Smoking Susceptibility Research Articles

Tobacco advertising/promotions and adolescents’ smoking risk in Northern Africa

BackgroundComprehensive tobacco advertising/promotion bans are effective against adolescent smoking but many developing countries have implemented only partial bans. This study examines the association between advertising/promotions exposure and adolescent cigarette smoking...

A cross-country comparison of the prevalence of exposure to tobacco advertisements among adolescents aged 13–15 years in 20 low and middle income countries

BackgroundThis study assessed the prevalence and influence of exposure to pro-tobacco advertisements among adolescents in 20 low and middle income countries (LMICs).MethodsThe 2007–2008 Global Youth Tobacco Survey was analyzed for students aged 13–15 years in 20 LMICs. Overall and sex-specific prevalence of exposure to tobacco advertisements in several media, as well as the prevalence of smoking susceptibility (i.e., the lack of a firm commitment among never smokers not to smoke in the future or if offered a cigarette by a friend) were assessed. The variability of the point estimates was assessed using 95% confidence intervals (CI). Logistic regression was used to assess the effect of exposure to multiple (i.e., ≥2) pro-tobacco advertisements on current smoking, adjusting for age and sex (P < 0.05). Data were weighted and analyzed with Stata version 11.ResultsOverall country-specific prevalence for different advertisement sources ranged as follows: movies/videos (78.4% in Lesotho to 97.8% in Belize); television programs (48.7% in Togo to 91.7% in the Philippines); newspapers/magazines (29.5% in Togo to 89.7% in the Philippines); and outdoor community events (30.6% in Rwanda to 79.4% in the Philippines). The overall proportion of never smokers who were susceptible to cigarette smoking ranged from 3.7% in Sri Lanka to 70.1% in Kyrgyzstan. Exposure to ≥2 sources of pro-tobacco advertisements was associated with significantly increased odds of cigarette smoking among adolescents in several countries including South Africa (adjusted odds ratio, aOR = 4.11; 95% CI:2.26-7.47), Togo (aOR = 3.77; 95% CI:1.27-11.21), the Former Yugoslav Republic of Macedonia (aOR = 1.42; 95% CI:1.01-1.99), Republic of Moldova (aOR = 1.53; 95% CI:1.11-2.12), Belize (aOR = 13.95; 95% CI:1.91-102.02), Panama (aOR = 5.14; 95% CI: 2.37-11.14) and Mongolia (aOR = 1.52; 95% CI:1.19-1.94).ConclusionPrevalence of exposure to various pro-tobacco advertisements was high among adolescents in the LMICs surveyed. Enhanced and sustained national efforts are needed to reduce exposure to all forms of tobacco advertising and promotional activities.

Exposure to Celebrity-Endorsed Small Cigar Promotions and Susceptibility to Use among Young Adult Cigarette Smokers

Small cigar smoking among young adult cigarette smokers may be attributed to their exposure to its advertisements and promotions. We examined the association between exposure to a celebrity music artist's endorsement of a specific brand of small cigars and young adult cigarette smokers' susceptibility to smoking that brand. Venue-based sampling procedures were used to select and survey a random sample of 121 young adult cigarette smokers, aged 18–35. Fourteen percent reported exposure to the artist's endorsement of the small cigar and 45.4% reported an intention to smoke the product in the future. The odds of small cigar smoking susceptibility increased threefold for those who reported exposure to the endorsement compared to those not exposed (OR = 3.64, 95% CI 1.06 to 12.54). Past 30-day small cigar use (OR = 3.30, 95% CI 1.24 to 8.74) and past 30-day cigar use (OR = 5.08, 95% CI 1.23, 21.08) were also associated with susceptibility to smoke a small cigar. An association between young adult cigarette smokers' exposure to the music artist's small cigar endorsement and their susceptibility to smoke small cigars was found. This association underscores the importance of monitoring small cigar promotions geared toward young people and their impact on small cigar product smoking.

