High School Smokers Research Articles

Prevalence and determinants of smoking initiation among school students in Bosnia and Herzegovina.

Tobacco smoking amongst the young is a matter of public health concern because of the immediate and long-term health consequences associated with tobacco use, such as asthma, cancers, and cardiovascular diseases. The purpose of this study was to identify the determinants of smoking initiation among a sample of high school students in Bosnia and Herzegovina. The study was conducted among 198 high school students in Zvornik, Bosnia and Herzegovina, during April 2013. A self-administered, pre-tested, structured, close-ended questionnaire was used for data collection. Fourth grade students mainly initiated smoking in high school (45%), while the majority of third and second grade students initiated smoking in primary school. Among students who smoke, an average duration of the smoking habit was <2 years. A multivariate analysis showed that males were 5.27 times more likely to have initiated smoking. For every unit increase in pro-smoking attitude towards smoking, students were 5.3 times more likely to have initiated smoking. Those with parents and friends who are smokers were 6.106 and 5.175 times, respectively, more likely to have initiated smoking. This study indicates that a high proportion of 15-18 year olds in the town of Zvornik are current smokers. Gender, age, and parent and peer influence were identified as important associations with smoking. Interventions should not only be confined to the secondary school environment but they should also extend to their places of residence so that influences in the home environment and social surroundings that contribute to tobacco use are also tackled.

Can bans break bad habits? An interrupted time series analysis of the impact of the 2005 high school smoking ban on teenage smoking behavior in Chile

Structure/Method/Design: We use detailed facility-level data from Colombia, Ghana, India, Kenya, Lebanon, Zambia, and Uganda. In each country, we collected data in approximately 200 facilities over a 5-year period. In addition, 12,000 patient interviews were conducted with the aim of gathering information on consumer perception of health facility quality. We specify a production model with five inputs and seven outputs. Inputs include the number of beds as proxy for capital, and four categories for labor (doctors, nurses, other medical staff, and administrative staff). As with respect to output, outpatient visits include basic outpatient services, ART (antiretroviral treatment), malaria, antenatal care, and emergency. For inpatient services we use inpatient days, births, and surgery. To avoid biased efficiency estimates due to heterogeneous technology, we propose an innovative approach that adjust outputs across facilities. We first identify all pharmaceuticals and equipment related to the production of each output and build a score that reflects the extent to which technology is available in the facility. We then use consistent bootstrap DEA models using the adjusted outputs to compute technical efficiency scores by controlling for measurement error and noisy data. We include minimal weight restrictions to reflect the relative importance of inputs and outputs in the production process of health facilities. Weight restrictions are chosen to maintain the radial nature of efficiency valid. We finally use output weights provided by DEA to calculate the marginal rate of transformation between outputs. This information is critical to the estimation of average costs for each output. Results (Scientific Abstract)/Collaborative Partners (Programmatic Abstract): We find evidence of important inefficiency (40% on average) with massive variation across facilities. Inefficiency substantially increases average costs to produce health services (35% on average). Also, we find evidence of efficiency increases over time of about 10%, likely due to the scale-up of ART treatment and related services. Additional evidence is necessary to assess the causal relationship. Summary/Conclusion: We find evidence of potential efficiency increases. Efficiency increase of health services production in developing countries is paramount to exploit the potential of service coverage extension and fair allocation of resources. For this purpose, higher-quality data and systematic efficiency assessment analyses are needed.

Scales of Smoking-Related Self-Efficacy, Beliefs, and Intention: Assessing Measurement Invariance among Intermittent and Daily High School Smokers

To examine the factorial validity and measurement invariance of scales that measure smoking-related self-efficacy, beliefs, and intention between daily and intermittent adolescent smokers. Cross-sectional survey design. Selected high schools in eastern Texas. Subjects were 2888 high school current smokers; mean age 16.2 years; 53.5% male; 67.4% White, 17.8% Hispanic, 6.2% Black, 8.6% "other." Daily smokers comprised 37.9% of the sample (i.e., smoked at least one cigarette every day 30 days prior to the survey). Smoking-related self-efficacy and intention were measured by three items; beliefs were measured by four items. Confirmatory factor analyses were conducted to test the invariance of the measures between daily and intermittent smokers. Fit indices included comparative fit index (CFI), nonnormed fix index (NNFI), and root mean square error of approximation (RMSEA). The three-factor measurement model had good fit for daily (CFI = .97, NNFI = .95, RMSEA = .09) and intermittent (CFI = .96, NNFI = .95, RMSEA = .09) smokers. Evidence of strong factorial invariance was found for the factors between the smoking subgroups (CFI = .96, NNFI = .96, RMSEA = .08). These measures may be used to capture and compare scores on self-efficacy to resist smoking, beliefs about benefits of smoking, and intention to smoke between daily and intermittent adolescent smokers.

