Determinants of smoking behaviour among adolescents in Semarang, Indonesia.

OBJECTIVES: To determine the smoking prevalence and to examine the determinants of smoking behaviour among male adolescents in Semarang, Indonesia. DESIGN: A random sample of schools in Semarang (population 1.5 million) was obtained using a stratified sampling procedure (strata based on type of school and district). A total of 149 schools were selected (response rate 72%). Within the schools 186 classes were selected, targeting the 11, 13, 15, and 17 year olds. An anonymous, self administered questionnaire was filled in by all students present at the day of the survey (total sample size 6276). OUTCOME MEASURES: Smoking prevalence, exposure to family and peer smoking, and other variables that may be related to smoking. Logistic regression was used to examine the determinants of smoking behaviour. Only male students were included in the analysis. RESULTS: Smoking increased dramatically between the ages of 11 and 17, from 8.2% to 38.7%. The variance explained by the regression model increased from 19.8% for 11 year olds to 53% for 17 year olds. The smoking behaviour of best friends was the most powerful determinant of smoking, and this was consistent across the age groups. Best friends' attitudes towards smoking and older brothers' smoking behaviour were also important determinants of smoking. CONCLUSIONS: Smoking prevalence among male adolescents in Semarang, Indonesia is high. Effective smoking prevention programmes should take into account the dominant influence of peers in the onset and maintenance of smoking behaviour. In general, school related items had a less important role in predicting smoking behaviour than expected.     

Adolescents' responses to cigarette advertisements: links between exposure,liking, and the appeal of smoking

OBJECTIVE—To evaluate adolescents'' responses to cigarette advertisements for different brands.DESIGN—Adolescents were shown one print advertisement for each of five cigarette brands (Camel, Marlboro, Kool, Benson & Hedges, and Lucky Strike). They indicated on a structured questionnaire how many times they had seen the advertisement (or one almost like it), how much they liked it, whether or not they thought it made smoking more appealing, and whether or not it made them want to smoke cigarettes of that brand.SETTING—Middle school and high school classrooms, seven schools in four states in the United States (New York, Pennsylvania, Ohio, and Texas). The classrooms were selected randomly within each school.PARTICIPANTS—534 adolescents in grades 6-12 (ages 11-18 years) from seven schools in four states, 54% female, 76% white.RESULTS—The advertisements for Camel and Marlboro were more likely than the advertisements for the other brands to be seen, to be liked, to be viewed as making smoking appealing, and to influence adolescents to want to smoke cigarettes of that brand. More than 95% of the adolescents had seen an advertisement featuring Joe Camel or the Marlboro Man at least once, and more than 50% had seen these advertisements six or more times. Nearly half believed that the Joe Camel advertisement makes smoking more appealing, and 40% believed that the Marlboro Man advertisement makes smoking more appealing. Adolescent smokers were more likely than non-smokers to believe that the advertisements for Camel and Marlboro make smoking more appealing.CONCLUSIONS—The advertisements most popular among adolescents are for two of the brands they are most likely to smoke—Marlboro and Camel. The results of the study are consistent with the view that certain cigarette advertisements enhance the appeal of smoking to many adolescents.     

Sharing the blame: smoking experimentation and future smoking-attributable mortality due to Joe Camel and Marlboro advertising and promotions

