Smoking Prevention Strategies Research Articles

Sociocultural determinants of tobacco use among Cambodian Americans

The objectives of this study included the following: obtaining qualitative information on tobacco use among Cambodian Americans, identifying cultural factors that influence tobacco use and acquiring information for the development of effective smoking prevention and cessation strategies. Data were collected by using demographic and behavioral questionnaires and focus group interviews. A total of 14 focus group interviews that covered cultural practices associated with smoking were administered. Statistical analyses included univariate frequency distributions and cross-tabulations. The subjects (n = 119) were Cambodian American volunteers who participated in social services programs offered by a community service organization. All subjects were 18 years of age or older and resided in the city of Long Beach. The principal outcomes measured were cigarette smoking and tobacco use. Other variables included reasons for smoking, traditional uses of tobacco, stress factors related to smoking and the perceived health effects of smoking. Predisposing, reinforcing and enabling factors associated with tobacco-use behaviors included peer group influences, smoking adopted as a coping method, tobacco used for medicinal purposes and smoking practiced within cultural traditions. The frequency of smoking was four times higher among males than among females. Smokers (n = 29) in comparison with non-smokers (n = 90) tended to be men (79% versus 33%), not married (68% versus 49%) and unemployed (79% versus 54%), and had attained somewhat lower levels of education. The role of cultural factors needs to be considered when designing appropriate smoking cessation strategies for Cambodian Americans.

A Longitudinal Study Exploring Liverpool Primary Schoolchildren's Perspectives on Smoking

A cohort study was designed to explore over 200 primary schoolchildren's (ages 4–7) perspectives on smoking in the context of their own lives and subsequently, to assess any changes in these perspectives over time. Results showed that, in general, the children had a negative disposition about the habit, which did not dissipate over the 3-year study period. They had a fairly substantive understanding of smoking, in particular of the consequences to health, which increased in breadth and depth over time and they acknowledged the central role that the family played within the 'culture' of smoking. Such results have implications for the development of effective school-based smoking prevention strategies.

Determinants of smoking in eight countries of the former Soviet Union: results from the Living Conditions, Lifestyles and Health Study

To provide accurate and timely data on the determinants of smoking in countries of the former Soviet Union in order to facilitate the development of effective tobacco control policies in the region. Such data are urgently needed given the absence of accurate comparative data in the region and the recent changes experienced. Cross-sectional surveys using standardized methods and representative samples of the adult population in eight former Soviet Union countries conducted as part of the EU-Copernicus Project Living Conditions, Lifestyle, and Health study. Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine. A total of 18 428 adults aged 18 plus; response rates 71-88%. The association of smoking with demographic and socio-economic factors was investigated using multiple logistic regression analyses, stratifying by gender. Age was a strong determinant of smoking in both genders, with elderly individuals being less likely to smoke. Men who were more socially disadvantaged (less educated, poorer economic situation and/or less social support) were more likely to smoke. In women, living in larger urban areas was the strongest predictor of smoking. Divorced, separated or widowed women were also more likely to smoke than married women. Muslim respondents smoked less frequently compared with other respondents. Smoking is a major public health issue in the FSU particularly affecting socially vulnerable men and young women living in urbanized areas. These high-risk groups should be targeted in future smoking prevention and cessation strategies in the region.