Smoking Cessation Recruitment Messages Tailored to African American High School Smokers

In accordance with thisresearch, prior studies have shown that African Americansexperience an unequal share of the health consequences ofsmoking. African American smokers, compared to theirwhite counterparts, have higher rates of smoking‐relatedcancers including cancersofthe lung,mouth, larynx, pharynx,esophagus, stomach, pancreas, and cervix.

Flavored-Little-Cigar and Flavored-Cigarette Use Among U.S. Middle and High School Students

Flavors can mask the harshness and taste of tobacco, making flavored tobacco products appealing to youth. We assessed the prevalence and correlates of flavored-little-cigar and flavored-cigarette use among U.S. middle and high school students in 2011. Data were obtained from the 2011 National Youth Tobacco Survey, a nationally representative school-based survey of U.S. students in grades 6-12. National estimates of current flavored-little-cigar use, flavored-cigarette use, and combined use of either product were calculated overall and among current smokers by respondent characteristics, including sex, race/ethnicity, school level, and grade. Additionally, intention to quit tobacco and smoking frequency were assessed by flavored product use. The overall prevalence of current use was 4.2% for flavored cigarettes, 3.3% for flavored little cigars, and 6.3% for either product. Among current cigar smokers, 35.9% reported using flavored little cigars, and among current cigarette smokers, 35.4% reported using flavored cigarettes. Among current cigar or cigarette smokers, 42.4% reported using flavored little cigars or flavored cigarettes. Flavored product use among current smokers was higher among non-Hispanic whites than among blacks and Hispanics, higher among high school students than middle school students, and increased with grade. Among cigar smokers, prevalence of no intention to quit tobacco was higher among flavored-little-cigar users (59.7%) than nonusers (49.3%). More than two fifths of U.S. middle and high school smokers report using flavored little cigars or flavored cigarettes, and disparities in the use of these products exist across subpopulations. Efforts are needed to reduce flavored tobacco product use among youth.

Hookah pipe smoking among health sciences students

Hookah pipe smoking is a social practice and has gained popularity, especially among South African youth. The extent of this practice among health sciences students, and their knowledge regarding the health risks, are unknown. This is important, as these students will become future health professionals possibly influencing the practice of individuals and communities. To explore the knowledge, attitudes and practices of hookah pipe smoking among students at the Faculty of Health Sciences, University of Cape Town. METHODS. A cross-sectional study was conducted among undergraduate and postgraduate students. A self-administered questionnaire was distributed as a hard copy and online survey. Of 228 participants, 66% had smoked a hookah pipe before, with 18% still smoking. Most began smoking in high school, with 25% initiating at university. Of the current smokers, 65% smoked occasionally socially, commonly at friends' houses for 30 - 60 min/session. A further 11% smoked cigarettes concurrently and 30% added other substances, mainly cannabis, to pipes. Most current hookah smokers had no interest in quitting (84%). Only 30% of participants had prior health information about hookah pipe smoking. Most knew that it was harmful (91%), with many not knowing why. A total of 80% of participants perceived that the practice was socially acceptable and 84% would recommend it to others.CONCLUSION; The poor knowledge about the dangers of hookah pipe smoking and the extent of its practice among health sciences students is alarming. These findings highlight the need for school and university health promotion campaigns, and for better regulation of hookah pipe smoking.

