Smoking Initiation Rates Research Articles

Childhood cognitive ability and smoking initiation, relapse and cessation throughout adulthood: evidence from two British cohort studies.

To test the relationship between early cognitive ability and major changes in smoking habits across adulthood, and test whether educational attainment mediates these associations. Prospective observational study to examine the link between cognitive ability and smoking initiation, relapse and cessation at multiple time-points throughout adulthood in a pooled analysis of two cohorts. Great Britain 1981-2013. A total of 16 653 participants from two British cohorts; 7191 from the 1970 British Cohort Study (BCS) and 9462 from the 1958 National Child Development Study (NCDS). Participants were 52.9% female and 27.3% were smokers, 24.8% were ex-smokers and 47.9% reported never smoking. Cognitive ability was assessed at age 10years in the BCS and 11years in the NCDS. Outcomes were smoking initiation, relapse and cessation derived from changes in smoking status observed across five time-points between ages 26-42 in the BCS and six time-points between ages 23-55 in the NCDS. Educational attainment was examined as a mediating variable. Controls were age, gender, social class, self-control, psychological distress, parental smoking and a study indicator (BCS/NCDS). In adjusted regression models, a 1 standard deviation increase in cognitive ability predicted a 0.5 percentage point (95% CI=-0.9 to -0.1) reduced probability of smoking and a 2.9 percentage point (95% CI=2.1-3.7) higher probability of smoking cessation throughout adulthood, but did not change the likelihood of smoking relapse significantly. Differences in educational attainment explained approximately half the association between childhood cognitive ability and smoking initiation/cessation. Lower cognitive ability, measured in childhood before smoking is initiated, appears to predict a higher likelihood of taking up smoking and a lower likelihood of quitting in adulthood. Educational attainment appears to mediate this effect: children with higher cognitive ability tend to become more highly educated adults which, in turn, predicts lower rates of smoking initiation and increased rates of smoking cessation.

Smoking Prevalence and Associated Factors among Students of Balıkesir University

Objective: This study aimed to investigate the smoking prevalence and associated factors among the students of Balikesir University and determine the level of nicotine dependence in smokers. Methods: Six faculties and two graduate schools located at the Balikesir University campus were enrolled. The cluster method was used as the sampling method. To observe the rates of smoking initiation while studying at the university, first-year and final year students were compared. Results: A total of 1096 students were enrolled, with a mean age of 20.4±2.2 years. The regular smoking prevalence rate was 25.5%, occasi- onal smoking rate was 9.5%, alcohol consumption rate was 28.0%, and drug abuse rate was 5.0%. The mean age for attempting to smoke was 16.6±2.2 years. The leading causes of smoking were curiosity, spiritual space, affection, and to comply with friends. According to the Fagerstrom questionnaire, the level of nicotine dependence was low in 53.0% of the participants, moderate in 8.7%, and high in 28.4%. The average smoking prevalence rate was 23.6% in first-grade students, whereas it was 44.8% in last-grade students. The factors that influence smoking were as follows: being in the last grade, mother, siblings, and friends who smoke, higher allowance, use of alcohol and drugs. Smoking was found to be more prevalent among males. Conclusion: Last-grade students had a higher smoking prevalence rate than the first-grade students. Family, social environment, and smoking behavior of friends have an influence on smoking. All risk factors, including past history and university period, should be considered together in tobacco control.

Decreased smoking initiation among male youths in China: an urban-rural comparison.

This study compared urban/rural differences in smoking initiation during the transition from adolescence to young adulthood among Chinese males. Data were derived from the China Health and Nutrition Survey (N=2395). Logistic and cox models were computed to assess smoking initiation between the ages of 15 and 20 across urban/rural administrative districts (i.e. urban neighborhood, suburban village, county town neighborhood, and rural village). Findings revealed that rates of smoking initiation decreased from the 1970 to 1996 cohorts in all four administrative districts. After adjusting for household and community characteristics, the inverse association between smoking initiation and birth year remained statistically significant (p<0.05) in all administrative districts with the exception of urban neighborhoods. County town neighborhoods and suburban villages witnessed accelerated reductions in smoking initiation. Decreased smoking initiation appears to be associated with birth year, which may be correlated with social and economic development of China in conjunction with an unprecedented rate of urbanization. Results suggest that the rate of smoking initiation for male youths may experience further decreases, particularly in areas with a heightened potential of urbanization.