Meanings of smoking and adolescent smoking across ethnicities

Purpose To develop insight into population-specific meanings of smoking in our highly multicultural middle schools in order to provide effective and appropriate tools for smoking prevention efforts. Methods We used focus group interviews to develop the Meanings of Smoking Index (MSI), a nine-item scale that uses a “mark all that apply” strategy to assess what smoking means to children who have tried smoking as well as to those who are susceptible to smoking. In 24 public and parochial middle schools in the greater Los Angeles area, 2336 7th graders (1483 Latino, 565 Asian/ Pacific Islander and 288 white, 55.2% of the sample was female) completed the MSI as part of a school-based trial of culturally-targeted smoking prevention strategies. Items were rank ordered according to salience (rate of endorsement) and relevance (strength of relationship with lifetime smoking) across the entire sample and separately for Hispanic/Latino, Asian/Asian-American and white respondents. Spearman correlation coefficient was used to compare results between ethnicities. Results The most frequently endorsed meanings were similar across ethnicities. Magnitude of associations between smoking behaviors and meanings were dissimilar across ethnicities. The meaning with the strongest relationship to lifetime smoking for whites and Latinos was “it helps me study” (OR 3.4 and 2.6 respectively), and for Asians was “don't want to make another smoke alone” (OR 5.4). Conclusions We have shown previously that interventions on meanings of eating behaviors changed dietary behaviors in adolescents. The present findings suggest that meanings are powerful determinants of adolescent smoking in culturally diverse populations and could offer powerful intervention tools to prevent adolescent smoking.

Meanings of smoking and adolescent smoking across ethnicities

Purpose To develop insight into population-specific meanings of smoking in our highly multicultural middle schools in order to provide effective and appropriate tools for smoking prevention efforts. Methods We used focus group interviews to develop the Meanings of Smoking Index (MSI), a nine-item scale that uses a “mark all that apply” strategy to assess what smoking means to children who have tried smoking as well as to those who are susceptible to smoking. In 24 public and parochial middle schools in the greater Los Angeles area, 2336 7th graders (1483 Latino, 565 Asian/ Pacific Islander and 288 white, 55.2% of the sample was female) completed the MSI as part of a school-based trial of culturally-targeted smoking prevention strategies. Items were rank ordered according to salience (rate of endorsement) and relevance (strength of relationship with lifetime smoking) across the entire sample and separately for Hispanic/Latino, Asian/Asian-American and white respondents. Spearman correlation coefficient was used to compare results between ethnicities. Results The most frequently endorsed meanings were similar across ethnicities. Magnitude of associations between smoking behaviors and meanings were dissimilar across ethnicities. The meaning with the strongest relationship to lifetime smoking for whites and Latinos was “it helps me study” (OR 3.4 and 2.6 respectively), and for Asians was “don't want to make another smoke alone” (OR 5.4). Conclusions We have shown previously that interventions on meanings of eating behaviors changed dietary behaviors in adolescents. The present findings suggest that meanings are powerful determinants of adolescent smoking in culturally diverse populations and could offer powerful intervention tools to prevent adolescent smoking.

Trends in US smoking rates in occupational groups: the National Health Interview Survey 1987-1994.

It is unknown if reductions in U.S. adult smoking rates are uniform across occupational groups. The National Health Interview Survey (NHIS) is a multistage area probability cross-sectional survey of the U.S. civilian population. Data on occupational and smoking status were collected on 141122 adult participants from the 1987, 1988, and 1990 -1994 NHIS annual surveys. Overall smoking rates ranged from 58% in roofers to 4% in physicians, with higher rates found among blue collar professions. There were reductions in smoking from 1987-1994 within 72% of occupational groups; 19 of these downward trends were significant and occurred exclusively within white collar professions. Blue collar workers continue to smoke in large numbers, whereas white collar workers report lower rates along with corresponding significant downward trends in rates among selected occupational groups. The development of effective smoking prevention strategies targeting blue collar groups is needed.

Parental, Family, and Home Characteristics Associated with Cigarette Smoking among Adolescents

This study examines the relationship between smoking-related parental, family, and home factors with adolescents' cigarette use. Cross-sectional surveys of adolescents, via a self-administered questionnaire in classrooms, and their parents, via a telephone interview, were conducted. Fifteen suburban and rural communities within Minnesota. The study sample included 8th, 9th, and 10th grade public school students and their parents. The dependent variable was monthly tobacco use among students. The independent measures were parental, family, and home smoking-related characteristics. There were 1343 parent-child dyads with completed surveys. The final, multivariate logistic regression model found the following variables to be independently related to higher smoking rates among adolescents: child's grade (odds ratio [OR] = 3.03 for 10th vs. 8th), parents' permissiveness of adult smoking (OR = 1.80), parents' having higher normative estimates of how many people smoke (OR = 1.70), parents' decreased likelihood of punishing their teenager for smoking (OR = 1.65), smoking by an adult living in the home (OR = 1.99), and sibling smoking (OR = 8.95). Lack of communication about consequences for breaking family smoking rules was associated with lower smoking rates among adolescents (OR = .49). The results of this study highlight the importance of parental smoking norms and attitudes and smoking role models in the home. It is important that smoking prevention strategies target and include the entire family. Limitations of the study are its cross-sectional design and that the sample was primarily white.

