Adolescent Smoking Prevalence Research Articles

The role of national policies intended to regulate adolescent smoking in explaining the prevalence of daily smoking: a study of adolescents from 27 European countries

This study seeks to examine whether contextual factors influence adolescents' daily smoking. A focus was placed on three modifiable policies operating at a national level, non-smoking policy at educational facilities, price and minimum age for buying tobacco. This study is based on a merged data set consisting of the 2001/02 Health Behavior in School-aged Children (HBSC) study and national-level data collected from the 2003 WHO European Tobacco Control Database and the World Development Indicators Database. HBSC is an international study including adolescents from 32 countries in Europe, Israel and North America. Data were analysed with multi-level hierarchical regression models. The study found large differences in the prevalence of daily smoking among adolescents, and also large differences between boys and girls within some countries. The study found that smoking bans in schools were associated with lower odds ratios of daily smoking, which was the one positive association in the study. The study found no association between cigarette prices and adolescent daily smoking prevalence, and also the somewhat unexpected finding that having an age limit for allowing adolescents to purchase tobacco was associated with an increased risk of daily smoking. There was an association between mandatory national bans on smoking and lower smoking prevalence. This should be confirmed by studies that examine whether mandatory bans are more rigorously implemented than voluntary bans. If this association is causal, introducing mandatory bans may reduce adolescent smoking prevalence. The findings that price was unrelated to smoking prevalence undermine findings elsewhere that adolescent smokers are more price-sensitive than adult smokers, but longitudinal studies are needed.

Smoking Status of Adolescents in 2 Countries and the Impact of the Smoking Status of Mother, Father, Grandparents, and Siblings

There is considerable agreement throughout the world that adolescent smoking preferences are influenced by parents grandparents and siblings. Learning about the influence of this modifiable family environmental factor is extremely important because prevention strategies focused on including relatives might lead to greater reductions in the incidence and prevalence of adolescent smoking than adolescent-only programs. Researchers have found that the effect of relatives on adolescent smoking preferences is variable among different cultures. However there has been little opportunity to determine if smoking preferences differ between adolescents of a similar culture and heritage who live in 2 completely different geographic environments. The US-Mexico border is a place where adolescents share similar culture and heritage but are exposed to different laws different finances and different economic resources. We recently conducted a study of adolescent smoking in the border area of El Paso TX (population: 78% Hispanic 64% Mexican) and Ciudad Juarez Chihuahua Mexico. While conducting this cross-sectional study we assessed the influence of relatives (parents grandparents and siblings) smoking preferences on adolescent smoking. (excerpt)

Association Between Family Structure, Parental Smoking, Friends Smoking and Smoking Habits in Asthmatic Adolescents

Prevalence of smoking in asthmatic adolescents is increasing and determinant factors have still not been well-established. Objective, to determine the Association between family structure, parental smoking, friends smoking and smoking habits in asthmatic adolescents.

The development of tobacco use in adolescence among "snus starters" and "cigarette starters": An analysis of the Swedish "BROMS" cohort

Whether the use of smokeless tobacco can facilitate the transition to cigarette smoking and/or to prolonged tobacco use in adolescence is unclear. We analyzed data from a cohort of 2,938 Swedish adolescents, with six follow-up assessments of tobacco use between the ages of 11 and 18 years. The majority of tobacco users (70%) started by smoking cigarettes, 11% took up snus before smoking, and 19% used both tobacco types close in time. Ever users of tobacco at baseline had a higher risk of being current smokers and/or smokeless tobacco users at the end of follow-up compared with never users, with the highest excess relative risk for "mixed users." Adolescents who initiated tobacco use with cigarettes had a non-significantly increased probability to end up as current smokers compared with snus starters (adjusted OR=1.42; 95% CI 0.98-2.10) The OR of smoking for "mixed starters" was 2.54 (95% CI 1.68-3.91). The risk of becoming current user of any tobacco was also significantly enhanced for "mixed starters." Marked sex differences were observed in these associations, as initiation with cigarettes rather than with snus predicted current smoking or tobacco use only among females. Progression of tobacco use in adolescence is not predicted by onset with snus or cigarettes, but rather by initiation with both tobacco types close in time and/or at young age. The proportion of adolescent smoking prevalence attributable to a potential induction effect of snus is likely small.