BACKGROUND: Despite public denials, internal tobacco company documents indicate that adolescents have long been the target of cigarette advertising and promotional activities. Recent longitudinal evidence suggests that 34% of new experimentation occurs because of advertising and promotions. OBJECTIVE: To apportion responsibility for smoking experimentation and future smoking-attributable mortality among major cigarette brands attractive to young people (Camel and Marlboro). DATA SOURCES, SETTING, AND PARTICIPANTS: Data were from confirmed never-smoking adolescents (12-17 years old) responding to the 1993 (n = 2659) and 1996 (n = 2779) population-based California Tobacco Surveys. MAIN OUTCOMES: Adolescents named the brand of their favourite cigarette advertisements and tobacco promotional items. Using these "market shares" and the relative importance of advertising and promotions in encouraging smoking, we estimated how many new experimenters from 1988 to 1998 in the United States can be attributed to Camel and Marlboro. From other data on the natural history of smoking, we projected how many future deaths in the United States can be attributed to each brand. RESULTS: Although Camel advertisements were favoured more than Marlboro and other brands in 1993 and 1996, the "market share" for promotional items shifted markedly during this period from Camel and other brands towards Marlboro. We estimated that between 1988 and 1998, there will be 7.9 million new experimenters because of tobacco advertising and promotions. This will result in 4.7 million new established smokers: 2.1, 1.2, and 1.4 million due to Camel, Marlboro, and other brands' advertising and promotions, respectively. Of these, 1.2 million will eventually die from smoking-attributable diseases: 520,000 from Camel, 300,000 from Marlboro, and the remainder from other brands. CONCLUSIONS: Our analysis provides a reasonable first estimate at sharing the blame for the long-term health consequences of smoking among the major brands that encourage adolescents to start smoking.     

A prescription for health: a primary care based intervention to maintain the non-smoking status of young people

OBJECTIVES: To evaluate the effectiveness of primary health care teams in maintaining a group of young people aged 10--15 years as non-smokers. DESIGN: Randomised controlled trial using postal questionnaires. SETTING: Oxfordshire, UK. SUBJECTS: 2942 young people who were initially self declared non-smokers. INTERVENTION: Information about smoking, sent under signature of the subject's general practitioner, certificates and posters intended to reinforce non-smoking behaviour. MAIN OUTCOME MEASURES: Changes in smoking behaviour, attitudes measured after one year. RESULTS: After a year, smoking uptake was 7.8% in the control group compared with 5.1% in the intervention group (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1 to 2.2). Among boys the corresponding results were 5.2% and 2.4% (OR 2.3, 95% CI 1.2 to 4.6), and among girls 10.0% and 7.5% (OR 1.4, 95% CI 0.9 to 2.1). Among boys aged 14-15 the uptake rate was 12.8% in the control group compared with 5.4% in the intervention group. However, among girls of the same age the intervention was less effective, with smoking uptake of 15.1% in the control group and 12.8% in the intervention group. The intervention was more effective among young people whose initial attitudes identified them as definite non-smokers than those who were potential smokers. CONCLUSIONS: The intervention substantially reduced smoking uptake among the young people, particularly boys. Primary health care teams can play an important role in maintaining the non-smoking status of their young patients. Confidential postal contact from the doctor direct to the young person at home is influential and cost-effective.     

One-year predictors of smoking initiation and of continued smoking among elementary schoolchildren in multiethnic, low-income, inner-city neighbourhoods

OBJECTIVE—To identify one-year predictors of smoking initiation among never-smokers, and of continued smoking among ever-smokers.
DESIGN—Two sequential cohorts of grade 4 and 5 children. Data were collected as part of Coeur en sante St Louis du Parc, a non-randomised controlled trial to evaluate the impact of a school-based heart health promotion programme.
SETTING—24 inner-city elementary schools located in multiethnic, low-income neighbourhoods in Montreal.
SUBJECT—1824 schoolchildren aged 9-12 years with baseline and one-year follow-up data.
MAIN OUTCOME MEASURES—Changes in smoking behaviour over a year; the ability of baseline data to predict smoking initiation and continued smoking a year later was investigated in logistic regression analyses.
RESULTS—The prevalence of ever-smoking was 21.1% at baseline and 30.2% at one-year follow up. One in six never-smokers initiated smoking; one in three ever-smokers continued smoking. Predictors of initiation included age (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3 to 2.0), male gender (OR = 1.5 (95% CI = 1.1 to 2.0)), friends who smoke (OR = 2.3 (95% CI = 1.7 to 3.3)), sibling(s) who smoke (OR = 1.9 (95% CI = 1.2 to 3.1)), father/mother who smokes (OR = 2.2 (95% CI = 1.6 to 3.0)), and frequent high fat/"junk food" consumption (OR = 1.6 (95% CI = 1.1 to 2.1)). Age and friends who smoke were also independent predictors of continued smoking in both genders. In addition, in boys, current smokers at baseline were 2.6 times (95% CI = 1.4 to 5.0) more likely to continue smoking than past smokers. In girls, being overweight was associated with continued smoking (OR = 3.5 (95% CI = 1.6 to 7.6)).
CONCLUSIONS—Smoking prevention programmes should address parental and sibling influences on smoking, in addition to refusal skills training. Among girls, weight-related issues may also be important.