Social capital and the miniaturization of community among daily and intermittent smokers: a population-based study

Background The impact of social participation, trust, and the miniaturization of community on daily and intermittent smoking was investigated. Methods The 2000 public health survey in Scania is a cross-sectional study. A total of 13,715 persons answered a postal questionnaire, which represents 59% of the random sample. A logistic regression model was used to investigate the association between the social capital variables and daily and intermittent smoking. The multivariate analysis was performed by using a logistic regression model to investigate the importance of possible confounders (age, country of origin, education, and snuff consumption) on the differences in daily and intermittent smoking between high versus low social participation, trust, and their four combination categories. The differences in the prevalences of the 13 social participation subitems between the high social capital and miniaturization of community categories were compared by t tests. Results Daily smoking is negatively associated with both social participation and trust, while intermittent smoking is positively associated with social participation and negatively associated with trust. This latter combination, named “the miniaturization of community,” is an indirect measure of the ideologically and culturally increasingly narrow forms of social participation that excludes generalised trust to other people. Study circles, meetings of organisations, theatre/cinema, arts exhibition, and gathering of relatives are more prevalent in the high social capital category, while visit(s) to night club/entertainment is more prevalent in the miniaturization of community category. Conclusions Low social capital is associated with daily smoking. “The miniaturization of community,” i.e., high social participation and low trust, is significantly associated with intermittent smoking. The results have direct implications for smoking prevention strategies.

Trends in smoking-related cancer incidence in Tarragona, Spain, 1980-96.

To analyze recent trends (1980-96) in the incidence of smoking-related cancers among men and women in Tarragona, Spain. Data were obtained from a population-based cancer registry. Age-standardized incidence rates were computed. Secular trends, between 1980 and 1996, were estimated using a Poisson regression model. From these figures, age, period, and cohort effects were assessed using the method proposed by Holford. The incidence of all smoking-related cancers combined increased significantly in both sexes. The annual increase was 3.0% in men and 4.5% in women. By sites the annual increase was 4.3% in oral cavity, 5.1% in pancreas, 2.5% in lung, 3.2% in bladder, and 7.7% in kidney cancers among men. Among women the corresponding increments were 7.0% in oral cavity, 7.3% in pancreas, 3.1% in lung, 2.1% in bladder, and 6.9% in kidney cancers. The increasing incidence of lung cancer in women was mostly due to the adenocarcinoma histological type. No increase was observed in esophagus and larynx cancer either in men or women. It was not possible to determine whether the increases are due to a period or cohort effect since the curvature analysis was found to be non-significant. All smoking-related cancers combined, except larynx and esophagus, are increasing in both sexes. The effect of tobacco, alcohol, and occupational exposure to carcinogens could explain the high rates of larynx, bladder, and upper digestive tract cancer in men. The rising incidence rates of lung cancer observed in younger women indicate a change in recent trends that is consistent with changes observed in smoking prevalence. Unless recent upward smoking trends in young women can be reversed, lung cancer in women will rise rapidly in the next few years. New smoking prevention strategies aimed at Spanish women, especially in the younger age groups, should be developed.

Investing in youth tobacco control: a review of smoking prevention and control strategies

OBJECTIVETo provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have...

An evaluation of a theatre production to encourage non-smoking among elementary age children: 2 Smart 2 Smoke

OBJECTIVETo evaluate the impact of a theatre production on smoking-related attitudes, norms, and intentions of children in grades 1–6 (aged 6–12 years).DESIGNSeventeen schools were randomly selected among 160 that were...

Intermittent smokers: a descriptive analysis of persons who have never smoked daily.