Gauging the Effect of U.S. Tobacco Control Policies From 1965 Through 2014 Using SimSmoke.

The year 2014 marked the 50th Anniversary of the first Surgeon General's Report. This paper estimates the effect of tobacco control policies in the U.S. after the 1964 Report using the SimSmoke tobacco control simulation model. SimSmoke uses National Health Interview Survey data from 1965 through 2012 on smoking prevalence, initiation, and cessation rates, and incorporates policies implemented since 1965. The model projects smoking prevalence and smoking-attributable deaths (SADs) from 1965 through 2065 and is validated against National Health Interview Survey data. Counterfactual scenarios with policies constant since 1965 and with individual policies are estimated. Analysis was conducted in February 2014. SimSmoke generally validated well during the time period from 1965 through 2012. As a result of all policies, smoking prevalence is estimated to have fallen by almost 55% by 2014, with a total of 2 million SADs averted from 1965 through 2014, increasing to 20.1 million SADs by 2065. The Fairness Doctrine is estimated to have reduced adult smoking prevalence by about 24% by 2014 and averted 10.4 million SADs by 2065, while price increases reduced smoking prevalence by 24% by 2014 and averted 7.3 million SADs by 2065. Smoke-free air laws, cessation treatment, and tobacco control spending individually reduced smoking rates by 3%-5.5% by 2014. By 2014, SimSmoke predicts a 53% reduction in smoking rates and almost 2 million SADs averted due to polices implemented since the 1964 Surgeon General's Report, with most of the health benefit still to occur in future years.

Socioeconomic Disparities in Age of Initiation and Ever Tobacco Smoking: Findings from Romania

Smoking initiation is considered the fundamental behaviour that determines the future health burden of tobacco smoking in a society. The aim of the study was to evaluate the socio-demographic factors associated with initiation of regular smoking among adults. The data source was the 2011 Global Adult Tobacco Survey Romania (GATS), which is a cross-sectional, nationally representative study. Multivariate logistic regression model was applied for relevant analysis. Among males, the regular smoking initiation rate was significantly higher compared to females (52.4% vs. 18.5%; p<0.001). Mean age of smoking initiation was lower in men compared to women (18.4±4.8 vs. 21.5±6.8; p<0.001). Age in men, awareness of environmental tobacco smoke consequences and place of living for women as well as educational attainment and employment status in both genders were associated with ever regular smoking. Moreover, cohabitation with a smoker was associated with greater odds for initiating smoking among both genders. GATS revealed a significant but diverse role of socioeconomic factors in initiation of regular smoking among adult Romanians.

Gender differences in age of smoking initiation and its association with health

Background: It is generally accepted that smoking starts in adolescence and earlier initiation is associated with more negative health outcomes. Some research suggests that women initiate smoking at later ages and have more negative health outcomes than men. The purpose of this study was to examine gender differences in age of initiation and its association with health.Methods: The sample included men (n = 8506) and women (n = 8479) with a history of smoking from the 2001–2002 National Epidemiological Survey of Alcohol Related Conditions. Logistic regression was used to examine gender differences in the effect of late smoking initiation on physical and mental health status after adjusting for covariates.Results: At mostly all ages after 16, women exceeded men in rates of smoking initiation (59.8% versus 50.3%, p < 0.001). Among late initiators (≥16), women were more likely than men to have hypertension (OR: 1.24, CI: 1.09–1.41), heart disease (OR: 1.20, CI: 1.00–1.45), major depressive disorder (OR: 2.54, CI: 2.22–2.92), and generalized anxiety disorder (OR: 2.34, CI: 1.84–2.99). Among early initiators (<16), women were more likely than men to have major depressive disorder (OR: 2.42, CI: 2.11–2.77) and generalized anxiety disorder (OR: 2.01, CI: 1.59–2.54) but there were no gender differences in the likelihood of having hypertension (OR: 1.04, CI: 0.89–1.22) and heart disease (OR: 1.11, CI: 0.90–1.36).Conclusions: In late adolescence and adulthood, women exceed men in smoking initiation. Late initiation was associated with more significant physical health risks for women than men. Our findings raise questions about generally accepted notions on the age at which smoking initiation occurs and its association with health.

