Youth Smoking Research Articles

Effects of Mental Health and Drinking Behavior on Youth Smoking: Using the 2019 Youth Health Behavior Survey

Effects of Mental Health and Drinking Behavior on Youth Smoking: Using the 2019 Youth Health Behavior Survey

A breath of fresh air: The effect of public smoking bans on Indigenous youth.

In general, past studies have estimated the average effect of public smoking bans on youth, ignoring differences across sub-populations. We extend the literature by considering Indigenous youth, who are a vulnerable and previously unexamined group (however, our analysis excludes First Nations youth who live on reserve). We also consider previously unexamined outcomes among youth: self-assessed health and subjective well-being. Our difference-in-differences estimates from Canada indicate that public bans reduced youth smoking and second-hand exposure in public places, on average. There was no displacement on the extensive margin, but the bans increased the number of people who smoke in the homes of youth, conditional on the presence of smokers in the household. Beyond average effects, however, we find that public bans reduced second-hand exposure in the homes of Indigenous youth (particularly Métis youth), on the extensive and intensive margins. The same youth experienced concurrent improvements in self-assessed health and life satisfaction. We conclude that public bans mitigate disparities in health and well-being between Indigenous and non-Indigenous youth, but the extent varies across Indigenous sub-populations, even within a particular country.

Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial.

BackgroundSmoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive.ObjectiveThis study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention.MethodsHomeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it.ResultsParticipants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention.ConclusionsThe TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions.Trial RegistrationClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585International Registered Report Identifier (IRRID)RR2-10.1186/s13722-020-00187-6

Measures of both perceived general and specific risks and benefits differentially predict adolescent and young adult tobacco and marijuana use: findings from a Prospective Cohort Study

Health behavior theorists and prevention researchers use a variety of measures of adolescent and young adult (AYA) risk and benefit perceptions to predict tobacco-use and marijuana-use behaviors. However, studies have not examined whether and how perception measures that ask about likelihood of more general outcomes such as “harm” versus ask about specific risk or benefit outcomes compare or whether they differentially predict AYA willingness to use if one of your best friends were to offer it and intentions to use in the next year; and if these measures have differential ability to predict actual use of tobacco and marijuana. We used data from a prospective cohort of California AYAs to create and test new scales to measure perceptions of specific health and social outcomes related to risks (e.g., smell bad) and benefits (e.g., look cool) related to tobacco and marijuana, and then addressed three questions: (1) Whether and how measures of perceptions of specific social and health risks and benefits (for our purposes “specific measures”) and measures of perceived general harm are differentially associated with measures of willingness, social norms, and intentions to use? (2) Are specific versus general measures differentially associated with and predictive of tobacco and cannabis use behavior? (3) Are specific perceptions measures differentially predictive of behavior compared to measures of willingness, social norms, and behavioral intentions? Our results demonstrate that to better predict AYA tobacco and marijuana use, measures that address general outcomes, such as harmfulness, as well as willingness and behavioral intention should be used. We also found that measures of specific perceived risks (short-term, long-term, social) and benefits were unrelated and correlated differently with different products. For example, adolescents perceived both risks and benefits from using products like e-cigarettes, and perceived greater risk from smokeless tobacco compared to combustible cigarettes. These findings indicate that measures of specific perceived social and health outcomes can be useful to discern nuanced differences in motivation for using different substances. Study implications are important for survey dimension-reduction and assessing relationships among perceptions, motivations, and use of tobacco and marijuana products.

Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies.