This study assessed the prevalence of and demographic variables associated with lifetime never-daily smoking in the United States. Descriptive demographic data and logistic regression analyses were used to examine associations with never-daily smoking. Lifetime never-daily smokers constituted a significant minority of non-White smokers. There was a strong association between never-daily smoking and college education among young adults, particularly men. Although never-daily smoking was associated with initiation behavior among young smokers, it also represented a persistent pattern for some smokers, particularly non-Whites and Hispanics. The demographic distribution of never-daily smoking may have implications for developing culturally appropriate smoking prevention and cessation strategies.

A Pilot Study of Preadolescents Using Focus Groups to Evaluate Appeal of a Video-Based Smoking Prevention Strategy

Every day, 3000 adolescents begin smoking.1 The process of nicotine addiction ensures that many of today's adolescent smokers will continue tobacco use into adulthood.1 Although widely publicized health warnings of tobacco have been disseminated, there has been no decrease in adolescent smoking over the last decade.1 Reducing the initiation of cigarette smoking of children and youth by 50% by the year 2000 is one of the nation' health objectives.2 The specific purpose of this exploratory study was to evaluate the appeal of a video-game intervention designed to prevent smoking initiation in preadolescents. Appeal was defined as the extent to which the study subjects expressed interest in the video-game intervention and the desire to continue using the game. Before evaluating the effectiveness of the educational video game as a smoking prevention strategy, it was important to determine the acceptability of this approach to children in the target population. The intervention, a health-hero video game,3 has n...

Inappropriate and Appropriate Selection of 'Peers' in Grant Review

To assess the members of the California Tobacco Related Diseases Research Program Behavioral and Public Health Research on Tobacco Study Section and those of the Agency for Health Care Policy and Research (AHCPR) Dissemination Study Section as "peers" to review tobacco policy research. Both study sections reviewed a similar grant application on tobacco policy research written by one of us (S.A.G.). Search of MEDLINE for 1989 through 1993 with the keyword tobacco for Tobacco Related Diseases Research Program and AHCPR reviewers. As a control, the National Institutes of Health Cardiovascular Study Section, which reviewed a ventricular function grant submitted by the same author with the keyword heart, was analyzed. Not applicable. Study section members. None. Publications by study section members in areas germane to the proposal being reviewed. Six (33%) of 18 Tobacco Related Diseases Research Program reviewers had no "tobacco" publications (median, two publications; interquartile range, zero to four). The members' "tobacco" publications concentrated on well-controlled experimental interventions on smoking cessation and prevention strategies, not tobacco policy. Only one member had primary expertise in tobacco policy research. None of the AHCPR reviewers had "tobacco" publications. All 31 (100%) of the National Institutes of Health reviewers had "heart" publications (median, nine publications; interquartile range, seven to 19). Five members had a primary interest in the subject of the National Heart, Lung, and Blood Institute application. Study section members' professional interests play a critical role in the level of interest and enthusiasm they will have for a proposal, which affects the priority score. In contrast to the study section that reviewed the heart grant, the study sections that reviewed the tobacco control grant were not "peers." The membership of these review committees has effectively precluded research on tobacco control policy.

Smoking, Cessation, and the Diabetes Health Care Team

Cigarette smoking is a major risk factor in diabetes and contributes to the development of microvascular and macrovascular complications. Despite this, approximately one third of patients with diabetes smoke. Nicotine is physically and psychologically addictive, with multiple factors contributing to the initiation and continuation of the habit. Cessation is a process in which the smoker progresses through several stages of change, including precontemplation, contemplation, action, maintenance, and relapse. Knowledge of this process is needed for the diabetes health care team to effectively individualize smoking prevention and cessation strategies. This stepped care approach includes preventive, behavioral, and pharmacologic strategies as a component of routine diabetes education.