Socioeconomic position and early adolescent smoking development: evidence from the British Youth Panel Survey (1994–2008)

ObjectiveSmoking usually develops in adolescence and is patterned by socioeconomic position (SEP). We examined whether early adolescent smoking development and associations with SEP have changed over time in a population...

Promoting smoking cessation among parents: Effects on smoking-related cognitions and smoking initiation in children

BackgroundParental smoking is associated with an increased risk of smoking among youth. Epidemiological research has shown that parental smoking cessation can attenuate this risk. This study examined whether telephone counselling for parents and subsequent parental smoking cessation affect smoking-related cognitions and smoking initiation among children of smoking parents. MethodsData of a two-arm randomized controlled trial were used in which 512 smoking parents were recruited into cessation support through their children's primary schools. After the baseline assessment, smoking parents were randomly assigned to tailored telephone counselling or a standard self-help brochure. Parental cessation was measured as 6-month prolonged abstinence at the 12-month follow-up. Children's smoking-related cognitions and smoking initiation were examined at 3-month, 12-month, and 30-month follow-up. ResultsNo statistical evidence was found that children of parents who received telephone counselling tailored to smoking parents or children of parents who achieved prolonged abstinence differ in smoking-related cognitions (i.e., smoking outcome expectancies, perceived safety of smoking, self-efficacy to refrain from smoking, susceptibility to smoking) or smoking initiation rate on any follow-up assessment. ConclusionsThis study is the first to examine the effects of an evidence-based smoking cessation treatment for parents and treatment-induced parental smoking cessation on cognitive and behavioural outcomes among children. Although descriptive statistics showed lower smoking initiation rates among children of parents who achieved prolonged abstinence, there was no statistical evidence that telephone counselling tailored to parents or treatment-induced parental smoking cessation affects precursors of smoking or smoking initiation among youth.

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Cancer-Related News from the CDC

Does Job Loss Make You Smoke and Gain Weight?

This paper estimates the effect of involuntary job loss on smoking behaviour and body weight using German SOEP data. Baseline non‐smokers are more likely to start smoking due to job loss, while smokers do not intensify smoking. In particular, single individuals and those with lower health or socioeconomic status prior to job loss exhibit high rates of smoking initiation. Job loss increases body weight slightly, but significantly. The applied regression‐adjusted semiparametric difference‐in‐difference matching strategy is robust against selection on observables and time‐invariant unobservables. This paper provides an indirect test that the identifying assumption is not violated.

The potential effects of tobacco control in China: projections from the China SimSmoke simulation model

Objective To use a computer simulation model to project the potential impact in China of tobacco control measures on smoking, as recommended by the World Health Organization Framework Convention on...

An examination of smoking initiation rates by age: results from a large longitudinal study in New Zealand.