Effects of Group Art Therapy Program on School Maladjustment, Self-Efficacy, and Interpersonal Relationship of Female High School Smokers

Effects of Group Art Therapy Program on School Maladjustment, Self-Efficacy, and Interpersonal Relationship of Female High School Smokers

A Shared Struggle with Tobacco Addiction

Smoking is up close and personal for me and I have been humbled by how difficult it is to stop. I come from a family of smokers and married into a family of smokers. Both my grandfather and father died of lung cancer. Among my earliest childhood memories, is being woken each morning by my father’s coughing and the ever-present pack of Camels next to my grandfather’s favorite chair. It was easy to start smoking in high school; in fact, didn’t all the cool kids smoke? And yes, I believed it increased my concentration and made me a sharper college girl. And I admit to raising my sons in a house filled with smoke, my husband and I both smoking away despite the clear evidence about the dangers.

Prevalence of and factors associated with daily smoking among Inner Mongolia medical students in China: a cross-sectional questionnaire survey.

BackgroundTo date, no study on smoking behavior of medical students in Inner Mongolia has been reported. The aim of the present study was to determine the 1-month prevalence of and factors associated with daily smoking among medical students in Inner Mongolia of China, to assist interventions designed to reduce the smoking behavior of medical college students in this region.MethodsDuring December 2010 and January 2011 a cross-sectional survey was conducted among medical students at the Inner Mongolia Medical College using a self-administered questionnaire. The questionnaire consisted of three sections: students’ basic information, attitude on smoking behavior, and smoking status of the student daily smokers. Students who smoked every day in the last 30 days were regarded as daily smokers. Factors associated with smoking were identified using binary logistic regression analysis.ResultsA total of 6044 valid surveys were returned. The overall prevalence of daily smoking was 9.8% while the prevalence of daily smoking among males and females were 29.4% and 1.7%, respectively. Males in the Faculty of Medicine Information Management had the highest daily smoking rate (48.9%). Logistic regression models found that the main factors associated with daily smoking among male medical students were highest year of study (OR = 3.62; CI: 1.18–11.05); attitude towards smoking behavior Do not care about people smoking around you (OR = 2.75; CI: 2.08–3.64); and Smoking is harmful to their health (OR = 4.40; CI: 2.21–8.75). The main factor associated with daily smoking among female medical students was attitude towards smoking behavior Eliminate smoking on campus (OR = 0.11; CI: 0.06–0.23). Both for male and female medical students, there was no association between ethnicity and cigarette daily smoking. In regard to smoking status, more than 60% of daily smokers began smoking in high school, 61.3% smoked less than 5 cigarettes per day, 62.9% of the daily smokers’ families opposed their smoking behavior, and after an hour of not smoking 74.6% daily smokers did not feel uncomfortable.ConclusionsAntismoking education should be further promoted in Inner Mongolia medical students, with consideration given to the factors associated with daily smoking behavior found in the present study.

Menthol Cigarettes Contribute to the Appeal and Addiction Potential of Smoking for Youth

Menthol cigarettes are a common choice of cigarettes among young smokers that contribute to the addictive potential of cigarette smoking. We reviewed prior research and analyzed the 2006 National Youth Tobacco Survey (NYTS), using logistic regression to assess the relationship between menthol cigarette use and needing a cigarette within 1 hr after smoking. In the 2006 NYTS, 51.7% (95% CI: 45.8-57.5) of middle school smokers and 43.1% (95% C.I.: 37.0, 49.1) of high school smokers reported that they usually smoked a menthol brand of cigarettes, using a menthol smoking status definition based on consistency between smokers' report of the brand and the menthol status of the cigarettes they usually smoked. A logistic regression model of dependence, controlling for background (i.e., school level, gender, and race/ethnicity) and smoking level (i.e., years, frequency, and level of smoking) found that smoking menthol cigarettes was significantly associated with reduced time to needing a cigarette among smokers with a regular brand (odds ratio [OR]: 1.86, p = .003) and among established smokers (OR: 2.06, p = .001). This is consistent with other studies that found that youth who smoked menthol cigarettes were significantly more likely than those who smoked nonmenthol cigarettes to report signs of nicotine dependency. Menthol cigarettes contribute to the appeal of youth smoking and to the addictive potential of smoking cigarettes among youth. It is important to control the use of menthol cigarettes and to implement cessation strategies that are effective with youth smokers.

State-level tobacco control policies and youth smoking cessation measures.