Four- and five-year follow-up results from four seventh-grade smoking prevention strategies

Recent studies have suggested that a prevention program that addresses the social influences that encourage smoking can be effective in deterring cigarette use by adolescents. This study presents 4- and 5-year follow-up results from two studies which evaluated three variations of this social influences model and compared them to a health consequences program and an existing-curriculum condition. The results suggest that a seventh-grade program, built around the social influences model and taught jointly by same-age peer leaders and local classroom teachers, may reduce 4-year weekly- and daily-smoking cumulative incidence rates, providing the first evidence for any long-term effects for the social influences model. However, the results also suggest that any long-term effects from such interventions are probably limited and may depend heavily on the manner in which the social influences model is translated during the intervention. Additional follow-up studies are needed to clarify the long-term effects of these intervention programs.

I Can Resist Anything But Temptation: Adolescent Expectations for Smoking Cigarettes1

Conformity to group pressure is widely considered a prime factor in experimentation with cigarettes. An alternative assumption is that the temptation to smoke arises out of the belief that cigarettes are instrumental in enhancing a sense of maturity, affiliation, and a reputation for autonomy. The present research assessed the relative saliency for both motive fulfillment and social pressure hypotheses in temptation dynamics and traced the causal influence of these factors on future expectations to smoke. Some 5,600 sixth, eighth and tenth graders rated the temptation value of four situations for smoking, varied along two dimensions: the composition of the group and the presence or absence of reasons that might minimize personal responsibility for smoking. Solitary smoking was a fifth situation. Between‐group analyses confirmed that smoking history of the individual (e.g., nonsmokers), grade level, and type of tempting situation all exerted a significant impact on perceived peer pressure, on temptation level, and on behavioral expectancy to smoke. However, beliefs about the instrumentality of cigarettes for reducing tension and enhancing a reputation for maturity and autonomy overshadowed peer pressure as causal agents for both temptation level and expectations. Moreover, instrumental beliefs were differentially salient in this temptation/expectancy dynamic, depending on the individual's smoking history. Finally, the causal saliency of instrumental beliefs differed, depending on whether temptation arose in solitary or group situations. The implications of these findings for adolescent smoking prevention and cessation strategies were considered.

Predicting experimentation with cigarettes: the childhood antecedents of smoking study (CASS).

In a two-year investigation of cigarette smoking incidence in a population of Minnesota adolescents, the perceived smoking behavior of friends at baseline was a strong predictor of smoking onset. Additional predictors included: siblings' smoking behavior, parents' education level, and seven psychosocial scales including independence and rebelliousness. Smoking prevention strategies which teach youth to cope with social influences are well founded. Results also indicate that younger adolescents may yet be dissuaded from beginning smoking by knowledge of the health consequences of smoking.

Enhancing Junior High School Students' Life Skills as a Smoking Prevention Strategy

(1985). Enhancing Junior High School Students' Life Skills as a Smoking Prevention Strategy. Health Education: Vol. 16, No. 3, pp. 45-49.

Physical, psychological, social, and lifestyle differences among adolescents classified according to cigarette smoking intention status.

This study was conducted to determine the extent to which multiple physical, psychological, social, and lifestyle measures differ among high school males classified according to cigarette smoking intention status including nonintenders, mild intenders, and strong intenders. The Physical Performance Test for California, to measure six traits of physical fitness and Cattell's 16PF Questionnaire to assess manifold dimensions of personality were administered to 386 high school males. Self-concept was measured by Rosenberg's Self-esteem Scale and body build was assessed using Tucker's Perceived Somatotype Scale and the Body Mass Index. Data relative to marital status of parents, exercise experience, church attendance, participation in athletics, alcohol drinking habits, television viewing behavior, intention to attend college, dating behavior, as well as general demographic information and intention to smoke cigarettes were assessed by a written questionnaire. Results indicated that nonintenders were significantly more self-confident, intelligent, emotionally stable, moralistic, conservative, group oriented, self-controlled, relaxed, and more likely to respond in a socially desirable manner than were strong intenders. Nonintenders reported less dating, less television viewing, less alcohol consumption, and perceived themselves as and were determined to be less obese than strong intenders. Nonintenders also reported greater intentions to attend college, greater varsity athletic participation, were more likely to be residing with their natural mothers, and were more physically fit than were strong intenders. Possible health education and youth smoking prevention strategies are discussed.