Social norms towards smoking are a key concept in tobacco control policy and research. However, the influence and strength of different types of social norms on youth smoking uptake is unclear. This study aimed to examine, quantify and compare evidence of the longitudinal associations between different types of social norms towards smoking and youth smoking uptake (initiation and escalation). Systematic review searching four databases (MEDLINE, EMBASE, PsycInfo, CINAHL) from January 1998 to October 2020. Evidence synthesis via narrative review, meta-analysis pooling unadjusted associations (initiation only, due to heterogeneity in escalation outcomes) and meta-regression comparing effect sizes by norm type and study characteristics. Studies included observational prospective cohort studies using survey methodology with youth aged ≤24years. Measurements included longitudinal associations between descriptive norms (perceived smoking behaviour) and injunctive norms (perceived approval/disapproval of smoking) among social network(s) and subsequent smoking initiation or escalation. Thirty articles were identified. In the narrative review, smoking initiation (but not escalation) was consistently predicted by two norms: parental and close friend smoking. Associations between smoking uptake and other descriptive norms (smoking among siblings, family/household, partner, peers, adults) and all injunctive norms (perceived approval of smoking among parents, siblings, close friends/peers, partner, teachers, people important to you, the public) were less consistent or inconclusive. In the meta-analysis pooling unadjusted associations, 17 articles were included (n=27 767). Smoking initiation was predicted by the following descriptive norms: smoking among parents [Odds Ratio (OR)=1.88, 95% Confidence Interval (CI)=1.56-2.28], close friends (OR=2.53, 95% CI=1.99-3.23), siblings (OR=2.44, 95% CI=1.93-3.08), family/household (OR=1.55, 95% CI=1.36-1.76) and adults (OR=1.34, 95% CI=1.02-1.75), but not peers (OR=1.14, 95% CI=0.92-1.42). Smoking initiation was also predicted by two injunctive norms, perceived approval of smoking among parents (OR=1.74, 95% CI=1.27-2.38) and the public (OR=4.57, 95% CI=3.21-6.49), but not close friends/peers (OR=2.36, 95% CI=0.86-6.53) or people important to the individual (OR=1.24, 95% CI=0.98-1.58). In this systematic review (narrative and meta-analysis), descriptive norms of parents' and close friends' smoking behaviour appeared to be consistent predictors of youth smoking initiation, more so than the descriptive norms of more distal social networks and injunctive norms.

Experiences of the First Year Implementation of a Nationwide School-Based Smoking Prevention Program in Korea.

Encouraged by the Framework Convention on Tobacco Control, Korea has implemented a nationwide School-based Smoking Prevention Program (SSPP) to reduce the prevalence of youth smoking. This qualitative study explored the school contexts of launching the SSPP in Seoul, Korea. Five focus groups were studied with 29 lead teachers in charge of the SSPP. Thematic analysis reveals three key findings. First, while infrastructure was insufficiently prepared due to the abrupt implementation, lead teachers agreed on the purpose of the SSPP. However, they perceived the program as myopic in only targeting smoking students and spending the mandatory budgets as a burdensome task. Second, the SSPP increased experience-based activities, influenced smoking family members, and created a smoke-free school environment. Third, to ensure more effective implementation, school principals should support inducing staff engagement. The teachers also maintained that the SSPP must be institutionalized as part of regular curricula with standardized books. For a more meaningful impact, the SSPP needs instructors and counselors to support smoking cessation programs that reflect school contexts. The teachers urged tobacco prevention measures at community, policy, and society levels. This study provides insights into a nationwide approach to initiating school-based smoking prevention program to achieve a tobacco-free generation.

Is Youth Smoking Related to the Density and Proximity of Outdoor Tobacco Advertising Near Schools? Evidence from Indonesia.

Background: Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. Objective: To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. Methods: We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. Results: We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. Conclusions: There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.

Machine Learning-Based Nicotine Addiction Prediction Models for Youth E-Cigarette and Waterpipe (Hookah) Users.

Despite the harmful effect on health, e-cigarette and hookah smoking in youth in the U.S. has increased. Developing tailored e-cigarette and hookah cessation programs for youth is imperative. The aim of this study was to identify predictor variables such as social, mental, and environmental determinants that cause nicotine addiction in youth e-cigarette or hookah users and build nicotine addiction prediction models using machine learning algorithms. A total of 6511 participants were identified as ever having used e-cigarettes or hookah from the National Youth Tobacco Survey (2019) datasets. Prediction models were built by Random Forest with ReliefF and Least Absolute Shrinkage and Selection Operator (LASSO). ReliefF identified important predictor variables, and the Davies–Bouldin clustering evaluation index selected the optimal number of predictors for Random Forest. A total of 193 predictor variables were included in the final analysis. Performance of prediction models was measured by Root Mean Square Error (RMSE) and Confusion Matrix. The results suggested high performance of prediction. Identified predictor variables were aligned with previous research. The noble predictors found, such as ‘witnessed e-cigarette use in their household’ and ‘perception of their tobacco use’, could be used in public awareness or targeted e-cigarette and hookah youth education and for policymakers.

OA10.06 Achieving the Tobacco Free Generation Endgame: #1 Reimagining the Implementation of Better Mass Tobacco Prevention Education

In the last decade, the tobacco endgame vision has gained increasing discourse, especially the Tobacco Free Generation (TFG) concept. The original TFG ideology proposed phasing out tobacco products amongst generations born in and after a certain birth year, specifically 2000. The ideology has transformed into a social movement that is anchored on educating and activating these generations to be tobacco-free. Since 2012, we have produced education content to activate these generations. Video competitions were organised, where youths created videos voicing their opinions about TFG under mentoring by medical students in 2013, and without mentoring in 2014. As the TFG social movement gained international interest, youths from the Philippines and South Africa came on board to produce videos from 2016 to 2019 under the guidance of medical doctors. Videos were uploaded onto social media for public viewing. Video themes were analysed against World Health Organisation’s core components of tobacco prevention education using qualitative data analysis software Nvivo. Presenting on TFG at schools is essential to our TFG education model. A key feature of our school programme is based on the WHO’s concept on replacement smokers, who are youths targeted by tobacco companies to replace smokers who quit or die from smoking and smoking-related diseases. Understanding this concept supplements the important life skills needed to resist negative peer pressure. As an outcome measure of our education model, we conducted cross-sectional studies on 1201 students, aged eight to 19 years old, from 13 elementary and secondary schools who attended these programmes. Thirty-four videos were produced. Videos produced under mentoring demonstrated more positive themes (good life skills, changing social norms, creating a generation’s identity), and fewer negative themes (including smokers’ guilt, antagonism against smokers). Our TFG education content included international languages with contextualisation for local communities to embrace the TFG concept strongly. A clear majority (90%) supported the TFG concept, significantly higher than previous papers by Khoo in 2010 (70.4% support) and Trainer in 2016 (75% adults, 68% youths support) when surveys were conducted based on ideology support without prior education on TFG concept. 96% students were convinced that smoking is dangerous to one’s health; 97% were determined not to become a replacement smoker. It is important to have optimised, compelling education materials prior to achieving any tobacco endgame. The TFG social movement reimagines a new educational approach for a non-antagonistic tobacco endgame strategy. Achieving zero smoking prevalence in future generations is now possible.

P40.01 Tobacco use in Adolescence and Associated Factors: Products, School, Family, Peers and Movies in Pandemic Period

Tobacco smoking among adolescents is still frequent and stalling in the last decades, so the main purpose of this research is to know if the COVID-19 pandemic had an impact on adolescents' perceptions regarding smoking. We investigated: 1) the prevalence of active cigarette smoking; 2) if smoking of parents and friends and school environment influences the choice to smoke; 3) if the students capture the presence of images of smoking in films; 4) the level of concern of the younger people regarding the association between Covid-19 disease and smoke. 719 students (65% boys, aged 13-19 years, from the high school, technical and professional institutes) filled an anonymous questionnaire (31-item), during Covid-lockdown. The students have been subdivided into the following categories: daily smokers (12.8%), occasional (30.3%), former (8.8%) and never smokers (48.1%). 52% of students have smoked at least once (n.s. for gender). Interestingly, over time the probability of starting to smoke decreases (fig1). Furthermore, the students who start smoking early tend to smoke daily (r=-0.13;p < 0.01) and more cigarettes (r=-0.30; p < 0.01). 83% of students start smoking out of curiosity and a spirit of adventure, consuming 1 to 4 cigarettes daily. Moreover 30% of them would want to quit but failed; 27% never thought about it; while 44% report that they will quit smoking in a few years. 59% consume manufactured cigarettes, 36% smoke rolling tobacco; 3% use HNB and 2% e-cigarettes. The type of cigarettes considered less harmful are electronic cigarettes. 68% of the student smokers have in turn someone in the family who smokes, on the contrary only 37.5% of non-smoking students have parent smokers. Considering only the students who smoked at least once, 65% replied that someone among friends smoke, while only 4% of no-smokers have smoking friends. Finally, the adolescents attending professional institutes smoke daily and more cigarettes (F (2, 368)=5.32; p<0.05) compared to the other. Moreover, it emerged that 48% do not pay attention to smoking scenes in the movies. About the coronavirus epidemic, 80% reported a upper-middle concern and 84% think that is very dangerous for smokers, while 76,3% consider that the respiratory symptoms of smokers Covid-19 patients could have a worse outcome and that being a smoker can become very dangerous for the clinical complications that can occur (84%). These data, even more meaningful during COVID-19 pandemic, highlight the importance and the need of primary prevention as well as of suitable secondary prevention programs.

Adolescent Risk and Protective Factors for the Use of Electronic Cigarettes

The use of electronic cigarettes (e-cigarettes) by adolescents is a serious public health concern. The major aim of the current study is to conduct a comprehensive examination of adolescent e-cigarette use in relation to risk and protective factors for a school-based sample. The present study is based on a secondary data analysis of the 2017 Prevention Needs Assessment (PNA) Survey that is administered every 2 years in the state of Utah to a large sample of students ( n = 54,853) in Grades 6, 8, 10, and 12 from more than 400 schools. The PNA Survey measures substance use, mental health symptoms, and antisocial behavior as well as their associated risk and protective factors. Almost 9% of adolescents in this study reported using e-cigarettes in the past 30 days. Adolescents who reported infrequent (1–5 days) and frequent (6+ days) use of e-cigarettes also indicated lower levels of protection (e.g., perceived harm) and higher levels of risk (e.g., favorable attitudes) compared with students who did not report using e-cigarettes in the past 30 days. The frequency of adolescent e-cigarette use can distinguish between risk and protective factors. Findings suggest that the risk and protective factors relevant for adolescent alcohol, cannabis, and tobacco use extend to the use of the e-cigarettes. Certain risk factors (e.g., favorable attitudes toward substance use) and protective factors (e.g., perceived risk for use of e-cigarettes) hold promise for preventive interventions in addressing this public health concern.

Testing the association between tobacco and cannabis use and cognitive functioning: Findings from an observational and Mendelian randomization study

BackgroundAlthough studies have examined the association between tobacco and cannabis use in adolescence with subsequent cognitive functioning, study designs are usually not able to distinguish correlation from causation. MethodsSeparate patterns of tobacco and cannabis use were derived using longitudinal latent class analysis based on measures assessed on five occasions from age 13–18 in a large UK population cohort (Avon Longitudinal Study of Parents and Children). Cognitive functioning measures comprised of working memory, response inhibition, and emotion recognition assessed at 24 years of age. Mendelian randomization was used to examine the possible causal relationship between smoking initiation, lifetime cannabis use and cognitive functioning. ResultsWe found evidence of a relationship between tobacco and cannabis use and diminished cognitive functioning for each of the outcomes in the observational analyses. There was evidence to suggest that late-onset regular tobacco smokers (b=-0.29, 95 %CI=-0.45 to -0.13), early-onset regular tobacco smokers (b=-0.45, 95 %CI=-0.84 to -0.05), and early-onset regular cannabis users (b=-0.62, 95 %CI=-0.93 to -0.31) showed poorer working memory. Early-onset regular tobacco smokers (b = 0.18, 95 %CI = 0.07 to 0.28), and early-onset regular cannabis users (b = 0.30, 95 %CI = 0.08 to 0.52) displayed poorer ability to inhibit responses. Late-onset regular (b=-0.02, 95 %CI=-0.03 to - 0.00), and early-onset regular tobacco smokers (b=-0.04, 95 %CI=-0.08 to -0.01) showed poorer ability to recognise emotions. Mendelian randomization analyses were imprecise and did not provide additional support for the observational results. ConclusionThere was some evidence to suggest that adolescent tobacco and cannabis use were associated with deficits in working memory, response inhibition and emotion recognition. Better powered genetic studies are required to determine whether these associations are causal.

Smoking cessation and counseling: A mixed methods study of pediatricians and parents.

Pediatric providers play an important role in parental and youth smoking cessation. The goal of this study was to understand smoking cessation attitudes of parents and the behaviors, confidence and self-efficacy of pediatricians related to providing smoking cessation counseling to parents and youth. A mixed methods study was conducted in a convenience sample of families (n = 1,549) and pediatric primary care clinicians (n = 95) in Connecticut using surveys and focus groups from April, 2016 to January, 2017. The smoking rate (cigarettes or electronic cigarettes) among all households surveyed was 21%. Interest in quitting smoking was high (71%) and did not differ based on smoking amount, duration, type of community of residence (urban, rural, etc), or race/ethnicity. For example, compared to participants who smoked for <10 years, those who smoked ≥20 years had a similar interest in quitting (OR = 1.12; 95% CI: 0.85-1.48). Ninety percent of clinicians surveyed asked parents about their smoking behavior at least annually but 36% offered no smoking cessation counseling services or referral. Clinicians almost always reported counseling youth about the dangers of nicotine and tobacco use (99%), were more confident about counseling youth than parents (p<0.01) and reported low self-efficacy about smoking cessation and prevention counseling of parents and youth. Ninety-three percent of clinicians opined that electronic cigarettes were equally or more dangerous than cigarettes but 34% never counseled youth about the dangers of electronic cigarettes. Clinicians frequently screen parents about their smoking behaviors, but rarely provide smoking cessation counseling and express low confidence in this activity. Clinicians are more confident counseling youth than parents. Clinicians also recognize the dangers of electronic cigarettes, yet they infrequently counsel youth about these dangers.

Challenging Assumptions About Race/Ethnicity, Socioeconomic Status, and Cigarette Smoking Among Adolescents.

Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents. Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted. Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions. The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

Tobacco-control challenges among adolescents in the Eastern Mediterranean region

The analysis of trends in global adolescent tobacco use by Chuanwei Ma and colleagues1 portrays a sombre situation and highlights the need to substantially strengthen public health efforts in tobacco control. Although the authors report a global 3·5% reduction in past-30-day cigarette use among adolescents aged 13–15 years over 10 years, they lament the unacceptably high most recent rates, especially among boys (11·3%). Worryingly, their findings uncovered a quietly growing phenomenon that has manifested into an urgent priority for the global tobacco-control agenda: the rise of non-cigarette tobacco products.

Prevalence and trends in tobacco use among adolescents aged 13–15 years in 143 countries, 1999–2018: findings from the Global Youth Tobacco Surveys

Tobacco use is a leading preventable cause of morbidity and mortality worldwide. Little is known about recent prevalence and trends in tobacco use among adolescents globally. We aimed to assess the recent global prevalence of tobacco use in young adolescents and the secular trends in prevalence between 1999 and 2018. We used the most recent Global Youth Tobacco Surveys data on adolescents aged 13-15 years from 143 countries or territories that had done at least one survey between Jan 1, 2010, and Dec 31, 2018, to assess the recent prevalence of tobacco use; and data from 140 countries that had done two or more surveys between Jan 1, 1999, and Dec 31, 2018, to assess the trends in the prevalence of tobacco use. 530 234 adolescents were included from the 143 countries that had done at least one survey between 2010 and 2018. 1 192 312 adolescents were included from the 140 countries that had done two or more surveys between 1999 and 2018. The most recent global prevalence of cigarette smoking was 11·3% (95% CI 10·3-12·3) in boys and 6·1% (5·6-6·6) in girls, based on cigarette smoking on at least 1 day during the past 30 days, 6·0% (5·5-6·6) and 2·6% (2·4-2·9) based on smoking on at least 3 days, and 4·2% (3·8-4·6) and 1·6% (1·4-1·8) based on smoking on at least 6 days. The most recent prevalence of the use of tobacco products other than cigarettes (eg, chewing tobacco, snuff, dip, cigars, cigarillos, pipe, electronic cigarettes) on at least 1 day during the past 30 days was 11·2% (9·9-12·6) in boys and 7·0% (6·4-7·7) in girls. The most recent prevalence of any tobacco use on at least 1 day during the past 30 days was 17·9% (16·1-19·6) in boys and 11·5% (10·5-12·4) in girls. The prevalence of cigarette smoking on at least 1 day during the past 30 days decreased between the first and last surveys in 80 (57·1%) of 140 countries, was unchanged in 39 countries (27·9%), and increased in 21 countries (15·0%). However, the prevalence of the use of tobacco products other than cigarettes was unchanged or increased in 81 (59·1%) of 137 countries. The global prevalence of tobacco use among adolescents aged 13-15 years was substantial. Although the prevalence of cigarette smoking decreased over time in the majority of countries, the prevalence of the use of other tobacco products increased or did not change in the majority of countries during the past two decades. These findings re-emphasise the need to strengthen tobacco control efforts among young adolescents globally. Shandong University.

Investigating the role of familial and peer-related factors on electronic nicotine delivery systems (ENDS) use among U.S. adolescents

IntroductionTobacco use is a public health concern, and adolescents are at an increased risk of starting and continuing to use tobacco relative to other age groups. Parent involvement and other social environmental factors may influence the development and persistence of tobacco use behaviors in adolescence. This study used the nationally representative Population Assessment of Tobacco and Health (PATH) study data set, and responses from 7025 adolescent participants were analyzed to illustrate the longitudinal relationship between social environment influences and use of adolescent electronic nicotine delivery systems (i.e., ENDS). MethodsSocial environmental factors were assessed at Wave 3 and then compared to electronic nicotine delivery systems (ENDS) status transitions (i.e., initiation, expansion, persistence) at follow-up. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI). ResultsInitiation and persistence of ENDS use were associated with tobacco availability in the house, perception of having no adverse parent reaction to discovering ENDS use and having a best friend who uses ENDS. Initiation of ENDS use was further associated with having biological relatives who have ever been diagnosed with a substance use disorder (SUD) and persistence of ENDS use was also positively associated with lack of in-house rules. Parents talking about ENDS use with adolescents had no association across all three outcomes. ConclusionsFindings suggest that parental and environmental factors alter the risk of initiation and persistence of ENDS and tobacco use in adolescents, and these should be considered when working with this at-risk population.

Linking political exposures to child and maternal health outcomes: a realist review

BackgroundConceptual and theoretical links between politics and public health are longstanding. Internationally comparative systematic review evidence has shown links between four key political exposures – the welfare state, political tradition, democracy and globalisation – on population health outcomes. However, the pathways through which these influences may operate have not been systematically appraised. Therefore, focusing on child and maternal health outcomes, we present a realist re-analysis of the dataset from a recent systematic review.MethodsThe database from a recent systematic review on the political determinants of health was used as the data source for this realist review. Included studies from the systematic review were re-evaluated and those relating to child and/or maternal health outcomes were included in the realist synthesis. Initial programme theories were generated through realist engagement with the prior systematic review. These programme theories were adjudicated and refined through detailed engagement with the evidence base using a realist re-synthesis involving two independent reviewers. The revised theories that best corresponded to the evidence base formed the final programme theories.ResultsOut of the 176 included studies from the systematic review, a total of 67 included child and/or maternal health outcomes and were included in the realist re-analysis. Sixty-three of these studies were ecological and data were collected between 1950 and 2014. Six initial programme theories were generated. Following theory adjudication, three theories in revised form were supported and formed the final programme theories. These related to a more generous welfare state leading to better child and maternal health especially in developed countries through progressive social welfare policies, left-of-centre political tradition leading to lower child mortality and low birth weight especially in developed countries through greater focus on welfare measures, and increased globalisation leading to greater child and infant mortality and youth smoking rates in LMECs through greater influence of multinational corporations and neoliberal trade organisations.ConclusionWe present a realist re-analysis of a large systematically identified body of evidence on how four key political exposures – the welfare state, democracy, political tradition and globalisation – relate to child and maternal health outcomes. Three final programme theories were supported.

Smoking in adolescence and harm reduction model as an alternative intervention

Introduction: Smoking is one of the main public health problems in the world, due to the fact that every year more than eight million people die from tobacco use. During adolescence, three out of five tobacco users generate an addiction. Objective: To carry out a systematic review that allows to know the smoking phenomenon in adolescence and the efficacy of the harm reduction model for treatment for this population group. Method: A systematic bibliographic review was performed, searching the PubMed, Ebsco, Dialnet y ScienceDirect, Redalyc, as well as documents issued by public and governmental institutions and organizations. Consider these cases that report evidence of the effectiveness of the harm reduction model in treatment for tobacco use in adolescents, from the first investigations to the year 2020. Using the following keywords: smoking, adolescence, harm reduction. Results: Of the 43 sources consulted, detect in PubMed (46%), EBSCO (11%), Dialnet (10%), ScienceDirect (7%), Redalyc (13%) and official pages (13%). Of the 13 peer-reviewed scientific articles that report evidence of the efficacy of the harm reduction model for the treatment of tobacco use in adolescents, nine conclude that this approach contributes to the treatment of adolescents who wish to stop using tobacco, while four Research affects that no changes are affected, and that this type of treatment may cause adverse effects. Conclusions: The harm reduction model as an intervention to reduce the risks of substance use, including tobacco, has shown favorable results, however, there is little research with adolescents who use tobacco that demonstrate the efficacy of said intervention.

Social class discrimination as a predictor of first cigarette use and transition to nicotine use disorder in Black and White youth.

To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking. Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth's and mother's social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates. In the adjusted first cigarette use models, neither youth's nor mother's social class discrimination was asignificant predictor among Black youth, but mother's discrimination was associated with increased risk [HR = 1.53 (1.18-1.99)] among White youth. In the adjusted ND models, mother's discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13-0.63)], but neither youth's nor mother's discrimination predicted transition to ND among White youth. The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother's discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.