Smoking Prevention Programs For Adolescents Research Articles

Adolescent E-cigarette Users at Highest Risk of Cigarette Smoking Intention.

Objectives: Adolescent e-cigarette users are at risk of developing smoking intention, an established predictor of conventional cigarette smoking. In this study, we identify subgroups of adolescent e-cigarette users who are most likely to intend to smoke conventional cigarettes. Methods: Cross-sectional data on 1357 8th and 10th grade e-cigarette users who had never smoked conventional cigarettes were obtained from 2014-2017 Monitoring the Future Surveys. We conducted latent class analysis to identify subgroups of adolescent e-cigarette users; through latent class regression analysis, we examined the association between subgroup membership and smoking intention. Results: We identified 3 subgroups of adolescent e-cigarette users: socially-protected (56.6%), peer-driven (29.8%), and market-vulnerable (13.6%). The peer-driven class reported the highest number of peers who smoke and the lowest proportion of friends who strongly disapproved of daily cigarette smoking. They were significantly more likely than the socially-protected and market-vulnerable classes to have smoking intention (AOR=2.46; 95% CI 1.84-3.28, and AOR=2.29; 95% CI 1.48-3.53, respectively). Conclusion: Our findings provide insights on the constellation of risk and protective factors that contribute to smoking intention among adolescent e-cigarette users. It highlights peer influence as an important area of emphasis for adolescent smoking prevention programs.

Using Intervention Mapping to Develop a Media Literacy-Based Smoking Prevention Program for Female Adolescents.

Smoking prevalence among female adolescents in South Korea has increased gradually, despite a decreasing trend seen for male adolescents. Smoking scenes or cigarette advertisements in the media have influenced female adolescents’ initiation into smoking. It is therefore crucial to develop a smoking prevention program to enhance female adolescents’ smoking media literacy by implementing gender-specific approach. The purpose of this study is to describe how intervention mapping protocol (IMP) was used to develop a media literacy-based smoking prevention program (MLSP) for female adolescents. The IMP was used in six steps: needs assessment (literature review and focus groups comprising 24 female adolescents and 12 teachers), program goal setting, selection of intervention methods, production of program components and materials, program implementation planning, and program evaluation by ten experts and three adolescents. Six performance objectives and 14 change objectives were generated. Each module consisted of theory-based methods such as raising consciousness. Half of the modules covered topics regarding smoking media literacy, while half covered topics related to gender-specific intervention. The major advantages of utilizing IMP are that MLSP has been developed to reflect multiple perspectives, including of adolescents, teachers, and professors through a systematic process, and identified to be acceptable and valid.

Meta-analysis of the effects of smoking prevention programs for young adolescents.

PurposeThis meta-analysis aimed to analyze the effects of smoking prevention programs for young adolescents at early smoking stages to identify the appropriate characteristics of prevention programs for this population.MethodsSearches of health-related databases and Google Scholar were conducted, and 23 randomized studies were included in the analysis. The main outcome variable was smoking behavior. The analysis was conducted using Comprehensive Meta-Analysis software (version 3.0).ResultsSmoking prevention programs significantly reduced smoking behaviors (OR=0.85, 95% CI=0.77-0.93). School-based programs (OR=0.79, 95% CI=0.75-0.83), programs by trained teachers or educators (OR=0.77, 95% CI=0.71-0.83), high-intensity programs (OR=0.82, 95% CI=0.75-0.91), and programs in an in-school setting (OR=0.82, 95% CI=0.74-0.90) had the most significant effect on reducing smoking behavior.ConclusionFor young adolescents, smoking prevention programs are most effective when they are school-based or highintensity programs, and when conducted by teachers or educators with proper training. Further studies are required since there was insufficient research to explore the effect of web-based programs or family-centered programs on adolescent smokers.

Towards a better understanding of factors affecting smoking uptake among Saudi male adolescents: A qualitative study.