Does harm minimisation lead to greater experimentation? Results from a school smoking intervention trial

Declines in adolescent smoking prevalence have slowed recently, resulting in increased interest and literature in tobacco harm minimisation. To date, harm reduction strategies have focused largely on modifying the product and alternative (safer) mechanisms of nicotine delivery. There has been little exploration of primary harm minimisation to prevent the onset of regular smoking among young people. A major concern expressed about harm reduction interventions and young people is that they may increase experimentation among non-users. The Smoking Cessation for Youth Project was a 2-year school-based cluster randomised controlled trial conducted in 30 Western Australian schools. Results on the primary outcome showed a significant reduction in regular smoking among 4636 13-15-year-olds receiving a harm minimisaton versus standard intervention. This paper addresses the intervention effects on 2078 students who had not smoked at baseline. At 20-month follow-up, smoking initiation was slightly lower among intervention students than comparison students (who received a largely abstinence-based intervention), although this difference did not attain statistical significance (OR=0.86; 95% confidence interval: 0.68, 1.09). This study provided limited evidence to suggest that harm minimisation is a superior approach to abstinence-based interventions for non-smokers. However, this intervention did not contribute to increased experimentation among non-smokers. Although more trials are required, these results indicate that fears of potential negative iatrogenic effects from school-based harm minimisation interventions may be unwarranted.

Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia

Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia

Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia

BackgroundTobacco smoking is a growing public health problem in the developing world. There is paucity of data on smoking and predictors of smoking among school-going adolescents in most of sub-Saharan Africa. Hence, the aim of this study is to estimate the prevalence of smoking and its associations among school-going adolescents in Addis Ababa, Ethiopia.MethodsData from the Global Youth Tobacco Survey (GYTS) 2003 were used to determine smoking prevalence, determinants, attitudes to, and exposure to tobacco advertisements among adolescents.ResultsOf the 1868 respondents, 4.5% males and 1% females reported being current smokers (p < 0.01). Having smoking friends was strongly associated with smoking after controlling for age, gender, parental smoking status, and perception of risks of smoking (OR = 33; 95% CI [11.6, 95.6]). Male gender and having one or both smoking parents were associated with smoking. Perception that smoking is harmful was negatively associated with being a smoker (odds ratio 0.3; 95% confidence interval, 0.2–0.5)ConclusionPrevalence of smoking among adolescents in Ethiopia is lower than in many other African countries. There is however need to strengthen anti-tobacco messages especially among adolescents.

“Deviance proneness” and adolescent smoking 1980 versus 2001: Has there been a “hardening” of adolescent smoking?

In a midwestern community sample, we tested for evidence of “hardening” of adolescent cigarette smoking between 1980 and 2001 by comparing adolescent smokers and nonsmokers at these two times on measures indicative of “deviance proneness” in Jessor and Jessor's [Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. NY: Academic Press] problem behavior theory. Results produced support for some “hardening” of adolescent smoking, but this was largely confined to younger cohorts. Changing social norms that are reflected in a lowered prevalence of adolescent smoking may have restricted smoking behavior to a somewhat more “deviance prone” segment of the adolescent population. Results illustrate the potential utility of considering changes in the larger social and historical context when studying the development of adolescent risk behavior.

The Global School Personnel Survey: a cross-country overview

Teachers and administrators are role models for students, conveyors of tobacco prevention curricula, and key opinion leaders for school tobacco control policies. School teachers and administrators have daily interaction with...

The prevalence of smoking and sedentary lifestyle in adolescents

The prevalence of smoking and sedentary lifestyle in adolescents

Tobacco use among youth and related characteristics, Turkey

To provide nationally representative data on smoking prevalence of Turkish adolescents; to examine their knowledge, attitude and exposure to tobacco. A school-based representative survey of adolescents (13-15 years) was conducted within the frame of Global Youth Tobacco Survey (GYTS). 15957 students were selected using a two-stage cluster sampling method and completed an internationally standardized questionnaire on tobacco use and related factors. About one-third of students had already experienced smoking and 10% were current smokers. Rate of exposure to passive smoking was high both in current smokers (89.0%) and never smokers (79.2%). More than one-third of current smokers had intended to quit. Susceptibility to initiate smoking was fairly high among never smokers, especially in boys (9.1% versus 5.8%). Considerable proportions of both never, and current smokers had positive attitude toward tobacco use. Half of the students had no school curriculum about the effects of tobacco use. Smoking prevalence among Turkish adolescents is alarmingly high and the gender gap is closing. A relevant legislation is a must for success in tobacco control but should be combined by other effective prevention and cessation programs.