Movie Smoking and Youth Initiation: Parsing Smoking Imagery and Other Adult Content

ObjectivesTo isolate the independent influence of exposure to smoking and other adult content in the movies on youth smoking uptake.MethodsWe used discrete time survival analysis to quantify the influence of exposure to smoking and other adult content in the movies on transitioning from (1) closed to open to smoking; (2) never to ever trying smoking; and (3) never to ever hitting, slapping, or shoving someone on two or more occasions in the past 30 days. The latter is a comparative outcome, hypothesized to have no correlation with exposure to smoking in the movies.ResultsAssessed separately, both exposure to smoking imagery and exposure to adult content were associated with increased likelihood of youth becoming open to smoking (OR = 1.09, 95% CI: 1.04–1.15 and OR = 1.10, 95% CI: 1.04–1.17) and having tried smoking (OR = 1.06, 95% CI: 1.00–1.12 and OR = 1.06, 95% CI: 1.00–1.13). Both measures were also separately associated with aggressive behavior (OR = 1.09, 95% CI: 1.04–1.14 and OR = 1.09, 95% CI: 1.04–1.15). A very high correlation between the two measures (0.995, p<0.000) prevented an assessment of their independent effects on smoking initiation.ConclusionAlthough exposure to smoking in the movies is correlated with smoking susceptibility and initiation, the high correlation between exposure to smoking in the movies and other adult content suggests that more research is needed to disentangle their independent influence on smoking.

School status may affect later smoking susceptibility

School status may affect later smoking susceptibility

Effectiveness of Antismoking Media Messages and Education Among Adolescents in Malaysia and Thailand: Findings From the International Tobacco Control Southeast Asia Project

Finding ways to discourage adolescents from taking up smoking is important because those who begin smoking at an earlier age are more likely to become addicted and have greater difficulty in quitting. This article examined whether anti smoking messages and education could help to reduce smoking susceptibility among adolescents in two Southeast Asian countries and to explore the possible moderating effect of country and gender. Data came from Wave 1 of the International Tobacco Control Southeast Asia Project (ITC-SEA) survey conducted in Malaysia (n = 1,008) and Thailand (n = 1,000) where adolescents were asked about receiving antismoking advice from nurses or doctors, being taught at schools about the danger of smoking, noticing antismoking messages, knowledge of health effects of smoking, beliefs about the health risks of smoking, smoking susceptibility, and demographic information. Data were analyzed using chi-square tests and logistic regression models. Overall, significantly more Thai adolescents reported receiving advice from their nurses or doctors about the danger of smoking (p < .001), but no country difference was observed for reported antismoking education in schools and exposure to antismoking messages. Multivariate analyses revealed that only provision of antismoking education at schools was significantly associated with reduced susceptibility to smoking among female Malaysian adolescents (OR = 0.26). Higher knowledge of smoking harm and higher perceived health risk of smoking were associated with reduced smoking susceptibility among Thai female (OR = 0.52) and Malaysian male adolescents (OR = 0.63), respectively. Educating adolescents about the dangers of smoking in schools appears to be the most effective means of reducing adolescents' smoking susceptibility in both countries, although different prevention strategies may be necessary to ensure effectiveness for male and female adolescents.

The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study

BackgroundTobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil.MethodsA between-subjects experiment was conducted in which 640 Brazilian women aged 16–26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery (“plain packaging”), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal.ResultsBranded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs.ConclusionsPlain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in Australia.

Association of nicotine dependence susceptibility gene, CHRNA5, with Parkinson's disease age at onset: Gene and smoking status interaction

BackgroundSmoking is a well documented environmental factor that reduces susceptibility to Parkinson's disease (PD). Several genetic variants within the nicotinic cholinergic receptor gene cluster, CHRNA5-CHRNA3-CHRNB4 have been reported to be associated with nicotine dependence (ND), and this association has been validated in multiple studies. ObjectivesDue to the inverse correlation between smoking and PD susceptibility, we investigated whether ND-related genetic variants are associated with age at onset (AAO) of PD among smokers. MethodsWe performed a genetic association study in a sample of 677 Italian PD patients, ages 34–76. 438 had never smoked (NS), and 239 were current or past smokers (ever-smokers, ES). Three independent SNPs within the CHRNA5-CHRNA3-CHRNB4 gene cluster (rs588765, rs16969968, rs578776) were analyzed for association with AAO. ResultsWe demonstrated an interaction between the rs588765 SNP and smoking status (NS vs. ES) that was nominally significant in its effect on PD AAO (p = 0.04). The rs588765 ND risk allele ‘C’ was associated with delayed AAO among ES (even when smoking intensity variables are accounted for), but had no significant effect among NS. In the ES group, a dominant model of inheritance was observed: carriers of the ‘CC’ genotype presented delayed AAO compared to carriers of the ‘CT’ or ‘TT’ genotypes. ConclusionOur preliminary results suggest that the ND risk variant, rs588765, has a protective effect in PD, and is associated with later AAO, but only when the individual was previously exposed to nicotine. This may be explained by modulating the neuroprotective effect of chronic nicotine exposure against striatal dopaminergic damage. Further validation studies in additional populations are required.