INTRODUCTIONAn increased smoking uptake by Saudi male adolescents and a lack of data about its determinants emphasize the need for a better understanding of factors leading to the onset of smoking and identifying ways to prevent it. The aim of this qualitative study is to explore adolescents’ views on smoking and their opinions about a smoking prevention program.METHODSA total of 103 school-going adolescents, aged 12–16 years, were purposely selected from grades seven, eight and nine from nine schools in Taif in Saudi Arabia. They were interviewed in 11 focus group discussions; five groups were held for smokers and six for non-smokers. An interview scheme was developed based on the I-Change Model, a model used for understanding smoking onset and prevention. We used QDA Lite version 2:0 software for data analysis.RESULTSMost of the participants agreed on the importance of social influences as determining factors to start smoking. The presence of smoking friend(s) and family member(s), especially the father, were mentioned. Factors such as having extra pocket money, absence of alternatives, showing off, to be seen as western, to be seen as an adult and the good taste of cigarettes were also mentioned as beliefs associated with smoking. Adolescents indicated to have low confidence not to smoke under peer pressure, suggesting self-efficacy problems. Intentions to smoke were also often mentioned. Almost all participants agreed that an interactive approach is optimal for an effective smoking prevention program.CONCLUSIONSDeterminants of smoking seem to be very similar to those outlined by previous studies. A smoking prevention program for Saudi adolescents should address how to cope with social pressure to smoke, the advantages connected with smoking, and how to increase self-efficacy. Information should be presented in an interactive rather than static way.

School-based Smoking Prevention in Adolescents in Developing Countries: A Literature Review

BACKGROUND: The incidence of diseases due to tobacco consumption has increased, especially in developing countries, where around 90% of smokers start consuming tobacco before the age of 18 years. School-based smoking prevention programs can prevent smoking among adolescents. This program is often implemented in developing countries because it is considered cost-effective, and the results are promising. At present, the school-based smoking prevention program is expanding with many methods.
 AIM: This study aims to describe the various types of school-based smoking prevention interventions in developing countries.
 METHODS: This research applied a literature review approach with the process of collecting data through the Science Direct, ProQuest, EBSCO, and NCBI databases. Search literature was by keyword “smoking AND prevention AND school-based AND adolescent AND randomized controlled trials or randomized controlled trials.” Inclusion criteria used for data collection were studies on school-based smoking prevention interventions, full text, and journal publishing from 2015 to 2019, using English. The research conducted in developing countries and prevention interventions was not only for smoking in the traditional way but also in the form of other than the consumption of tobacco such as cigars, smokeless tobacco, and hookah or shisha. Exclusion criteria in this review were publication articles not in the form of original publications such as letters to editors, only abstracts, and books.
 RESULTS: The literature search results found 594 journals with details of 99 Science direct journals, ProQuest 385 journals, NCBI 85 journals, and 25 EBSCO journals. The entire database belongs to the inclusion criteria and only seven articles meet the requirements. The results of the analysis revealed that interventions conducted in school-based smoking prevention programs for adolescents in developing countries included the application of the anti-smoking curriculum, behavior change intervention (BCI), and peer education.
 CONCLUSION: Interventions considered useful for preventing smoking in adolescents are the anti-smoking curriculum, BCI, and peer education.

276. A Cross-Cultural and Gender-Related Effect of Social Influence on the Success of a Smoking Prevention Program for Adolescents

276. A Cross-Cultural and Gender-Related Effect of Social Influence on the Success of a Smoking Prevention Program for Adolescents

Current status of evidence-based smoking prevention and cessation programs for Spanish adolescents

Current status of evidence-based smoking prevention and cessation programs for Spanish adolescents

International Approaches to Tobacco Use Cessation Programming and Policy in Adolescents and Young Adults: the Case of Spain

Spain has one of the highest smoking rates among adolescents and young adults worldwide. Smoking prevention and cessation programs have been developed for this population; however, the status of evidence-based programs in Spain remains unknown. Previous reviews evaluated the efficacy of smoking prevention and cessation programs, but an update of the results is needed for these and new interventions implemented in Spain. The objective of this paper was to examine the current status of evidence-based smoking prevention and cessation programs for Spanish adolescents and young adults. The current prevalence of tobacco use among Spanish adolescents is described at the state level. We reviewed the results of drug-prevention programs (including tobacco) and provide an in-depth analysis of evidence-based school programs, focused on prevention and cessation of tobacco use in Spain The strengths and shortcomings of the programs are identified, and recommendations for future studies and applications are proposed.