Investigations of smoking initiation often focus on the experiences of children and youth. However, prevalence data from the Tobacco Use Surveys (TUS) and the New Zealand (NZ) census suggest substantial uptake of smoking occurs after 15 years of age, including among young adults aged 18-24 years. Identifying initiation rates is difficult using cross-sectional prevalence data, particularly among older age groups, which are subject to cohort effects and where quitting and premature mortality reduce prevalence. We aimed to identify initiation rates using a prospective study design. The SoFIE-Health longitudinal survey included 15,095 subjects aged 15 years or older who responded in the three years that include the health module: 2004/05, 2006/07 and 2008/09. We calculated the proportion of 'never smokers' who became regular smokers (initiation) by age at baseline. Initiation between 2004/05 and 2008/09 was 14.2% for 15-17 year olds, 7.0% for 18-19 years, 3.1% for 20-24 years and 1.4% for 25-34 years, with low levels of initiation (<1.0%) among older age groups. There were strong age-related gradients in smoking initiation. Substantial initiation occurs among older youth and young adults, but is rare after age 24. Efforts to prevent initiation of smoking should focus not only on adolescents but also on older youth and young adults.

Contribution of H. pylori and Smoking Trends to US Incidence of Intestinal-Type Noncardia Gastric Adenocarcinoma: A Microsimulation Model

Although gastric cancer has declined dramatically in the US, the disease remains the second leading cause of cancer mortality worldwide. A better understanding of reasons for the decline can provide important insights into effective preventive strategies. We sought to estimate the contribution of risk factor trends on past and future intestinal-type noncardia gastric adenocarcinoma (NCGA) incidence. We developed a population-based microsimulation model of intestinal-type NCGA and calibrated it to US epidemiologic data on precancerous lesions and cancer. The model explicitly incorporated the impact of Helicobacter pylori and smoking on disease natural history, for which birth cohort-specific trends were derived from the National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS). Between 1978 and 2008, the model estimated that intestinal-type NCGA incidence declined 60% from 11.0 to 4.4 per 100,000 men, <3% discrepancy from national statistics. H. pylori and smoking trends combined accounted for 47% (range = 30%-58%) of the observed decline. With no tobacco control, incidence would have declined only 56%, suggesting that lower smoking initiation and higher cessation rates observed after the 1960s accelerated the relative decline in cancer incidence by 7% (range = 0%-21%). With continued risk factor trends, incidence is projected to decline an additional 47% between 2008 and 2040, the majority of which will be attributable to H. pylori and smoking (81%; range = 61%-100%). Limitations include assuming all other risk factors influenced gastric carcinogenesis as one factor and restricting the analysis to men. Trends in modifiable risk factors explain a significant proportion of the decline of intestinal-type NCGA incidence in the US, and are projected to continue. Although past tobacco control efforts have hastened the decline, full benefits will take decades to be realized, and further discouragement of smoking and reduction of H. pylori should be priorities for gastric cancer control efforts.

Study protocol: A cluster randomised controlled trial of implementation intentions to reduce smoking initiation in adolescents

BackgroundThe current literature suggests that forming implementation intentions (simple ‘if-then’ plans) about how to refuse the offer of a cigarette may be an effective intervention to reduce smoking initiation in adolescents. This study is a pragmatic trial to test the effectiveness and cost-effectiveness of such an intervention in reducing smoking initiation in a sample of UK adolescents.Methods/DesignA cluster randomised controlled trial with at least 36 schools randomised to receive an implementation intention intervention targeting reducing smoking initiation (intervention group) or increasing homework (control group). Interventions will be conducted at the classroom level and be repeated every six months for four years (eight interventions). Objectively assessed (carbon monoxide monitor) and self-reported smoking plus smoking related cognitions (e.g., smoking intentions, attitudes, norms and self-efficacy) will be assessed at baseline and 12, 24, 36 and 48 months post baseline. Objectively assessed smoking at 48 months post baseline will be the primary outcome variable. Health economic analyses will assess life years gained.DiscussionThe results of the trial will provide information on the impact of a repeated implementation intention for refusing offers of cigarettes on rates of smoking initiation in adolescents.Trial registrationISRCTN27596806

The dynamic role of parental influences in preventing adolescent smoking initiation