Tobacco promotion 'below-the-line': Exposure among adolescents and young adults in NSW, Australia

Exposure to tobacco advertising and promotion increases the likelihood of smoking amongst young people. While there is a universal ban on traditional or ‘above-the-line’ advertising in Australia, the types and extent of exposure of young people to ‘below-the-line’ tobacco advertising and promotion is largely unknown. In this study we aim to identify levels of exposure of New South Wales (NSW) adolescents and young adults to tobacco promotion at the point-of-sale (PoS), on the internet, in entertainment media and at venues such as events or festivals and pubs, clubs, nightclubs, or bars; and to identify those most at risk of exposure. A telephone survey of 1000 NSW adolescents and young adults aged 12 to 24 years was conducted. Self-reported exposure to tobacco promotions or advertising in the last month were measured in four areas: (1) promotions or advertising at (a) events or festivals and (b) pubs, clubs, nightclubs or bars, (2) on the internet, (3) people smoking cigarettes in (a) movies, (b) TV shows, (c) video games and (d) on the internet, and (4) displays of cigarette packs for sale at (a) large supermarkets, (b) grocery stores or small supermarkets, (c) convenience stores, and (d) service or petrol stations. Smoking status and susceptibility to smoking was also assessed. A substantial proportion of the young people surveyed reported seeing tobacco promotion sometimes or often in the last month over most of the channels studied.The highest levels of exposure were at the PoS (approx. two-thirds) and to people smoking cigarettes in movies(77%). Lower levels of exposure to tobacco promotions and imagery were reported on the internet (20%); at events or festivals (22.5%); in pubs, clubs, nightclubs or bars (31%); and in video games (23%). However, the odds of exposure through video games increased by 8% for every additional hour spent on the internet per day. This study shows that adolescents and young adults in NSW are exposed to tobacco advertising or promotion at the PoS, on the internet, in entertainment media and at venues such as events or festivals and pubs, clubs, nightclubs or bars, despite the restrictions on the marketing of tobacco in Australia.

Receptivity to tobacco marketing and susceptibility to smoking among non-smoking male students in an urban setting in Lao PDR

BackgroundTobacco marketing is a contributing factor to adolescent smoking, and now targeting adolescents in low- and middle-income countries. Especially, promotional items with tobacco brand logos have a great impact on...

Youth Opinions of Tobacco Control in New Zealand: Support for Specific Measures and the Relationship With Smoking Behaviors Among 14-15-Year-Olds

The purpose of this study was to assess the attitudes of young people toward tobacco control and explore the association between these attitudes and both smoking intentions and behavior. The study used data from a national survey of 14- and 15-year-old students in New Zealand (NZ) investigating tobacco use and attitudes. Attitudes to tobacco control were assessed using student responses to 7 statements relating to specific tobacco control measures; outdoor smoking bans, increased and hypothecated tax, display bans, plain packaging, and reduced access. Analysis was conducted on a final sample of 24,495 students aged 14-15 years. Chi-square testing was used to determine group differences in smoking status and attitudes toward tobacco control measures, while logistic regression was used to test associations between youth attitudes and both smoking susceptibility and current smoking. Our results demonstrate youth support for tobacco control interventions in NZ. Commercial access measures received the most support, while plain packaging and display bans were the least supported measures among young people. Young people's attitudes toward tobacco control measures were found to be associated with smoking behavior; those who were opposed to measures were more likely to be susceptible to smoking or be current smokers. Young people in NZ have opinions when it comes to tobacco control, and it is important to investigate these when developing tobacco control policies that are aimed to have an effect on this demographic. The results provide evidence to support the proposed "end game" strategies currently being considered in NZ.

Thai Adolescents' Normative Beliefs of the Popularity of Smoking Among Peers, Adults, the Successful and Elite, and Parents

AbstractThe purpose of this study was to assess the perceptions of Thailand adolescents regarding the prevalence of smoking, the popularity of smoking among successful/elite elements of society, and disapproval of smoking by friends and parents. These perceptions were analyzed in conjunction with actual smoking and smoking susceptibility rates among the subjects to determine whether beliefs and behaviors were associated with each other. This study was conducted among a school‐based sample of 2516 Chiang Mai, Thailand upper secondary and vocational students. Although perceived prevalence of smoking was not associated with smoking outcomes, perceived popularity of smoking among the successful and elite was associated with higher risk, and perceived disapproval by friends/parents was associated with lower risk. Youth smoking programs should consider assessing and taking these social normative factors into account when considering educational intervention strategies that aim to lower adolescent smoking rates.

