistic regression models showed that demographic factors were mostly not significantly associated with attitudes of the college tobacco users. Instead, while knowledge about harmful effects of exposure to secondhand tobacco smoke significantly increased support for both TFPs and TFCs, parental and peer smoking and exposure to tobacco industry promotions significantly decreased the likelihoods of support compared with respective referent groups. Study findings suggest that campus advocacy and education campaigns for campus tobacco policies to pay attention to tobacco use behavior of familial relations, tobacco industry activities, and other political determinants of tobacco users' attitudes. Thus, this study should inform national initiatives to promote TFPs nationwide such as the Tobacco-Free College Campus Initiative.

Social Norms and Teenage Smoking: The Dark Side of Gender Equality

This paper is the first to provide evidence that cultural attitudes towards gender equality affect behaviors with potentially devastating health consequences, and that they do so differently for male and female teenagers. In particular, we show that descending from more gender-equal societies makes girls relatively more prone to smoke than boys. Using data from over 6,000 second-generation immigrant teenagers coming from 45 different countries of ancestry and living in Spain, we find that the higher the degree of gender equality in the country of ancestry, the higher the likelihood that immigrant girls smoke relative to boys, even after we control for parental, sibling, and peer smoking. Importantly, we uncover similar patterns when analyzing other risky behaviors such as drinking or smoking marijuana. This reinforces the idea that more gender-equal social norms may come at an extra cost to women's health, as they increasingly engage in risky behaviors (beyond smoking) traditionally more prevalent among men.

Smoking Peer Effects Among Adolescents: Are Popular Kids More Influential?

In this paper I analyze adolescent peer effects on cigarette consumption while considering the 'popularity' of peers. The analysis is based on AddHealth data, a four wave panel survey representative of American high-school students. The data include the social network of each school, which we use to measure peers' popularity from network centrality measures, in particular weighted-eigenvector centrality. We use lagged peers' behavior at the grade level to alleviate potential homophilic confounds, and we include school fixed effects to control for contextual confounds. We find that most of the aggregate peer effects regarding cigarette smoking come from the smoking propensity of the 20% most popular kids, suggesting a mediation from social status. This effect persists seven and thirteen years later (wave 3 and 4 of the data). Indeed, the smoking propensity of the bottom 80% seems to have a negative influence on the probability of smoking in the long run (wave 3 and 4). These results hint to the importance of knowing not only the smoking propensity within a school but also the place of the smokers within the social hierarchy of the school.

Effect of Knowledge, Peer Group, Family, Cigarette Price, Stipend, Access to Cigarette, and Attitude, on Smoking Behavior

Background : Passive smokers inhale 75% of ambient smoke and 50% of exhaled smoke. A cigarette contains 4.000 poisonous chemical agents, at least 69 of which are carcinogenic. Therefore ambient tobacco smoke is detrimental to health. The purpose of this study was to analyze the effect of knowledge, peer group, family, cigarette price, stipend, access to cigarette, and attitude, on smoking behavior. Subje cts and Me thod : This was an analytic and observational study with cross sectional design. This study was conducted at School of Health Polytechnics, Surakarta, Central Java. A total of 105 male students was selected for this study. The dependent variable smoking status. The independent variables knowledge, peer group, family, cigarette price, stipend, access to cigarette, and attitude. The data were collected by a set of questionnaire, and were analyze by logistic regression model. Results : High smoking peer group (OR= 3.21; 95% CI=1.18- 8.72; p= 0.022), high stipend (OR= 3.66; 95% CI= 1.28-10.49; p= 0.016), convenient access to cigarette (OR= 3.02; 95% CI= 1.04 to 8.73; p= 0.042) increased the likelihood of smoking. High knowledge about tobacco smoking (OR= 0.35; 95% CI=0.13-0.95; p = 0.039) and non-smoking family (OR= 0.16; 95% CI=0.03 to 0.70; p= 0.015) decreased the likelihood of smoking. High price of cigarette (OR= 0.86; 95% CI= 0.23 to 3.19; p= 0.819) and possitive attitude (OR= 0.88; 95% CI= 0.33 to 2.36; p= 0.795) did not show statistically significant effect on smoking. Conclusion : Smoking peer group, stipend, access to cigarette increase the probability of smoking. Knowledge about tobacco smoking and non-smoking family decrease the probability of smoking. K eywords : knowledge, peer group, family, cigarette price, stipend, access to cigarette, attitude, smoking behavior Correspondence : R. Asto Soesyasmoro.School of Health Polytechnics, Surakarta. Email: asto_monti@yahoo.co.id. Journal of Health Promotion and Behavior (2016), 1(3): 201-210 https://doi.org/10.26911/thejhpb.2016.01.03.07

Prevalence and determinants of cigarette smoking among college students: a cross-sectional study in Douala, Cameroon.

BackgroundTobacco is the most important avoidable risk for non communicable diseases. While tobacco consumption is stable or declining in developed countries, it is increasing in the developing world with a rate of 3.4 % per annum. The objective of this study was to estimate the prevalence and factors associated with cigarette smoking among college students.MethodsA cross-sectional study was conducted from December 2012 to April 2013 in secondary schools in Douala, Cameroon. A self-administered questionnaire was used to collect sociodemographic data, smoking behavior and peer smoking among college students. Logistic regression analyses was employed to identify factors associated with cigarette smoking.ResultsOf a total of 2623 students included, 1579 (60.2 %) were female. The mean age of participants was 19.2 ± 2.53 years. The prevalence of current smoking was 11.2 % [95 % confidence interval (CI) 10 – 12], with 20 % in males and 5.3 % in females. Cigarette smoking was with significantly associated with friends smoking [Odds ratio (OR) 6.66; 95 % CI 4.69 – 9.45)], male gender (OR 3.61; 95 % CI 2.52 – 5.16), increase in age (OR 1.10; 1.03 – 1.17), parental smoking 1.69 (1.04 – 2.76), and attending general education (OR 1.85; 1.23 – 2.78).ConclusionsCigarette smoking constitutes a significant health hazard in college students in Douala. Youth population and especially male students should be continuously targeted by preventive measures and sensitization campaigns against tobacco use. Parents should be aware on the influence of their smoking behavior on initiation of smoking in their children and should be encouraged to quit smoking.

Abstract B15: Second-hand smoke (SHS) and smoking cessation in non-tobacco related cancers

Abstract Introduction: Continued smoking after a diagnosis of cancer has been found to lead to poorer treatment response, reduced survival and quality of life and increased risk of second primary cancers. We have previously demonstrated that SHS (exposure at home, with spouses and peers) is a significant barrier to smoking cessation in tobacco-related (lung and head and neck) cancers with adjust odds ratios of 6-9 (PMID: 24419133, 23765604) for quitting 1 year after diagnosis and quitting at any time after diagnosis; relationships stronger than in non-cancer populations. Here, we examined whether this relationship exists in cancers that are not traditionally associated with smoking. Patients and Methods: Cancer survivors from a single tertiary cancer centre, Princess Margaret Cancer Centre (Toronto, Canada) completed a one-time cross-sectional questionnaire assessing their socio-demographics, functional status, smoking history and SHS exposure. Clinico-pathological variables were obtained through review of patient charts. Multivariate logistic regression and Cox-proportional hazard models evaluated the association of SHS with smoking cessation at 1 year after diagnosis and any time after diagnosis, and time-to-quitting respectively, adjusted for significant co-variates. Results: A total of 1011 non-tobacco related cancer survivors were surveyed between 2012 and 2014: 19% breast, 15% gastrointestinal, 16% genitourinary, 12% gynecological, 23% hematologic, 15% other. Median follow-up time after diagnosis was 26 months. Among the 162 patients currently smoking at diagnosis, 35% quit 1 year after diagnosis and 48% quit at any time after diagnosis. None of the 306 ex-smokers and 543 never smokers (re-)started smoking after diagnosis. Home exposure to SHS was found to be strongly associated with reduced smoking cessation in cancer patients at any time after diagnosis (aOR=4.28, 95% CI (1.56-11.78), P=4.8E-3), while there was a less strong and non-significant trend for home exposure to SHS and reduced smoking cessation at 1 year after diagnosis (aOR=2.56, 95% CI (0.91-7.22), P=0.08)). Time-to-quitting analysis for home exposure to SHS were consistent with these results (aHR=2.76, 95% CI (1.15-6.59), P=0.02)). Unlike lung and head and neck cancer patients, spousal and peer smoking were not found significantly associated with smoking cessation at either time-point (P>0.05). Kaplan-Meier analysis found that 72% of patients who quit, did so within 1 year of their cancer diagnosis. When comparing factors between patients quitting one year after diagnosis versus quitting more than one year after diagnosis, those quitting at one year were more likely older (P<0.05) and have received surgery as part of their cancer care (P=0.06). Conclusions: Home exposure to SHS is a significant barrier to quitting smoking after a diagnosis of cancer in both tobacco-related and non-tobacco related cancers; while spousal and peer smoking were not found significantly associated with smoking cessation in non-tobacco related cancers. Unlike in tobacco-related cancers, home exposure to SHS had a weaker association with quitting at 1 year after diagnosis than quitting at any time after diagnosis; suggesting the effect of the “teachable moment” with SHS and cancer may not be as strong in these cancers. Survivorship programs focusing on secondary prevention and smoking cessation in cancer patients should focus on incorporating SHS exposure. Citation Format: Lawson Eng, Xin Qiu, Jie Su, M Catherine Brown, Margaret Irwin, Dan Pringle, Hiten Naik, Chongya Niu, Mary Mahler, Henrique Hon, Kyoko Tiessen, Rebecca Charow, Henry Thai, Valerie Ho, Vivien Pat, Lindsay Herzog, Anthea Ho, Jennifer M. Jones, Doris Howell, David P. Goldstein, Meredith E. Giuliani, Wei Xu, Peter Selby, Geoffrey Liu. Second-hand smoke (SHS) and smoking cessation in non-tobacco related cancers. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B15.

Association between perceived peer smoking and personal smoking among adolescents in Denmark

Association between perceived peer smoking and personal smoking among adolescents in Denmark

Real-Time Readiness to Quit and Peer Smoking within a Text Message Intervention for Adolescent Smokers: Modeling Mechanisms of Change

The psychological construct, readiness to change, is established as a central construct within behavioral change theories such as motivational interviewing (MI). Less is known about the interplay of mechanisms for change within adolescent treatment populations. Understanding the timing and interactive influence that adolescents' readiness to stop smoking and peer smoking have on subsequent tobacco use is important to advance intervention research. Toward this end, we used ecological momentary assessment (EMA) data from an automated texting smoking intervention randomized controlled trial to model the interactive effects of readiness to stop smoking and friends smoking on adolescent tobacco use. Two hundred adolescents were randomized into experimental treatment or attention control conditions, provided smart phones, and were followed for 6months. African American youth represented the majority of the sample. We collected monthly EMA data for 6months on friends smoking and readiness to stop smoking as well as survey outcome data. We tested a moderated mediation model using bias corrected bootstrapping to determine if the indirect effect of treatment on cigarettes smoked through readiness to stop smoking was moderated by friends smoking. Findings revealed that readiness to stop smoking mediated the effects of treatment on cigarettes smoked for those adolescents with fewer friends smoking, but not for those with more friends smoking. These results support importance of peer-focused interventions with urban adolescents and provide target mechanisms for future research.

Multiple substance use patterns in adolescents—A multilevel latent class analysis

BackgroundMultiple substance use among adolescents is associated with a number of negative consequences. Therefore, we aim to investigate multiple substance use patterns among young adolescents and identify possible multilevel predictors. MethodsWe analyzed a longitudinal sample of 2490 German students (51% male; Mage=13.32, SD=0.57) at 45 schools in four German states (Bremen, Hesse, North Rhine–Westphalia, Schleswig–Holstein), who completed two assessments in fall, 2010 and fall, 2013. We conducted multilevel latent class analysis for follow-up data on a variety of outcomes, and tested our final 3-class-model for possible baseline predictors. Follow-up substance use measures included lifetime use, current use, and amount of substance for cigarettes and alcohol. Baseline covariates comprised age, gender, socio-economic status, bullying, victimization, peer and parental use, type of school, and health certification of school. ResultsWe identified three latent classes: non-users (n=1541; 61.9%), experimenters (n=722; 29.0%), and multiusers (n=227; 9.1%). Experimental consumption was predicted by higher baseline age (OR=1.71; 1.31–2.24), paternal drinking (OR=2.89; 1.23–6.79), and school type (OR=2.57; 1.83–3.61), while multiuse was predicted by peer smoking (OR=2.94; 1.80–4.80) and drinking (OR=2.13; 1.32–3.44), maternal drinking (OR=6.26; 2.02–19.43), bullying (OR=1.69; 1.15–2.48), higher age (OR=1.92; 1.40–2.62), and school type (OR=4.76; 2.75–8.24) compared to the non-users class. ConclusionsPrevention and further research on multiple substance use need to concentrate on social influence models and behavior-related interventions, especially at schools without a college-preparatory track.

Secondhand Smoke Exposure Among Nonsmoking Adolescents in West Africa.

We estimated the prevalence and determinants of secondhand smoke (SHS) exposure among nonsmoking adolescents in 9 West African countries. We conducted a pooled analysis with nationally representative 2006 to 2009 Global Youth Tobacco Survey data. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using a multivariable logistic regression model to determine factors associated with SHS exposure. We investigated average marginal effect results that show the probability of SHS exposure, adjusting for all other attributes. SHS exposure inside the home ranged from 13.0% to 45.0%; SHS exposure outside the home ranged from 24.7% to 80.1%. Parental or peer smoking behaviors were significantly associated with higher probability of SHS exposure in all 9 countries. Knowledge of smoking harm, support for smoking bans, exposure to antismoking media messages, and receptivity of school tobacco education were significantly associated with higher SHS exposure in most countries. West African policymakers should adopt policies consistent with Article 8 of the World Health Organization Framework Convention on Tobacco Control and its guidelines and public health education to promote smoke-free households.

Youth Whose Weight Exceeds Healthy Guidelines Are High-Risk Targets for Tobacco Prevention Messaging and Close Monitoring of Cigarette Use.

Adolescents are long-standing tobacco prevention targets, given that smoking patterns typically originate before adulthood. Pediatric overweight/obesity remains at epidemic levels. Links between these two biobehavioral risks are not well understood, yet of keen public health and pediatric care relevance. The aims of the present study were to examine smoking behaviors and attitudes of overweight (OV), obese (OB), and severely obese (SO) adolescents, compared to healthy weight (HW), utilizing the nationally representative sample, Monitoring the Future. Smoking behavior prevalence (ever, current, or age of initiation), perceived risk of harm, disapproval of others smoking, and peer smoking were determined for a pooled 2008-2009 sample of 19,678 10th graders (Mage=16.09±0.47 years) by CDC-defined BMI percentile-based categories within race/ethnic group (69.5% white, 14.5% African American, and 16.0% Hispanic). Logistic regression examined the impact of excess weight status on smoking behaviors and attitudes relative to HW. Relative to HW of same race/ethnicity, white or African American OV, OB, and SO had higher odds of recent smoking, with the highest prevalence among SO. For white youth, excess weight increased odds of ever smoking, early daily smoking (before grade 9), perceiving low risk of harm, and not disapproving of others smoking. Findings varied for African American or Hispanic youth. As we move toward fostering a tobacco-free generation, youth whose weight exceeds healthy guidelines are high-risk targets for tobacco prevention messaging and close monitoring of cigarette use, particularly those who are severely obese as well as white youth of excess weight, starting before adolescence.

Misconceptions about smoking in patients with type 2 diabetes mellitus: a qualitative analysis.

To investigate the smoking behaviours, perceptions about quitting smoking and factors associated with intention to quit in patients with type 2 diabetes mellitus. Smoking causes type 2 diabetes mellitus. There has been limited research on the needs and concerns of smokers with type 2 diabetes mellitus about quitting smoking. The study used a qualitative design. Patients diagnosed with type 2 diabetes mellitus who had a history of smoking were recruited at the outpatient diabetic clinics of two major local hospitals in Hong Kong for a semi-structured interview (n = 42), guided by the theory of planned behaviour. At data saturation, 22 current smokers and 20 ex-smokers with type 2 diabetes mellitus were recruited. The current smokers reported they had not quit smoking because of satisfaction with present health status, and misconceptions about the association between diabetes and smoking, and the perceived hazards of quitting. In contrast, ex-smokers had a positive opinion about quitting smoking, accepted advice about quitting from health professionals and received more family support than current smokers. Psychological addiction and weight gain after cessation made quitting challenging. Satisfaction with health status, inadequate knowledge about the relationship between type 2 diabetes mellitus and smoking, and misconceptions about quitting smoking resulted in negative attitudes toward quitting by type 2 diabetes mellitus smokers. Smoking peers, psychological addiction and post-cessation weight gain hindered the quitting process. Education on the causal link between smoking, type 2 diabetes mellitus and its complications is important to raise health awareness and counter misconceptions about quitting smoking. Behavioural counselling with weight control strategies should be part of a comprehensive smoking cessation intervention for type 2 diabetes mellitus smokers.