‘담배없는 세대’를 위한 청소년 금연 프로그램의 생태체계적 전략과 실제 : 스코틀랜드 사례를 중심으로

본 연구는 스코틀랜드의 생태체계적 청소년 금연 프로그램의 전략과 실천을 분석하고, 2017년 서울시에서 진행된 ‘담배없는 세대’ 프로그램을 위한 정책적 제언을 하는데 목적이 있다. 본 논문은 청소년 흡연을 개인적 특성과 사회적인 측면이 내포된 복합적인 문제로 보고, 청소년 금연을 위해서 생태체계적 접근이 필요하다고 본다. 이것은 대부분의 한국의 금연 프로그램이 청소년 개인 문제로 접근하고 있는 것과 차별적이다. 연구결과 ‘담배없는 세대’를 만들기 위해서는 첫째, 사회문화적 환경을 바꾸는 ‘낙수효과 접근방식’의 흡연예방을 실시해야 한다. 둘째, 흡연예방의 방향이 처벌중심에서 건강한 삶의 긍정적 선택의 방향으로 나아가야 한다. 셋째, 흡연문화 재생산 방지를 위한 가족의 교육이 필요하다. 넷째, 또래 지원자 양성을 통한 또래문화를 변화시키는 접근이 필요하다. 마지막으로 이를 위해 지속적이고 안정적인 재정지원이 요구된다. 본 연구는 ‘담배없는 세대’를 먼저 시행하고 있는 스코틀랜드의 사례를 통해 한국의 정책과 프로그램이 어떻게 나아가야 할지 단초를 제공하였다는 점에서 중요한 의미를 지닌다.

The influence of tobacco retailers on adolescent smoking: prevention and policy implications

Smoking rates are higher among adolescents in South Korea than among those in other Asian countries. Researchers have reported associations between the presence of licensed tobacco retailers and adolescent smoking rates. However, few researchers have examined the factors that influence adolescent smoking including those that are intrapersonal, interpersonal or related to the tobacco retailers' environment. The purpose of this study was to describe factors related to the students, the licensed tobacco retailers and the schools and how those factors are associated with adolescent smoking outcomes such as tobacco marketing receptivity, lifetime smoking and current smoking. The survey data were gathered from 740 South Korean adolescents, and geographic data for 3488 licensed tobacco retailers were also used. Geographic Information Systems and multilevel modeling were used to describe the variables and determine the factors associated with smoking outcomes in the sample. The factors that influenced receptivity to tobacco marketing included the presence of peers who smoke and the frequencies of licensed tobacco retailers passed on the way to school. The factors that influenced lifetime smoking included gender, perceived economic status, weekly income, the presence of siblings or peers who smoke and frequencies of licensed tobacco retailers passed on the way to school. The factors that influenced current smoking included gender, weekly income, and the presence of siblings or peers who smoke. These factors will guide adolescent tobacco prevention programs and policies. The study's implications for nursing practice and health policy are that school nurses and public health nurses need to be encouraged to use retailer-related factors in adolescent smoking-prevention programs. There is also a need for zoning and licensing regulations to restrict licensed tobacco retailers in areas that adolescents frequent, including schools.

From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents.

BackgroundWeb-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes.ObjectiveBased on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model.MethodsA total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted.ResultsA total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04).ConclusionsAdolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes.Trial RegistrationClinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0)

The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial.

IntroductionAlthough web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, “A Smoking Prevention Interactive Experience,” an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States.MethodsSixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students.ResultsNever-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44–0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44–1.46).ConclusionsASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe.Implications(1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.