Keywords: children; smoking initiation predictors     

湖南烤烟主要化学成分与评吸质量的非线性关系解析

以湖南烤烟B2F、C3F和X2F等级375个样本为研究对象,运用广义可加模型较为系统地研究了烤烟主要化学成分/指标与评吸质量间的线性与非线性关系。结果表明:除部分主要化学成分/指标与烤烟评吸质量呈现较强的线性关系外,在一定含量范围内,多数主要化学成分/指标与评吸质量呈现"∩"或"∪"形抛物线关系;表征湖南烤烟评吸质量的关键化学成分/指标有糖碱比、烟碱、总氮、总糖、还原糖、氮碱比和有机钾,其适宜值分别为9、3%、2.2%、25%、22%、0.8和1.2%左右;烤烟主要化学成分/指标对香气量和刺激性的影响最大,对余味的影响最小;在钾氯比、有机钾和钾硫比这3项化学指标中,有机钾对烤烟评吸质量的总体表征效果最好,其次是钾硫比,钾氯比的总体表征效果最差。与有机钾一样,钾硫比也是1个较好的综合评价指标。     

Psychosocial factors related to adolescent smoking: a critical review of the literature

OBJECTIVE: To extend the analysis of psychosocial risk factors for smoking presented in the United States surgeon general's 1994 report on smoking and health, and to propose a theoretical frame of reference for understanding the development of smoking. DATA SOURCES: General Science Index, Medline, PsycLIT, Sociofile, Sociological Abstracts, and Smoking and Health. Holdings of the Addiction Research Foundation of Ontario Library as well as the authors' personal files. STUDY SELECTION: Reviewed literature focused on studies that examined the association of sociodemographic, environmental, behavioural, and personal variables with smoking. DATA SYNTHESIS: Adolescent smoking was associated with age, ethnicity, family structure, parental socioeconomic status, personal income, parental smoking, parental attitudes, sibling smoking, peer smoking, peer attitudes and norms, family environment, attachment to family and friends, school factors, risk behaviours, lifestyle, stress, depression/distress, self-esteem, attitudes, and health concerns. It is unclear whether adolescent smoking is related to other psychosocial variables. CONCLUSIONS: Attempts should be made to use common definitions of outcome and predictor variables. Analyses should include multivariate and bivariate models, with some attempt in the multivariate models to test specific hypotheses. Future research should be theory driven and consider the range of possible factors, such as social, personal, economic, environmental, biological, and physiological influences, that may influence smoking behaviour. The apparent inconsistencies in relationships between parental socioeconomic status and adolescent disposable income need to be resolved as does the underlying constructs for which socioeconomic status is a proxy.     

Development of smoking by birth cohort in the adult population in eastern Finland 1972-97

OBJECTIVE: To analyse the dynamics of smoking prevalence, initiation, and cessation in relation to sex, age, birth cohort, study year, and educational level. DESIGN: Six independent cross-sectional population surveys repeated every five years between 1972 and 1997. SETTING: The provinces of North Karelia and Kuopio in eastern Finland. SUBJECTS: Independent random samples of 18,088 men and 19,200 women aged 25-64 years. Those comprising the oldest birth cohort were born in 1913-17 and those in the youngest were born in 1968-72. RESULTS: Among men the prevalence of smoking decreased over time, but the cohort effect observed in smoking initiation was obscured by the changes in smoking cessation. Differences between the educational categories were small. Among women the prevalence of smoking increased during the study period. This was mainly caused by the less highly educated, in whom smoking initiation clearly increased in successive birth cohorts, but a more moderate cohort effect was also present among the more highly educated women. CONCLUSIONS: In men decreased initiation and increased cessation contributed to the downward trend in smoking prevalence, whereas among women, changes in smoking were mostly caused by augmented initiation in successive birth cohorts. During the study period educational inequalities in smoking widened, as the less highly educated came increasingly to form the smoking population.     