Das Rauchverhalten von Jugendlichen im Vergleich von bevölkerungsrepräsentativ, regional oder selektiv erhobenen Daten und Implikationen für die Prävention

The prevalence of adolescent smoking underlines the necessity of preventive measures, which goals are based on representative data. It is not known whether schools participate in prevention interventions, where smoking constitutes a relatively big or minor problem. This study examines a population of adolescents on (a) different smoking variables and (b) compares them with representative, population based data. Survey of n = 324 adolescents of grade 7-10 in 3 schools in Greifswald and surroundings that were ready to participate in a prevention curriculum. In total, 80% of the students under examination indicated to have at least tried smoking in their lifetime. Daily smokers were 31%, 18% were occasional smokers, 39% have indicated that they hat tried to quit without success. These figures vary across age, grade and sex. Smoking prevalence is comparable between schools ready to participate in prevention and regionally assessed data, but much higher than population based data would have estimated. The goal of preventive measures can not be solely grounded on representative, population-based data, but needs (a) to be regionally defined and (b) to consider the population actually participating in such prevention interventions. The readiness to participate is not higher in schools where smoking constitutes a comparable minor problem. Preventive measures are applied in schools where the problem is perceived.

How have smoking risk factors changed with recent declines in California adolescent smoking?

To compare predictors of smoking initiation in two longitudinal studies in California conducted during periods when adolescent smoking prevalence was increasing (1993-96) and decreasing (1996-99). Cohorts of 12-15-year-old never smokers were identified from the cross-sectional 1993 and 1996 California Tobacco Surveys (large population-based telephone surveys) and followed-up 3 years later (1993-96, n = 1764; 1996-99, n = 2119). We compared cohort transition rates to any smoking by follow-up in risk groups defined by known predictors of smoking initiation at baseline. Besides examining predictors individually, risk groups were defined using a multivariate analysis. Overall, transition to any smoking by follow-up occurred in 38.3 +/- 4.0% (% +/- 95% confidence interval) of never smokers in the 1993-96 cohort and 31.1 +/- 2.6% in the 1996-99 cohort. For most predictors, the transition rate for adolescents with the characteristic was the same or only slightly lower in the 1996-99 cohort compared to the 1993-96 cohort, but the transition rate in those without the characteristic was generally much lower, thus increasing the power of the predictor. The multivariate analysis confirmed that compared to the 1993-96 cohort, transition occurred much less often in the 1996-99 cohort for adolescents at low rather than at medium or high risk of future smoking. The turnaround in California adolescent smoking in the mid-1990s, when smoking began to decline, appears to come primarily from adolescents already at low risk of future smoking (as defined by a variety of predictors), who transitioned to smoking at much lower rates than previously.

Prevalence of hypertension, hypercholesterolemia, smoking and overweight in older Belgian adolescents

Risk factors in young adulthood may persist into later life and eventually lead to cardiovascular (CV) disease. The purpose of this study was to describe the prevalence of hypertension and other established CV risk factors in older adolescents. Study nurses examined 120 girls and 80 boys with a mean age of 17.4 (SD, 0.8; range 15.8-19.6 years). After 5 minutes of sitting rest, resting blood pressure (BP) of the participants was measured in triplicate by sphygmomanometry. Body height and weight were measured and body mass index (BMI) was calculated. Serum lipids, smoking and drinking status were assessed. Hypertension was diagnosed according to the criteria specified in the 1996 update of the Task Force on BP treatment in Children and Adolescents (Pediatrics 1996;98:649-58). Almost 25% of the subjects currently smoked with a median daily consumption of 6 (Interquartile 4-9) and 11 (6-16) cigarettes in girls and boys, respectively. Fourty-nine (41%) girls used oral contraceptives. Systolic (118 versus 109 mm Hg, p<0.001) and diastolic BPs (70.5 versus 68.0 mm Hg, p=0.033) were significantly higher in boys than in girls. Two (2%) girls and four (5%) boys had systolic hypertension; diastolic hypertension was found in six (5%) girls and one (1%) boy. Twelve (10%) girls and six (8%) boys were overweight (>25.0 kg/m2). Twenty (17%) girls and seven (9%) boys had hypercholesterolemia (total serum cholesterol > or =5.2 mmol/L). Overall, 50 (42%) girls and 31 (39%) boys had at least one CV risk factor, 12 (10%) girls and four (5%) boys had two risk factors, and three (3%) girls and one (1%) boy had more than two risk factors. In 17-year-olds living in an affluent society the prevalence of CV risk factors was high. These findings underscore the importance of health education and prevention at this age.