Prevalence of Smoking, and its Relationship with Depression, and Anxiety in a Sample of Iranian High School Students

Psychiatric disorders, like anxiety and depression, are risk factors for drug abuse and smoking behavior. The purpose of this survey was to determine the prevalence of smoking, depression and anxiety and their relationship among school age students. This cross-sectional survey was done on 1020 high school students (male and female) recruited randomly and DSM-IV interview was done by researchers. A psychiatry resident accompanied by 3 last year medical students interviewed with students and a questionnaire containing demographic , anxiety and depression questions was filled simultaneously. The obtained data were analyzed using SPSS16. 50% of the students were female and the remainder male. 277 students (27.2%) were in the first year, 242 (23.7%) in the second year and 501 (49.1%) in the third year of high school. 55 students (5.4%) were smoker and used cigarette , water pipe (hobble bobble) and pipe.183 students (18%) had anxiety and stress symptoms (mild, moderate , sever). The 29 smoker students (2.84%) had anxiety. 144 students (14.1%) had depression (mild, moderate, sever) and 23 smoker students (2.25%) had depression symptoms. There was no significant correlation between smoking and anxiety and depression symptoms among school age students. As conclusion, we hypothesized that smoking may increase the tendency to depression and anxiety in high school students. Although the above results didn't demonstrate any significant correlation between these three issues, school counselors and teachers need to be informed about the prevalence of problematic behaviors associated with smoking and it would be necessary to develop smoking prevention programs for adolescents, while taking the psychological factors such as depression and anxiety and school and family atmosphere into account.

Long-Term Health and Medical Cost Impact of Smoking Prevention in Adolescence

PurposeTo estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. MethodsUsing data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. ResultsCompared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th–12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24–32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. ConclusionsEffective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs.

Poster #M117 EVIDENCE THAT CHILDHOOD URBAN ENVIRONMENT IS ASSOCIATED WITH BLUNTED STRESS REACTIVITY ACROSS GROUPS OF PSYCHOTIC PATIENTS, RELATIVES AND CONTROLS

Background: This study reports the prevalence of adolescent smoking in the urban and rural areas of Wuhan, China, the capital of Hubei Province, on the Yangtze River in central China.Methods: Smoking behavior was examined by age, gender, and urbanicity as part of the Wuhan Smoking Prevention Trial. Subjects included 6994 seventh- to ninth-grade students attending 22 randomly selected schools in urban and rural districts. Outcome measures included lifetime smoking, past-30-day smoking, established smoking (>100 cigarettes in lifetime), and susceptibility to smoking (absence of a firm commitment not to smoke).Results: Lifetime smoking prevalence was 47% among boys and 18% among girls. Past-30-day smoking prevalence was 16% among boys and 4% among girls. Established smoking prevalence was 2% among boys and 0% among girls. The prevalence of susceptibility to smoking was 31% among boys and 10% among girls. Smoking increased significantly with age (p<.0005). Susceptibility was more prevalent in rural areas than in urban areas (p<.05), but there were no urban-rural differences in lifetime, past 30-day smoking, or established smoking. Trend analyses revealed that smoking increased with age more rapidly among boys than among girls (p<.05). Smoking was more prevalent among rural boys than among urban boys, but it was more prevalent among urban girls than among rural girls (p<.05).Conclusions: Adolescent smoking is a significant public health problem in China. Boys are at particularly high risk, as are girls living in urban areas. Effective smoking prevention programs for adolescents, as well as restrictions on tobacco industry marketing and youth access to tobacco, are needed to prevent tobacco-related morbidity and mortality in China.

Exploring Recommendations for an Effective Smoking Prevention Program for Indonesian Adolescents

The present qualitative study assessed the need, acceptability and appropriateness for implementing effective and culturally appropriate smoking prevention programs for adolescents in schools in Indonesia. Snowball sampling was used to recruit participants. The study sample comprised a mixture of staff in the education department, junior high school teachers and individuals who had taught junior high school students in Aceh Province, Indonesia. Data were collected through one hour in-depth face to face or telephone interviews and analyzed using a descriptive content analysis procedure. School teachers and policy makers in education firmly supported the implementation of a school-based smoking prevention program in Aceh. An appropriate intervention for smoking prevention program in schools in Aceh should involve both health and Islamic based approaches, and be provided by teachers and external providers. Potential barriers to the program included smoker teachers and parents, time constraints of students and/or teachers, lack of teachers' ability, increase in students' load, the availability of tobacco advertising and sales, and lack of tobacco regulation and support from community and related departments. To increase program effectiveness, involvement of and coordination with other relevant parties are needed. The important stakeholders in Indonesian childhood education agreed that school-based smoking prevention program would be appropriate for junior high school students. An appropriate intervention for smoking prevention program for adolescents in schools in Indonesia should be appropriate to participants' background and involve all relevant parties.