Smoking Susceptibility and its Predictors among Adolescents in China: Evidence from Ningbo City

Susceptibility to smoking is a risk factor of actual adolescent smoking behaviors. This study aimed to estimate the rate of smoking susceptibility and its predictors in China with a sample of 4,695 junior high school students in Ningbo, China. Core questions from the Global Youth Tobacco Survey (GYTS) were adapted to the China context and administered to these students. The rate of smoking susceptibility, measured by “Do you foresee yourself taking up smoking in the next 12 months”, is 6.1%. Results from logistic regression suggested that among boys, adolescents’ health knowledge that smoking can cause lung cancer (OR=2.73), the belief that smoking can help people relax (OR=2.32), and self-report of never having seen anti-smoking information on campus (OR=1.80) predicted increased susceptibility to smoking. Conversely, the belief that boys who smoke are less attractive (OR=0.64), that parents will have a problem with their child smoking (OR=0.50), having no friends or classmates who smoke (OR=0.22), and not seeing teachers smoke in the previous week (OR=0.61) predicted decreased susceptibility to smoking. Findings for girls were similar. This study suggested the need for comprehensive programs aiming to improve family, peer, and school environments to decrease smoking susceptibility among adolescents.

Parental behaviours, but not parental smoking, influence current smoking and smoking susceptibility among 14 and 15 year‐old children

To explore whether parental behaviours related to smoking socialisation and parenting are associated with smoking susceptibility and current smoking in 14-15 year old students. Data were sourced from the New Zealand 2006 Year 10 In-depth Survey, a school-based survey of 3,189 students. Outcome measures were susceptibility to smoking and current smoking. Potential determinants were second-hand smoke exposure in the home, parental smoking, parental anti-smoking expectations, anti-smoking rules, pocket money, monitoring of pocket money expenditure, general rule setting and monitoring, and concern about education. Analysis used logistic regression to adjust for potential confounding factors. Exposure to second-hand smoke and lack of parental anti-smoking expectations were independently associated with smoking susceptibility and current smoking. Parental smoking was not independently associated with current smoking or susceptibility. Receiving pocket money and an absence of monitoring of expenditure were associated with smoking susceptibility and current smoking. Lack of parental rule setting was associated with smoking susceptibility. Findings were similar whether or not one or more parents were smokers. Not allowing smoking in the home, communicating non-smoking expectations to children, monitoring pocket money, and setting rules to guide behaviour are strategies which are likely to reduce risk of smoking uptake. The study provides evidence to inform the development of parent-focused interventions to reduce the risk of smoking initiation by children.

Social normative beliefs regarding cigarette smoking in Hungarian adolescents

Hungary will continue to experience a high burden of disease and death from lung cancer and other tobacco-induced disease unless there is a significant reduction in youth smoking. Social factors have been found to be among the most important determinants of adolescent smoking, yet few studies have investigated social normative beliefs in Hungarian youth. The purpose of the current study was to investigate three measures of smoking normative beliefs thought to influence adolescent smoking: perceived prevalence of smoking; perceived popularity of smoking among successful/elite elements of society; and perceived disapproval by friends and family. A cross-sectional school-based survey of eighth grade (n = 258) and 12th grade (n = 288) students in Mako, Hungary was conducted to assess social normative beliefs about smoking, current smoking, ever smoking, and susceptibility to smoking. The association of the normative beliefs with the smoking behavior variables was examined through logistic regression analysis, and the underlying factor structure of the normative belief items in the current sample was determined through factor analysis. The percent of boys reporting current smoking was 40.5% in 12th grade and 27.0% in eighth grade. Among girls, the percent was 44.0% of 12th graders and 29.1% of eighth graders. Parent/peer disapproval was the most consistently associated normative belief with smoking behavior and susceptibility to smoking across both samples. Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

The Association Between Point-of-Sale Displays and Youth Smoking Susceptibility

According to tobacco industry documents, tobacco displays within the retail environment assume a much greater importance with the loss of other marketing channels. The impact of these displays upon young people and their future intentions to smoke (susceptibility) is, therefore, of significant interest to public health. A cross-sectional in-home survey was conducted in 2008 with young people (N = 1,401) aged 11-16 years, recruited from across the United Kingdom. We examine the salience of and attraction to cigarette displays at point-of-sale (POS), among youth, and whether this is associated with susceptibility. We concentrate exclusively on the 956 never-smokers. Logistic regression, controlling for known risk factors of youth smoking, found that noticing cigarette displays was associated with higher levels of susceptibility (odds ratio [OR] = 1.77, p < .05) and greater attraction to displays was associated with higher susceptibility (OR = 1.07, p < .001). It is difficult, if not impossible, to safeguard young people from exposure to displays of tobacco at POS. That these displays were associated with increased susceptibility suggests that moves to place tobacco out of sight in the United Kingdom, and elsewhere, are justified.

Smoking is a risk factor in the progression to kidney failure

To study the role of smoking in renal damage, we measured gender-specific effects, dose-response relationships, and whether cessation reduced the risk of smoking on future kidney failure. During a median follow-up of 10.3 years, 124 of 65,589 participants of the HUNT II study, a Norwegian population, progressed to stage 5 chronic kidney disease. Former- and current-smokers less than 70 years of age at inclusion had significant multi-adjusted hazard ratios of 3.32 and 4.01 for kidney failure compared to those who never smoked. In men, the risk increased with a significantly higher trend for cumulative smoking (pack-years); however, the risk significantly decreased with increased elapsed years since smoking cessation. Although the prevalence of current smoking did not differ between genders, females had smoked less (10.2 compared to 15.8 pack-years) and the number of kidney failure cases was lower in females than in men (46 compared to 78). The effect of smoking on the risk of kidney failure was similar (hazard ratios of 2.94 and 4.30 in current-smoking women and men, respectively), but did not reach statistical significance in women. Thus, in this large population-based sample, we found that smoking is a significant risk factor for future kidney failure. Smoking cessation decreased this risk, at least in men.

Smoking susceptibility among students followed from grade six to eight

Background Smoking is a leading risk factor for heart disease and cancer. By identifying factors associated with smoking onset, more effective prevention programs can be developed. Research questions are 1) does smoking susceptibility status change from grade six to eight, 2) are indicators of risk (perceived harm, smoking susceptibility status, positive peers, and resilience) measured in sixth grade associated with smoking susceptibility status in eighth grade and, 3) are there differences by gender in either research question? Methods The current study is a secondary analysis of data collected during the evaluation of a Safe Schools Healthy Students Project. Students were followed from grade six to grade eight, with survey data collected in each grade from August 2006 to December 2008. Participants (n = 577) were in grade six at baseline, 52% were girls and 57% identified as White, non-Hispanic. Results From grade six to grade eight the number of students in the high smoking susceptibility status doubled (5% to 17%). More boys than girls moved into the high susceptibility group over time. By eighth grade, boys were twice as likely to belong to the high smoking susceptibility group compared to girls (p = 0.01). Multiple logistic regression models showed that the positive peers' variable in grade six was protective for girls in their reported smoking susceptibility in grade eight. In contrast, higher resilience scores in grade six were protective for boys' reported smoking susceptibility in grade eight. Conclusions Smoking susceptibility rose over time for all adolescents, but boys had notably sharper increases. Positive peers and having resources important to resilience may be beneficial in preventing the attitudes that support smoking initiation. Based on these results, we recommend gender-tailored, school-based smoking prevention programs that begin in grade six.

Sensitivity to Secondhand Smoke Exposure Predicts Future Smoking Susceptibility

Susceptibility to cigarette smoking in tobacco-naive youth is a strong predictor of smoking initiation. Identifying mechanisms that contribute to smoking susceptibility provide information about early targets for smoking prevention. This study investigated whether sensitivity to secondhand smoke exposure (SHSe) contributes to smoking susceptibility. Subjects were high-risk, ethnically diverse 8- to 13-year-old subjects who never smoked and who lived with at least 1 smoker and who participated in a longitudinal SHSe reduction intervention trial. Reactions (eg, feeling dizzy) to SHSe were assessed at baseline, and smoking susceptibility was assessed at baseline and 3 follow-up measurements over 12 months. We examined the SHSe reaction factor structure, association with demographic characteristics, and prediction of longitudinal smoking susceptibility status. Factor analysis identified "physically unpleasant" and "pleasant" reaction factors. Reported SHSe reactions did not differ across gender or family smoking history. More black preteens reported feeling relaxed and calm, and fewer reported feeling a head rush or buzz compared with non-Hispanic white and Hispanic white counterparts. Longitudinally, 8.5% of subjects tracked along the trajectory for high (versus low) smoking susceptibility. Reporting SHSe as "unpleasant or gross" predicted a 78% reduction in the probability of being assigned to the high-smoking susceptibility trajectory (odds ratio: 0.22 [95% confidence interval: 0.05-0.95]), after covariate adjustment. Assessment of SHSe sensitivity is a novel approach to the study of cigarette initiation etiology and informs prevention interventions.

Sensitivity to Secondhand Smoke Exposure Predicts Future Smoking Susceptibility

Sensitivity to Secondhand Smoke Exposure Predicts Future Smoking Susceptibility