Nicotine replacement therapy, professional therapy, snuff use and tobacco smoking: a study of smoking cessation strategies in southern Sweden

Objectives

The strategies used to support smoking cessation among quitters were investigated according to year of smoking cessation and sociodemographic characteristics.

Methods

The 2004 public health survey in Skåne, Sweden, is a cross‐sectional study. A total of 27 757 people aged 18–80 answered a postal questionnaire. The participation rate was 59%. Different strategies to support smoking cessation—that is, no therapy, nicotine replacement (NRT), professional therapy and snus (snuff) use, were investigated among quitters according to year of smoking cessation, and demographic and socioeconomic characteristics.

Results

14.9% of the men and 18.1% of the women were daily smokers. The prevalence of daily snus use was 19.5% among men but only 2.3% among women. Stratifying the data according to year of smoking cessation (1938–2004) revealed a significant increase in active smoking cessation strategies such as NRT, professional therapy and snus use. NRT was more common among women (23.6%) than men (14.8%) among smokers who quit in 2000–4, but snus use was more common among men (30.4% versus 8.7%). No replacement or other therapy at all was significantly more common among women (63.6%) than men (52.1%). People aged 35–80 years used more nicotine replacement than people aged 18–34, while men aged 18–34 used snus to quit smoking significantly more than men aged 55–80.

Conclusions

Snus is used commonly among men as a support for smoking cessation in Sweden. Women use pharmacological NRT to a greater extent, but this can probably not compensate for the much higher extent of snuff use as a cessation strategy among men.     

Features of sales promotion in cigarette magazine advertisements, 1980-1993: an analysis of youth exposure in the United States

OBJECTIVE: To examine the presence of features of sales promotion in cigarette advertising in United States magazines, and to describe trends in youth (ages 12-17) exposure to such advertising (termed "promotional advertising"). DESIGN: Analysis of 1980-1993 annual data on: (a) total pages and expenditures for "promotional advertising" (advertising that contains features of sales promotion) in 36 popular magazines (all magazines for which data were available), by cigarette brand; and (b) readership characteristics for each magazine. We defined promotional advertising as advertisements that go beyond the simple advertising of the product and its features to include one or more features of sales promotion, such as coupons, "retail value added" promotions, contests, sweepstakes, catalogues, specialty item distribution, and sponsorship of public entertainment or sporting events. MAIN OUTCOME MEASURES: Total pages of, and expenditures for promotional advertising in magazines; and gross impressions (number of readers multiplied by the number of pages of promotional advertising) among youth and total readership. RESULTS: During the period 1980-1993, tobacco companies spent $90.2 million on promotional advertising in the 36 magazines. The proportion of promotional advertising appearing in "youth" magazines (defined as magazines with a greater than average proportion of youth readers) increased from 7% in 1980 to nearly 100% in 1987. Although youth readers represented only 19% of magazine readers, the proportion of youth gross impressions to total gross impressions of tobacco promotional advertising exceeded this value throughout the entire period 1985-1993, peaking at 33% in 1987. The five "youth" cigarette brands (defined as brands smoked by at least 2.5% of smokers aged 10-15 years in 1993) accounted for 59% of promotional advertising in all magazines, but for 83% of promotional advertising in youth magazines during the study period. CONCLUSIONS: In their magazine advertising, cigarette companies are preferentially exposing young people to advertisements that contain sales promotional features.     