Evaluating depressive symptom interactions on adolescent smoking prevention program mediators: a mediated moderation analysis.

Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world's current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts. The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation. Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program x Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation. This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition x Social Environmental Influences may be important when developing future effective prevention programming.

What works to prevent adolescent smoking? A systematic review of the National Cancer Institute's Research-Tested Intervention Programs.

Cigarette use remains the leading preventable cause of death in the United States. Although school is an ideal setting for antismoking interventions, school-based programs have not been successful in the long term. The purpose of this study was to explore characteristics of programs deemed to be successful short-term Research-Tested Intervention Programs (RTIPs) by the National Cancer Institute (NCI). To identify adolescent smoking prevention programs, 2 independently working researchers applied specified selection criteria to all programs in the NCI's RTIP database. Selected programs were abstracted using a structured form for general information, participants, interventions, outcomes, and quality. Extracted data were then assessed for common themes and contrasts in each category. As of June 2008, 18 studies met the NCI's standards for RTIPs preventing smoking among adolescents. After selection criteria were applied, only 5 programs remained. Each independently working researcher arrived at the same pool of programs. In chronological order according to date of publication of outcomes evaluation, the 5 programs ultimately included were Project Towards No Tobacco Use, Pathways to Health, Native FACETS, Kentucky Adolescent Tobacco Prevention Project, and Sembrando Salud. The majority of these programs were targeted toward a particular sociodemographic group (eg, American Indians, Hispanic migrant communities). New school-based programs are needed to address current issues in tobacco control. To improve chances of success, these programs may wish to target certain specific high-risk demographic groups, use professional health educators and/or trained community members, and build in methods of updating material.

Survey on Adolescents' Knowledge and Attitudes as related to Temptation toward Cigarette Smoking

Purpose: The purpose of this study was to identify the relationship of knowledge and attitude to temptation toward cigarette smoking in adolescents. Methods: A survey was conducted using a 52-item questionnaire in 2 high school settings. Descriptive statistics, t-tests, ANOVA, post hoc analysis and Pearson correlation coefficients were used with SPSS WIN version 14.0 to analyze the data. Results: There were significant differences in attitude toward smoking and smoking temptation depending on gender, academic performance, religion, current smoking status, parental responses toward smoking, initiation of smoking, and the number of friends who smoke (p<.001). The level of smoking knowledge was not related to any of general characteristics as well as attitude toward smoking and smoking temptation. However, negative attitude toward smoking was moderately correlated with reduced smoking temptation (r=-.608, p<.001). Conclusion: Adolescents’ attitude toward smoking and coping ability against smoking temptation were influenced by various factors related to smoking behavior and social situations, rather than by the level of smoking knowledge. In order to develop an effective smoking prevention and cessation program for adolescents, various strategies to change attitudes toward smoking should be included.

The Influence of School Smoking Policies on Student Tobacco Use

To investigate the association between smoking behavior among secondary school students and school smoking policies. Cross-sectional provincially representative study. Quebec secondary schools. Complete data were available for 763 of 1058 students aged 13 years in 50 schools and for 768 of 1160 students aged 16 years in 57 schools. School principals provided data on school smoking policies. Main Exposure School smoking policies. Outcome Measure Student tobacco use. Of students aged 13 years, 3.8% of boys and 7.1% of girls smoked daily; 21.0% of boys and 25.2% of girls aged 16 years smoked daily. Of schools, 28.0% permitted staff to smoke indoors, 84.1% permitted staff to smoke outdoors on school grounds, and 83.2% permitted students to smoke outdoors on school grounds. Daily smoking was not associated with policies targeting student smoking or those targeting indoor smoking by staff. In multilevel analyses, girls aged 13 years were almost 5 times more likely to be daily smokers if they attended schools at which staff were permitted to smoke outdoors. Younger girls may be more susceptible to social influences at school related to tobacco use. School policies banning smoking by teachers and other school personnel within and outside the school should be an important component of comprehensive adolescent smoking prevention programs.