BackgroundAs adolescents grow, protective parental influences become less important and peer influences take precedence in adolescent's initiation of smoking. It is unknown how and when this occurs. We sought to: prospectively estimate incidence rates of smoking initiation from late childhood through mid-adolescence, identify important risk and protective parental influences on smoking initiation, and examine their dynamic nature in order to identify key ages. MethodsLongitudinal data from the National Survey of Parents and Youth of 8 nationally representative age cohorts (9–16years) of never smokers in the U.S. were used (N=5705dyads at baseline). Analysis involved a series of lagged logistic regression models using a cohort-sequential design. ResultsThe mean sample cumulative incidence rates of tobacco use increased from 1.8% to 22.5% between the 9 and 16years old age cohorts. Among risk factors, peer smoking was the most important across all ages; 11–15year-olds who spent time with peers who smoked had 2 to 6.5 times higher odds of initiating smoking. Parent–youth connectedness significantly decreased the odds of smoking initiation by 14–37% in 11–14year-olds; parental monitoring and punishment for smoking decreased the odds of smoking initiation risk by 36–59% in 10–15year-olds, and by 15–28% in 12–14year-olds, respectively. ConclusionsParental influences are important in protecting against smoking initiation across adolescence. At the same time, association with peers who smoke is a very strong risk factor. Our findings provide empirical evidence to suggest that in order to prevent youth from initiating smoking, parents should be actively involved in their adolescents' lives and guard them against association with peers who smoke.

Does Job Loss Make You Smoke and Gain Weight?

This paper estimates the effect of involuntary job loss on smoking behavior and body weight using German Socio-Economic Panel Study data. Baseline nonsmokers are more likely to start smoking due to job loss, while smokers do not intensify their smoking. Job loss increases body weight slightly, but significantly. In particular, single individuals as well as those with lower health or socioeconomic status prior to job loss exhibit high rates of smoking initiation. The applied regression-adjusted semiparametric difference-in-difference matching strategy is robust against selection on observables and time-invariant unobservables. This paper provides an indirect test showing that the identifying assumption is not violated in the difference-in-difference estimator. The findings are robust over various matching specifications and different choices of the conditioning variables.

Academic achievement and smoking initiation in adolescence: a general growth mixture analysis

This study aims to: (i) explore the relations between smoking initiation and different profiles of academic achievement trajectories in early to mid-adolescence; and (ii) to investigate whether background characteristics (gender, ethnicity, grade repetition, parental education) and proximal processes (parental practices, extra-curricular involvement) predicted class membership and smoking initiation. Four-year longitudinal cohort study (7th-10th grade). Adolescents completed the questionnaires during school hours. At total of 741 adolescents with no history of smoking in grade 7 participating in the Montreal Adolescent Depression Development Project. Self-report questionnaires were used to assess predictors and previous smoking in year 1, and smoking initiation by the end of the study. Grade point average (GPA) was obtained twice yearly from school records. Three academic achievement trajectories were identified and found to differ significantly in rates of smoking initiation: persistently high achievers (7.1% smoking), average achievers (15.1% smokers) and unstable low achievers (49.1% smoking). Further, results showed that general parenting practices and parental education indirectly reduced the likelihood of smoking by reducing the risk of membership in classes with lower GPA. Adolescents who do well in school are less likely to smoke and it may be cost-effective for smoking prevention to focus on the few (12%) easy to identify unstable low achievers who form 35% of smoking onsets. In addition, as parental support and democratic control reduced the likelihood of poor academic performance, promoting essential generic parenting skills from a young age may also prevent future onsets of smoking in adolescence.