单料烤烟主流烟气中主要酚类化合物及其与感官质量相关性分析

考察了云南部分烟叶产地、部位和品种对主流烟气中主要酚类化合物含量的影响及与感官质量之间的相关关系,结果表明:主流烟气中的主要酚类化合物包括对苯二酚、间苯二酚、邻苯二酚、苯酚、间甲酚、对甲酚和邻甲酚,这7种酚类化合物的含量受烟叶的产地、部位和品种的影响较大,变异系数均大于15%,最高达到80%,其中着生部位的影响最大,最大变异系数达到63.5%;在主流烟气中这7种酚类化合物的含量间呈现复杂的关系,均表现为极显著的正相关.通过因子分析发现,主流烟气中这7种酚类化合物的含量与感官质量部分指标间也有较为明显的相关性,随着综合得分的增加,劲头和烟气浓度的感官得分均增加,而刺激性和湿润程度得分显著减少,香型偏向浓香型,对香气、杂气和余味影响较小.     

Favourite movie stars, their tobacco use in contemporary movies, and its association with adolescent smoking

OBJECTIVE: To assess the relation between adolescents' favourite movie stars, the portrayal of tobacco use by those stars in contemporary motion pictures, and adolescent smoking. DESIGN AND SETTING: 632 students (sixth to 12th grade, ages 10-19 years) from five rural New England public schools completed a voluntary, self administered survey in October 1996. The survey assessed tobacco use, other variables associated with adolescent smoking, and favourite movie star. In addition, tobacco use by 43 selected movie stars was measured in films between 1994 and 1996. OUTCOME MEASURES: Students were categorised into an ordinal five point index (tobacco status) based on their smoking behaviour and their smoking susceptibility: non-susceptible never smokers, susceptible never smokers, non-current experimenters, current experimenters, and smokers. We determined the adjusted cumulative odds of having advanced smoking status based on the amount of on-screen tobacco use by their favourite film star. RESULTS: Of the 43 stars, 65% used tobacco at least once, and 42% portrayed smoking as an essential character trait in one or more films. Stars who smoked more than twice in a film were considered smokers. For adolescents whose favourite stars smoked in only one film, the odds of being higher on the smoking index was 0.78 (95% confidence interval (CI) 0.53 to 1.15). For adolescents whose favourite stars smoked in two films, the odds of being higher on the smoking index was 1.5 (95% CI 1.01 to 2.32). For adolescents whose favourite stars smoked in three or more films (Leonardo DiCaprio, Sharon Stone, John Travolta), the odds of being higher on the smoking index was 3.1 (95% CI 1.34 to 7.12). Among never smokers (n = 281), those who chose stars who were smokers in three or more films were much more likely to have favourable attitudes toward smoking (adjusted odds ratio 16.2, 95% CI 2.3 to 112). CONCLUSIONS: Adolescents who choose movie stars who use tobacco on-screen are significantly more likely to have an advanced smoking status and more favourable attitudes toward smoking than adolescents who choose non-smoking stars. This finding supports the proposition that the portrayal of tobacco use in contemporary motion pictures, particularly by stars who are admired by adolescents, contributes to adolescent smoking.     

A longitudinal study of smoking in year 7 and 8 students speaking English or a language other than English at home in Sydney, Australia

OBJECTIVE—To compare the rates and predictors of smoking uptake between adolescents speaking English and those speaking a language other than English (LOTE) at home.
DESIGN—A cross-sectional survey of year 7 and 8 students (aged 12 and 13 years) was conducted in 1994 and repeated 12 months later. A cohort of students was identified with respondents at baseline matched at follow up. χ² and logistic regression were used for analysis.
SETTING—38 schools in southern, east, and northern Sydney, Australia.
SUBJECTS—Year 7 and 8 students in the schools were included and examined on two occasions, with complete data for 5947 (80%) students at baseline and 6177 (98%) students at a 12-month follow up. Records were able to be matched perfectly for 3513 respondents (59%).
MAIN OUTCOME MEASURES—Smoking rates and predictors of smoking uptake among students speaking English or a LOTE at home.
RESULTS—At baseline, 6.1% of students surveyed were smokers. Twelve months later, 15.8% of student surveyed were smokers. There were significantly lower smoking rates among students speaking a LOTE at home compared with those speaking English at home at baseline and at 12 months. Using matched data, for students speaking English at home, five variables were significant predictors of smoking uptake: thinking it acceptable to smoke, perceived benefits of smoking, and having a brother, sister, or close friend who smokes. For students speaking a LOTE, the only predictor was the smoking status of close friends.
CONCLUSIONS—Despite the higher smoking prevalence among men with a non-English-speaking background, and the reported strong association between fathers' smoking status and smoking onset of their children, adolescents speaking a LOTE at home were significantly less likely to be smokers than their English-speaking counterparts. Thus, there would seem to be a delay of smoking onset among students speaking a LOTE at home. The smoking rates among respondents speaking a LOTE at home in this study are lower than those obtained from the studies conducted in Europe and the United States. Effective smoking prevention interventions need to be implemented at an early stage of adolescence.