Smoking Patterns Among Young People With Asthma

To the Editor. We read with great interest, and we congratulate the authors of, the article by Precht et al1 that describes the prevalence of smoking and the relationship between smoking and asthma among adolescents. In the conclusions, the authors state that asthmatic people smoke more and smoke more cigarettes per day than nonasthmatic subjects. In the introduction to their article, it is stated that the literature indicates that the smoking prevalence of adolescents with asthma is higher than or similar to that of adolescents without asthma. Moreover, they only found 1 study that asthmatic adolescents smoke less than nonasthmatics. We recently published an article2 with a similar objective. We studied 600 young people with asthma with a mean age of 20 years (20 ± 3 years), a little higher than that …

Smoke constituent exposure and smoking topography of adolescent daily cigarette smokers

Adolescent smoking prevalence is a major health concern, with 24.4% reporting smoking in the past 30 days and 15.8% considered daily smokers. The purpose of this study was to characterize biobehavioral nicotine dependence, smoke constituent exposure and smoking topography in adolescent daily smokers. Relationships among biological markers of nicotine dependence (nicotine boost, carbon monoxide [CO] boost and cotinine levels) with existing self-report measures (modified Fagerström Tolerance Questionnaire [mFTQ] and the motivations for smoking scale) were examined. Gender differences were characterized. Fifty adolescents 13-18 years old were recruited for the study, 50% female. CO, plasma nicotine levels pre- and postcigarette, cotinine, and smoking topography were measured during a smoking bout with participant's usual cigarette. Average CO boost, pre- to postcigarette was 7.2 + 3.6 ppm, baseline cotinine level averaged 224.0 +/- 169.6 ng/ml and nicotine boost averaged 23.4 +/- 21.7 ng/ml. Mean puffs per cigarette was 14.2 +/- 6.3. Males had significantly higher total puff volumes, but similar smoke constituent exposure to females, and higher handling of cigarettes as smoking motive. In regression analysis, 35% of variance in tobacco use, as indicated by baseline cotinine concentration, was explained by maximum puff duration, postcigarette CO level, and nicotine dependence, as measured by the mFTQ. Results indicated adolescents had considerable smoke constituent exposure and nicotine dependence suggesting the importance of appropriate smoking cessation treatment.

Is the prevalence of youth smoking affected by efforts to increase retailer compliance with a minors' access law?

This study correlated measures of youth smoking behavior with community-level indicators of retailer compliance with a minors' tobacco access law. The study was carried out between 1992 and 1996 in 12 communities in Erie County, New York. Retailer compliance was assessed by having adolescents attempt to purchase tobacco products in licensed tobacco-selling outlets in fall 1994 and fall 1995 after implementation of an aggressive enforcement program. Communities were grouped in two ways: (a) those that did or did not increase retailer compliance rates by 200% or more between 1994 and 1995 and (b) those that did or did not achieve an 80% retailer compliance rate in 1995. School-based surveys conducted in 1992 and 1996 assessed the tobacco use behaviors of ninth-grade public school students. Between 1994 and 1995, retailer compliance increased in all 12 communities by an average of 155%. In 1995, six of the 12 communities achieved retailer compliance rates in excess of 80%. Indicators of youth smoking behavior did not vary significantly between communities that increased their retailer compliance rates by more or less than 200%. The prevalence of past 30-day smoking remained stable between 1992 and 1996 in the six communities that achieved a retailer compliance rate of at least 80% and increased slightly in the remaining communities. The prevalence of frequent smoking decreased between 1992 and 1996 in the communities that achieved a retailer compliance rate of at least 80% and increased slightly in the six communities that failed to achieve this rate. Achieving a high rate of retailer compliance with a minors' access law appears to have caused youths to rely more on noncommercial sources of cigarettes and may have had a small effect on adolescent smoking prevalence, especially frequent smoking.

Methodological issues in measuring treatment outcome in adolescent smoking cessation studies.

As the prevalence of adolescent smoking and, notably, regular smoking has increased over the last decade, researchers and practitioners have called for a consideration of treatment programs to promote cessation among adolescents who smoke. The adolescent smoking cessation treatment field is still in its infancy, though. The literature addressing adolescent cessation is rather limited to date, often plagued by methodological problems and characterized by little success. Many basic methodological questions remain for researchers to address before we will be able to answer questions such as which treatment approaches work best for which adolescent smokers. The purpose of this paper is to review briefly what is known about adolescent smoking cessation, to identify some important methodological issues to consider in treatment outcome studies, and to make recommendations to researchers to help provide a common ground for future comparisons of results across studies. We will address the natural history of adolescent smoking cessation, treatment outcomes, validity of self-reports and biochemical validation, and research recommendations.

Limiting youth access to tobacco: a failed intervention.

For the last decade, the most widely used intervention to reduce adolescent smoking has been enactment of “youth access” laws, which make it illegal to sell cigarettes to teenagers. These laws have been required by the federal government to obtain funding for substance abuse programs [1] and were the primary enforcement element of the tobacco regulation proposed by the Food and Drug Administration [2] and struck down by the U.S. Supreme Court. The Centers for Disease Control and Prevention [3] and the Institute of Medicine [4] recommend youth access controls as part of a comprehensive tobacco control program. All 50 states and over 1000 local governments have passed youth access laws. Unfortunately, while these programs do make it difficult for teens to purchase cigarettes [5–7], they do not affect teen smoking prevalence [8]. The paper by Castrucci et al [9] in this issue of the Journal of Adolescent Health, together with previous studies that reached similar conclusions based on different data sets [10–14], explains why this seemingly logical intervention does not work: As youth access laws make it harder to purchase cigarettes, teens simply get their cigarettes elsewhere. Castrucci et al [9] recognize that it is likely impossible to block noncommercial sources and realistically, in contrast to others [14], do not recommend policies to block these “social sources.” The fact that youth access controls are not associated with lower teen smoking [8] is not surprising because, although most smokers start experimenting with cigarettes in their teens, few teens smoke daily, so do not need to procure many cigarettes, and as Castrucci et al [9] observe, it is these youngest experimenters who are most likely to obtain their cigarettes from noncommercial sources. It has been argued that even if they do not affect youth smoking prevalence, youth access programs are valuable because they are politically safer than policies involving clean indoor air or anti-tobacco media campaigns and that they engage the public and help build coalitions for tobacco control [5,15]. The tobacco industry, however, has done an even better job of using the threat of youth access legislation to organize a large grass-roots network of merchants which has helped the tobacco industry fight a wide variety of effective tobacco control policies, particularly clean indoor air laws [16], and shift the emphasis in tobacco control away from the tobacco industry’s marketing practices. For example, Philip Morris tobacco company is actively promoting messages telling parents to keep their cigarettes away from their kids [17, 18]. Castrucci et al [9] also conclude that “while limiting commercial sources of cigarettes remains an important part of a comprehensive approach to reduce tobacco use, adolescent smoking prevalence will likely only continue to decline with further implementation of policies that are known to decrease tobacco use.” No one can disagree with the second part of this statement—that we should seek implementation of policies that are known to decrease tobacco use: smokefree workplaces and homes [19–23], taxes [20–22, 24, 25], media campaigns [26], and secondhand smoke messages [27]. From the Center for Tobacco Control Research and Education, Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, California This work was supported by NIH National Cancer Institute Grant CA-61021. Address correspondence to: Stanton A. Glantz, Ph.D., Professor of Medicine, Box 0130, University of California, San Francisco, CA 94142. E-mail: glantz@medicine.ucsf.edu. JOURNAL OF ADOLESCENT HEALTH 2002;31:301–302

Mediation in a Family-Directed Program for Prevention of Adolescent Tobacco and Alcohol Use

Background. Family Matters is a universal intervention designed to prevent adolescent tobacco and alcohol use through involvement of family members and by targeting family risk factors for tobacco and alcohol use. Previously reported findings suggest that the program reduced the prevalence of both adolescent smoking and drinking in the 12 months after program completion. This paper reports analyses conducted to identify the mediators through which the program influenced adolescent smoking and drinking.Methods. One thousand fourteen adolescents ages 12 to 14 years and their families, identified by random-digit dialing, were entered into a randomized trial. Adolescents and their parents provided data by telephone for measuring mediator and behavioral variables at baseline, 3 months, and 12 months after program completion. Repeated-measures logistic regression with generalized estimating equations was used to assess mediation processes.Results. The program resulted in statistically significant changes in several substance-specific aspects of the family, such as rule setting about tobacco and alcohol use. However, the intermediate family effects did not account for the program effects on adolescent behavior.Conclusions. The variables hypothesized to explain program effects were not identified by direct empirical examination.