Socioeconomic Indicators Associated with Initiation and Cessation of Smoking among Women in Seoul

BackgroundWhile smoking prevalence in Korean men has been decreasing, it is increasing in Korean women. Little is known about women's smoking inequalities in Korea. This study was conducted to investigate the association of socioeconomic indicators with the initiation and cessation of smoking among Korean women.MethodsThis was a cross-sectional study on 9,089 women aged 25-64 years from the 2008 Seoul Community Health Survey. The data on smoking and socioeconomic status were obtained through face-to-face interviews. Smoking initiation rate was defined as the proportion of the individuals who had started smoking at least one cigarette among all subjects. Smoking cessation rate was calculated by dividing the number of individuals who had quit smoking by the number of ever smokers. Education level, total family income and occupation were investigated as socioeconomic indicators.ResultsEducation level was significantly associated with both initiation and cessation of smoking. Lower educated women had a higher likelihood of smoking initiation (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.17 to 2.51) but lower likelihood of smoking cessation (OR, 0.38; 95% CI, 0.22 to 0.66) than higher educated women. Smoking initiation rate was higher in manual workers (OR, 1.65; 95% CI, 1.20 to 2.27) than in non-manual workers. However, there were no significant differences of both initiation and cessation of smoking according to total household income.ConclusionThis study shows that there are smoking inequalities among Korean women. It is thought that education level and occupation are important determinants of women's smoking status.

Theory- and Technology-Driven Educational Curricula Addressing Tobacco Use

Project ASPIRE is an interactive computer-assisted technology designed to decrease smoking initiation among English- and Spanish-speaking students. Sixteen high schools were randomized to ASPIRE or standard-care. At 18-months follow-up, smoking initiation rates were lower in ASPIRE participants than controls. Project CASA was designed to reduce secondhand smoke (SHS) among Mexican-Americans through increased knowledge/awareness. Ninety-one households were randomly assigned into a fotonovela-based intervention or pamphlet-based standard care group. At the end of study, SHS exposure was lower among intervention households than controls. The use of these evidence-based resources offers potential for expanded tobacco control.

Abstract PL03-02: Using technology for early cancer prevention among youth

Abstract Computer and internet technology is becoming widely available and heavily used by youth in the United States. Today's cancer prevention programs geared towards young individuals ought to consider technology as a cost-effective and attractive channel of information delivery. Our investigative team has implemented several technology-assisted early cancer prevention programs aimed at smoking prevention and cessation. Our first large-scale study that used computer technology (CD-ROM) was Project ASPIRE. This interactive multimedia program tailored to the needs of individual user was tested in 16 Houston-area high schools. At 18-month smoking initiation rates were significantly lower in the ASPIRE condition compared to controls (N=1,160; 1.9% vs. 5.9%, p&amp;lt;.05). The additive effects of multiple smoking initiation risks were examined using a cumulative model. As the level of risk increased smoking initiation increased significantly in the control group (2.7% to 17.2%, p&amp;lt;.001), while remaining low and stable in the intervention group. Currently, ASPIRE is being disseminated online among thousands of users in 21 states. Smoking cessation programs for community college students (laptop-assisted Project Look at Your Health) and university students (internet-based Project SUCCESS) were tested in two randomized controlled trials. In Project Look at Your Health (N=326), the cotinine-validated smoking quit rates at 10-month follow-up were 17.2% and 10.2% in the experimental group and standard-care group, respectively (p&amp;lt;.06). Statistically significant results were achieved in the updated and improved online version of the intervention used in Project SUCCESS. At 12 months, (N=236), the intent-to-treat analysis revealed the quit rates of 20% in the experimental condition versus 10% in the standard care, (p&amp;lt;.01). Currently, we are designing the 3rd version of the smoking cessation intervention for college students that systematically addresses depressive symptoms and alcohol use. Our investigative team is among the leaders designing the cutting-edge educational tools for youth in the form of video games. Our DOD-funded prototype tobacco prevention and cessation video game, Escape with Your Life, is using a hospital metaphor in which participants learn about the dangers of tobacco use while visiting various rooms (surgery, patient records, waste disposal, accounting, etc.). This novel educational tool is richly equipped with animations, videos, and interactive features. Escape with Your Life has produced promising preliminary results. Currently, we are in the final stages of designing a tablet computer-based smoking cessation video game for the U.S. Army service members who are at high risk for lifelong nicotine dependence and multiple tobacco-attributable cancers. Citation Information: Cancer Prev Res 2011;4(10 Suppl):PL03-02.