Keywords: cigarette smoking; adolescents; ethnicity     

The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies.

The present study examined the relationship between recent smoking cessation activities and sociodemographic characteristics, smoking intensity, and tobacco control policies among daily smokers in the United States. The study used the U.S. Current Population Survey 1998-1999 Tobacco Use Supplement, supplemented with information on state-level tobacco control policies. The sample was limited to individuals aged 25 years or older who were smoking daily 1 year ago. We estimated frequencies and multivariate logistic equations for making a quit attempt and remaining abstinent at least 3 months. These measures were related to demographic characteristics, smoking intensity, and tobacco control policies. Younger, higher socioeconomic status (SES), and less intense (fewer cigarettes per day) daily smokers were more likely to make quit attempts, but the likelihood of remaining abstinent for those making a quit attempt was greater for older, higher SES, and heavy daily smokers. We found evidence that cessation behaviors were related to higher cigarette prices and the presence of state-level media/comprehensive campaigns, but less clear evidence exists for an association with bans restricting workplace smoking. The results indicate that certain types of smokers are more likely to attempt to quit and to have success and that the characteristics of these smokers differ. Price policies can have an important role in helping daily smokers to quit. Further research is needed regarding the role of quantity smoked.     

Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA

OBJECTIVE: To describe the extent to which comprehensive statewide tobacco control programmes in the USA have made progress toward reducing teenage smoking. DATA SOURCES: Literature search of Medline for reviews of effectiveness of programme and policy elements, plus journal articles and personal request for copies of publicly released reports and working papers from evaluation staff in each of the state programmes of California, Massachusetts, Arizona, Oregon, and Florida. STUDY SELECTION: All studies, reports, and commentaries that provided information on aspects of programme implementation and evaluation. DATA SYNTHESIS: Statewide comprehensive programmes show high levels of advertising recall and generally positive improvement in smoking related beliefs and attitudes among teenagers. More fully funded programmes lead to increased mass media campaign advertising and community initiatives; a greater capacity to implement school based smoking prevention programmes; and an increase in the passage of local ordinances that create smoke free indoor environments and reduce cigarette sales to youth. The combination of programme activity and increased tobacco tax reduce cigarette consumption more than expected as a result of price increases alone, and these effects seem to apply to adolescents as well as adults. Programmes are associated with a decline in adult smoking prevalence, with these effects observed to date in California, Massachusetts, and Oregon. Arizona and Florida have yet to examine change in adult prevalence associated with programme exposure. California and Massachusetts have demonstrated relative beneficial effects in teenage smoking prevalence, and Florida has reported promising indications of reduced prevalence. Arizona has yet to report follow up data, and Oregon has found no change in teenage smoking, but has only two years of follow up available. One of the most critical factors in programme success is the extent of programme funding, and consequent level of programme implementation, and the degree to which this is undermined by the tobacco industry and other competitors for funding. CONCLUSIONS: Despite the different strengths and combinations of programme messages and strategies used in these comprehensive programmes, there is evidence that they lead to change in factors that influence teenage smoking, and to reductions in teenage smoking.     