Research on the effects of state-level tobacco control policies targeted at youth has been mixed, with little on the effects of these policies and youth smoking cessation. This study explored the association between state-level tobacco control policies and youth smoking cessation behaviors from 1991 to 2006. The study design was a population-based, nested survey of students within states. Study participants were 8th, 10th, and 12th graders who reported smoking "regularly in the past" or "regularly now" from the Monitoring the Future study. Main cessation outcome measures were: any quit attempt; want to quit; non-continuation of smoking; and discontinuation of smoking. Results showed that cigarette price was positively associated with a majority of cessation-related measures among high school smokers. Strength of sales to minors' laws was also associated with adolescent non-continuation of smoking among 10th and 12th graders. Findings suggest that increasing cigarette price can encourage cessation-related behaviors among high school smokers. Evidence-based policy, such as tax increases on tobacco products, should be included as an important part of comprehensive tobacco control policy, which can have a positive effect on decreasing smoking prevalence and increasing smoking cessation among youth.

Smoking Behavior Among 84 315 Open-University Students in Thailand

The aim of this study was to estimate the prevalence of smoking among students in an open university in Thailand and to describe smoking patterns in relation to the personal and social characteristics of the sample. A self-administered questionnaire survey was conducted in 2005 with 87 134 open-university students in Thailand; the respondents aged 15 to 60 years (N = 84 315) are the participants in this study. We found a substantial difference in smoking prevalence by sex, with a much higher proportion of smoking male (20.9%) than female (1.0%) students in all sociodemographic categories. Smoking decreased among men with a higher level of education or income; in contrast, among women, higher incomes were associated with more smoking. Most of the smokers started smoking in high school. The findings provide evidence that future policy making should aim to reduce smoking among the younger population in Thailand, and in particular, they point to the need to preserve low smoking rates among women.

Social cognitive mediators of adolescent smoking cessation: results from a large randomized intervention trial.

Only one prior study has examined why adolescent smoking cessation interventions are effective. To address this understudied and important issue, we examined whether a large adolescent smoking cessation intervention trial's outcomes were mediated by social cognitive theory processes. In a randomized trial (N = 2,151), counselors proactively delivered a telephone intervention to senior year high school smokers. Mediators and smoking status were self-reported at 12-months postintervention eligibility (88.8% retention). At least 6-months abstinence was the outcome. Among all enrolled smokers, increased self-efficacy to resist smoking in (a) social and (b) stressful situations together statistically mediated 55.6% of the intervention's effect on smoking cessation (p < .001). Among baseline daily smokers, increased self-efficacy to resist smoking in stressful situations statistically mediated 56.9% of the intervention's effect (p < .001). Self-efficacy to resist smoking is a possible mediator of the intervention's effect on smoking cessation.

Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation.

The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools?

Objective To examine the quantity (density) and location (proximity) of tobacco outlets and retail cigarette advertising in high school neighborhoods and their association with school smoking prevalence. Methods Data from the 135 high schools that participated in the 2005–2006 California Student Tobacco Survey were combined with retailer licensing data about the location of tobacco outlets within walking distance (1/2 mi or 805 m) of the schools and with observations about the quantity of cigarette advertising in a random sample of those stores ( n = 384). Multiple regressions, adjusting for school and neighborhood demographics, tested the associations of high school smoking prevalence with the density of tobacco outlets and retail cigarette advertising and with the proximity of tobacco outlets to schools. Results The prevalence of current smoking was 3.2 percentage points higher at schools in neighborhoods with the highest tobacco outlet density (> 5 outlets) than in neighborhoods without any tobacco outlets. The density of retail cigarette advertising in school neighborhoods was similarly associated with high school smoking prevalence. However, neither the presence of a tobacco outlet within 1000 ft of a high school nor the distance to the nearest tobacco outlet from school was associated with smoking prevalence. Conclusions Policy efforts to reduce adolescent smoking should aim to reduce the density of tobacco outlets and retail cigarette advertising in school neighborhoods. This may be achieved through local zoning ordinances, including limiting the proximity of tobacco outlets to schools.

Sociodemographic and smoking-related psychosocial predictors of smoking behavior change among high school smokers

The purpose of the study was to explore whether sociodemographic characteristics and baseline psychosocial factors were related to short-term smoking cessation and reduction, after controlling for the effects of participating in a virtual world, Internet chat room intervention. Results indicate that smoking-related psychosocial factors are important predictors of adolescent smoking cessation and reduction, independent of the effects of participating in the intervention. Self-efficacy for quitting, social support, and perceived benefits of quitting was related to positive short-term changes in smoking behavior.

Addressing challenges in adolescent smoking cessation: Design and baseline characteristics of the HS Group-Randomized trial

Objective. Well-documented challenges have hampered both intervention development and research in teen smoking cessation. Addressing these challenges, the Hutchinson Study of High School Smoking (HS Study), the largest group-randomized trial in adolescent smoking cessation to date, incorporates several design innovations to investigate the effect of a counselor-initiated, individually tailored telephone counseling smoking cessation intervention for older adolescents. This paper presents and discusses these innovative design features, and baseline findings on the resulting study population. Method. The trial used a population-based survey to proactively identify and recruit all high school juniors who had smoked in the past month – potentially expanding intervention reach to all smokers, even those who smoked less than daily and those not motivated to quit. For ethical and intervention reasons, some nonsmokers were enrolled in the intervention, also. Other important design features included the random allocation of schools into experimental conditions (intervention vs. no-intervention control) and a multi-wave design. Results and conclusion. The design innovations address problems and challenges identified in adolescent smoking cessation literature. The heterogeneous baseline characteristics of the study population, well-balanced between the two arms, have three significant implications: They (1) demonstrate the effectiveness of the trial's design features, (2) highlight several intervention-related issues, and (3) provide assurance that the trial's evaluation of intervention effectiveness will be unbiased.

Are the stages of change for smokers qualitatively distinct? An analysis using an adolescent sample.

According to the transtheoretical model (J. O. Prochaska & C. C. DiClemente, 1983), current smokers can be usefully divided into three distinct stages. Questionnaire items needed for staging smokers contain questions about intentions to quit within fixed time frames (30 days and 6 months) and require "Yes" or "No" responses. However, some smokers might not think of quitting in terms of fixed time frames. If this were the case, these smokers would select "Yes" or "No" arbitrarily and be assigned to stages on the basis of arbitrary responses. This research employed a sample of high school smokers (n = 775) to address this issue by expanding the available responses to the stages of change (SOC) questionnaire items. In addition to "Yes" and "No," smokers were given the option of "Don't know/Undecided." When responding to the 30-day and 6-month questions, 33.1% and 35.8% of smokers, respectively, chose "Don't know/ Undecided." These results suggest that the SOC questionnaire items do not capture qualitative distinctions among adolescent smokers.

Smoking-related self-efficacy, beliefs, and intention: Assessing factorial validity and structural relationships in 9th–12th grade current smokers

Smoking-related self-efficacy and beliefs about the benefits of smoking are consistently related to intention to continue smoking, a common proximal outcome in youth smoking cessation studies. Some measures of these constructs are used frequently in national and state youth tobacco surveys, despite little evidence of validity for high school smokers. Further, the association of the constructs with intention has not been demonstrated in this group. The factorial validity of the measures and the cross-sectional correlations among self-efficacy, beliefs, and intention were examined among 9th–12th grade current smokers ( N = 2767, 13.8% reporting smoking > 1 cigarette in the previous 30 days; mean age 16.2; 61.2% white, 6.2% Black, 17.8% Hispanic, 5.0% Asian, 3.5% other; response rate 70%) from a convenience sample of 22 Texas schools. Confirmatory factor analyses supported evidence of factorial validity for the scales in this sample. Structural equation modeling analyses suggested youth smokers have low confidence in their ability to avoid smoking, believe smoking offers emotional or social benefits, and intend to continue smoking. The scales assess smoking-related self-efficacy, beliefs, and intention in this sample. Prospective studies are needed before intervention development implications are suggested.

Smoking and quitting history correlates of readiness to quit in multiethnic adolescents.

To describe smoking and quitting history among multiethnic adolescent smokers and examine these as correlates of readiness to quit. Data were analyzed from 121 high school smokers. Sociodemographic characteristics, self-reported smoking history, number and duration of recent quit attempts, attitudes toward smoking/quitting, and readiness to quit were included. Smoking and quitting history variables were associated with adolescents' stage of readiness to quit. A reasonably consistent pattern emerged in which those in the preparation stage were significantly different from the precontemplators and contemplators. Results are discussed in terms of interventions matched to individuals' readiness to quit.