Measuring environmental tobacco smoke exposure in infants and young children through urine cotinine and memory-based parental reports: empirical findings and discussion

OBJECTIVE: This study examined the reliability and potential biases of two urine collection methods from which cotinine measures were obtained and the validity of memory-based parental reports of their children's exposure to environmental tobacco smoke (ETS). DESIGN: Structured interviews were conducted with mothers of infants and young children to obtain memory-based estimates of recent ETS exposure. Urine samples were collected through standard and cotton roll collection methods for cotinine analysis. SETTING: All interviews took place at an off-campus research facility. Urine samples were collected at the study office or the subjects' homes. PARTICIPANTS: Mothers were recruited from San Diego county sites of the Women, Infants, and Children (WIC) Supplemental Food and Nutrition Program. Sample 1 (infants) consisted of eight boys and eight girls aged 1-44 months (mean = 12.6 months). Sample 2 (children) included 10 boys and 10 girls aged 3-8 years (mean = 61.2 months). MAIN OUTCOME MEASURES: Urine cotinine and memory-based parent reports of ETS exposure from structured interviews. RESULTS: There was overall high reliability for urine cotinine measures and no effect of collection method on urine cotinine levels. Memory-based reports obtained from smoking mothers showed moderately strong and consistent linear relationships with urine cotinine measures of their infants and children (r = 0.50 to r = 0.63), but not for reports obtained from non-smoking mothers. CONCLUSIONS: Memory-based parental reports of short-term ETS exposure can play an important role in quantifying ETS exposure in infants and children.     

Sex and race differences in young people's responsiveness to price and tobacco control policies

OBJECTIVE: To determine if there are differences in young people's responsiveness to price and tobacco control policies for population subgroups and to examine whether or not these differences, if they exist, can explain sex and racial differences in trends in the prevalence of smoking in young people in the United States. DESIGN: Use cross-sectional and intertemporal variation in local and state tobacco control policies and prices to calculate demand responses to these policies using regression analysis techniques. SUBJECTS: A nationally representative sample of American eighth grade (ages 13-14 years), 10th grade (15-16 years) and 12th grade (17-18 years) students obtained from the 1992-1994 Monitoring the Future surveys. MAIN OUTCOME MEASURE: Thirty-day smoking prevalence. RESULTS: Young men are much more responsive to changes in the price of cigarettes than young women. The prevalence elasticity for young men is almost twice as large as that for young women. Smoking rates of young black men are significantly more responsive to changes in price than young white men. Significant differences in responsiveness to particular tobacco control policies also exist. These differences, however, explain relatively little of the differences in smoking prevalence among young population subgroups. CONCLUSIONS: Policymakers need to keep in mind that there is not a "one-size fits all" strategy for discouraging smoking among young people.     

Role of snus in initiation and cessation of tobacco smoking in Sweden

Objective

To examine patterns of smoking and snus use and identify individual pathways of Swedish tobacco users in order to clarify whether snus use is associated with increased or decreased smoking.

Methods

Retrospective analysis of data from a cross‐sectional survey completed by 6752 adult Swedes in 2001–2 focusing on identifying tobacco use history by survey items on current and prior tobacco use and smoking initiation and cessation procedures.

Results

15% of the men and 19% of the women completing the survey were daily smokers. 21% of the men and 2% of the women were daily snus users. Almost all (91%) male daily smoking began before the age of 23 years, whereas initiation of daily snus use continued throughout the age range (33% of initiation after age 22). 20% of male primary snus users started daily smoking compared to 47% of non‐primary snus users. Thus, the odds of initiating daily smoking were significantly lower for men who had started using snus than for those who had not (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.22 to 0.36). Among male primary smokers, 28% started secondary daily snus use and 73% did not. 88% of those secondary snus users had ceased daily smoking completely by the time of the survey as compared with 56% of those primary daily smokers who never became daily snus users (OR 5.7, 95% CI 4.9 to 8.1). Among men who made attempts to quit smoking, snus was the most commonly used cessation aid, being used by 24% on their latest quit attempt. Of those men who had used one single cessation aid 58% had used snus, as compared with 38% for all nicotine replacement therapy products together. Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum.

Conclusion

Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking.