Adolescents' smoking expectancies: psychometric properties and prediction of behavior change.

Outcome expectancies have been related to smoking behavior among adults, but less attention has been given to expectancies about smoking among adolescents at differing levels of smoking experience. The present study reports the psychometric properties and predictive validity of a brief expectancy scale across two samples of adolescents. Sample 1 (N = 349) consisted of high school students (54% female) who were regular smokers enrolled in a cessation program. Sample 2 (N = 273) consisted of 8th- and 10th-grade early experimenters (54% female) involved in a natural history study of smoking trajectories. In both samples, a principal component analysis of a 13-item expectancy scale yielded four factors (taste, weight control, boredom relief, and negative affect management), each with high internal consistency (coefficient alphas >.77) and accounting for 73% and 80% of the total variance for each sample, respectively. Expectancies were significantly higher among current smokers than among early initiators. In Sample 1, boredom relief and weight management expectancies predicted smoking status 6 months later. In Sample 2, students whose smoking increased over 18 months had higher overall expectancies at baseline compared with those who tried smoking and did not escalate. These findings support the predictive validity of expectancies in predicting escalation and cessation. Implications for the importance of expectancies in understanding adolescent smoking behavior are considered.     

Adolescent smoking trajectories and nicotine dependence.

The present study correlates empirically constructed prospective adolescent smoking trajectories with indicators of nicotine dependence assessed in adolescence and in adulthood. Excluding individuals who reported no smoking during repeat assessment (nonadopters), we identified five smoking trajectory groups: experimenters (n=116, 48.5%), late increasers (n=39, 16.3%), early increasers (n=37, 15.5%), quitters (n=22, 9.2%), and persistent smokers (n=25, 10.5%). Higher frequency of nicotine dependence symptoms in adolescence occurred in the quitters and persistent smokers groups, who smoked at higher levels relative to the experimenters, late increasers, and early increasers groups, who reported a similar frequency of nicotine dependence symptoms and smoked at low levels. Lifetime nicotine dependence was assessed in adulthood in lifetime daily smokers using the Fagerstr?m Test for Nicotine Dependence (FTND) and the Nicotine Dependence Scale (NDS). Lifetime FTND levels were similar across trajectory groups. Relative to experimenters, all remaining smoking trajectory groups had higher NDS levels that were similar to one another. These results suggest that higher levels of adolescent nicotine dependence were associated with heavier smoking trajectory groups, and that regardless of trajectory group membership, smoking more than a few cigarettes per week throughout adolescence resulted in similar levels of lifetime nicotine dependence as measured by the FTND and NDS.     

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation

Objective

To determine the effect of magazine incidental smoking imagery on youths'' smoking intentions.

Methods

A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non‐smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non‐smokers aged 14–17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions.

Results

Smokers made more unprompted mention of smoking imagery than non‐smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non‐smokers who viewed Smoking Magazine were more likely than those who viewed Non‐smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non‐smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non‐smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non‐smoking females (46% vs 46%). Male smokers and non‐smokers did not differ in their responses by magazine type.

Conclusions

Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.With a view to reducing tobacco related harm, a number of countries around the world have implemented comprehensive advertising and sponsorship bans of tobacco in accordance with the World Health Organization''s Framework Convention on Tobacco Control (FCTC). Even with comprehensive tobacco control legislation, loopholes remain that can be exploited by the tobacco industry to circumvent comprehensive advertising restrictions. For example, product placements in movies and television programmes popular with adolescents are a noted tactic of the tobacco industry.¹ Furthermore, incidental depictions of tobacco in popular media, although not necessarily instigated by the tobacco industry, can serve to counter restrictions on advertising. Smoking depictions within youth oriented advertisements for non‐tobacco products are common, being used as a device by advertisers to focus on the lifestyle and image of the user, rather than on the intrinsic value or merits of the product itself.² Incidental images of smoking are also common in editorial and feature components of youth oriented entertainment media, including movies, television, magazines and the internet. Although social determinants such as having parents, older siblings and peers who smoke are the best predictors of smoking initiation in youth,³ portrayals of smoking in popular media appear to contribute by presenting socially attractive images and inflating the perception of smoking prevalence.^2,4,5Studies consistently suggest that incidental smoking is depicted far more commonly than is normal within the actual population, and that the majority of depictions are associated with popular and desirable role models with positive attributes such as fame, attractiveness, sexiness, sophistication and glamour.^6,7,8 For instance an analysis of popular Hollywood movies in the late 1990s suggested that one in two heroes smoke, including 80% of leading male characters.⁸ In the early 1990s an audit of Australian youth oriented magazines suggested that photographs featuring smoking were “infrequent” (one depiction per 147 pages). An increase of 12% in smoking depictions was noted between 1990 and 1993 in the period after the introduction of the complete tobacco advertising ban but, as this increase was non‐significant, natural variation could not be discounted.⁹ However, a similar audit of magazines conducted a decade later suggested that far from being infrequent, depictions of smoking were commonplace: 96% of a sample of youth oriented magazines included at least one depiction of incidental smoking (average 3.5 per magazine; one per 50.3 pages), with 97% of these depictions being favourable.¹⁰ Although the methodologies differed between the two studies, it appears that the tobacco advertising ban in Australia was followed by an increase rather than decrease in prevalence of smoking portrayals in magazines.There is clear evidence that exposure to positive portrayals of smoking in movies and on television increases adolescents'' positive attitudes towards smoking, the likelihood of smoking initiation, and imitation of modelled smoking actions.^11,12 However, research investigating the impact of incidental portrayals of tobacco use in magazines is sparse. Amos and colleagues¹³ assessed adolescents'' perceptions of photographs of models using tobacco products and compared these to adolescents'' perceptions of identical photographs but with the tobacco paraphernalia digitally removed. They found that the presence of a cigarette affected how the model in a photograph was perceived: when tobacco products were present, models were associated with “drug taking,” “wildness” and being “depressed,” and to a lesser extent being “vain,” “tarty” and “posers.” Without the smoking paraphernalia the same models were perceived as being more “healthy,” “rich,” “nice,” “fashionable,” “slim” and “attractive.” Although traits such as “druggy,” “wild” and “tarty” may appear to be negative associations, smokers sampled in the study were found to be more drawn to such traits than non‐smokers, and were found to rate themselves less negatively in terms of these traits than non‐smokers. The authors concluded that although young smokers and non‐smokers associated the same attributes to the smoking models, smokers identified more strongly with these attributes than did non‐smokers, and hence the smoking imagery served to positively reinforce the self identity of young smokers. In a later complementary study,¹⁴ Amos and her colleagues conducted focus groups with young smokers and found that smoking imagery in magazines helped reinforce positive perceptions of smoking as attractive, sociable and reassuring thereby reinforcing young smokers'' own identities. Furthermore the lack of obvious vested interests in incidental smoking portrayals meant that such were potentially more powerful than tobacco advertising imagery.The present study aims to extend the studies of Amos and colleagues by using a randomised controlled trial to assess the impact of smoking images in magazines on smoking and non‐smoking youth, and particularly their intentions for future smoking. We hypothesised that positive smoking imagery in a youth oriented magazine would:

• lessen young smokers'' future intentions to quit;
• increase non‐smokers'' future intentions to take up smoking;
• increase young people''s perceptions of the prevalence of smoking;
• increase young smokers'' urge to smoke while reading the magazine; and
• increase young smokers'' positive perceptions of the depicted models but decrease young non‐smokers'' positive perceptions of the depicted models.

     

Gabapentin for smoking cessation: a preliminary investigation of efficacy.

Gabapentin affects the glutamate and gamma amino butyric acid (GABA) neurotransmitters through which it may facilitate smoking abstinence. To obtain preliminary estimates of efficacy of gabapentin for smoking cessation, we conducted a single-arm, open-label study of gabapentin, 1,800-mg/day administered in three equal divided doses for 8 weeks. A total of 50 adult smokers were enrolled. All participants received a brief behavioral intervention at each medication visit. A total of 37 participants completed all follow-up assessments. At end-of-treatment the biochemically confirmed point-prevalence and prolonged smoking abstinence rates were 28% (95% CI=16%-42%) and 24% (95% CI=13%-38%), respectively. At 6 months, the biochemically confirmed point-prevalence and prolonged smoking abstinence rates were 20% (95% CI=10%-34%) and 16% (95% CI=7%-29%), respectively. Among subjects who continued to smoke and completed the follow-up assessments, the reported number of cigarettes smoked per day (mean+/-standard deviation) was significantly less than at baseline: -10.0+/-8.2 (p<.001). Adverse effects were minor and well tolerated. Our results suggest that gabapentin may increase smoking abstinence. An adequately powered randomized clinical trial assessing different doses of this drug against a placebo would be the reasonable next step.     

Influences affecting adolescent smoking behavior in China.

This study examined multiple influences on the use of tobacco by adolescents in China. Using the theory of triadic influences as a guide, we selected interpersonal, attitudinal/cultural, and intrapersonal constructs from baseline data to predict adolescent smoking 1 year later. We used prospective data from middle and high school students (N = 11,583) and their parents from the China Seven Cities Study, a longitudinal study that is evaluating the effects of changing economic and social factors on health behaviors including tobacco use. A multilevel regression analysis provided some support that each of the influences in the theory of triadic influences affects adolescent smoking in China. After adjusting for important confounders including age, gender, socioeconomic status, and smoking behaviors (lifetime and past 30-day) at baseline, we found significant risk factors within each of the three categories, including interpersonal influences (parental monitoring, good friend smoking, and peer smoking), attitudinal/cultural influences (school academic ranking, initial liking of smoking, and the meaning of smoking), and intrapersonal influences (susceptibility to smoking, and low self-confidence to quit smoking). Results suggest that the etiology of smoking among adolescents in China might be similar to that observed in western countries and that some of the techniques used successfully in prevention programs in those countries might be useful guides when developing prevention programs in China.     

Western media's influence on Egyptian adolescents' smoking behavior: the mediating role of positive beliefs about smoking.

Western media has been implicated as an adolescent smoking risk factor in numerous Western studies, but little research has investigated that influence on adolescents from developing Arab countries. One such country is Egypt, which has the highest rate of smoking in the Arab world. An estimated 34% of Egyptians are daily smokers, 4% of whom are under the age 15 years and 0.6% of whom are under the age 10. The present study investigated the association between exposure and receptivity to Western media, positive beliefs about smoking, and Egyptian adolescents' smoking behavior. A school-based cross-sectional survey of 1,930 Egyptian adolescents in 7th, 9th, and 12th grades, from randomly selected schools in Alexandria, Egypt, was conducted in May 2003. Self-reported smoking behaviors, demographics, psychosocial factors, and exposure to Western and pro-tobacco media were assessed. Controlling for demographics, psychosocial smoking risk factors, and pro-tobacco media exposure, we found that Western media exposure was positively associated with ever-smoking across genders and 30-day smoking among adolescent males only. Positive beliefs about smoking partially mediated this association among ever-smokers and completely mediated it among 30-day male smokers. The results indicate that the influence of Western media on Egyptian adolescents' smoking behavior is at least partially mediated by its influence in increasing adolescents' positive beliefs about smoking and consequently their smoking behavior. Regulation of the glamorization of smoking behavior in Western media and correction of the erroneous perception of positive beliefs about smoking among adolescents is necessary to help curb the rising smoking epidemic in Egypt.     

吸烟行为的动因分析

吸烟是一种理性成瘾行为。从个人角度看,促使其吸烟的现实动因是追求生理快感、调节心理情绪、密切社会交往、增添生活乐趣和实现自我认可。从群体角度看,促使人类吸烟的历史动因主要是航行和人口迁移导致全球扩散,药用和“烟疗百疾”引发使用流行,战争和社会动荡刺激消费增长,贸易和技术变革推动供给创新,文化和艺术关联提升精神影响。吸烟行为具有历史合理性,烟草控制具有价值正当性,以史为鉴,对待烟草问题应避免落入“塔西陀陷阱”,防止良好动机和控烟政策难以落地。      

The genetic basis for smoking behavior: a systematic review and meta-analysis.

Considerable evidence indicates that smoking behavior is under a degree of genetic influence. We conducted a systematic review of candidate gene studies of smoking behavior and, where sufficient studies existed, combined reported data using meta-analytic techniques. A total of 41 studies were identified by the search strategy, of which 28 contributed to the meta-analysis. The meta-analysis included data on the DRD2, DAT, 5HTT, and CYP2A6 genes and smoking behavior. Categorical data were extracted on smoking status (never-smoker, ex-smoker, current smoker). Continuous data were extracted on number of cigarettes smoked per day. Evidence indicated effects of the DRD2 Taq1A polymorphism and smoking initiation, the 5HTT LPR and CYP2A6 reduced-activity polymorphisms and smoking cessation, and the DRD2 Taq1A and CYP2A6 reduced-activity polymorphisms and cigarette consumption. The evidence for an effect of specific genes was modest, however, and evidence indicated substantial between-study heterogeneity in most cases, with the exception of the effects of the 5HTT and CYP2A6 genes on smoking cessation. When a random-effects model was applied to analyses in which evidence indicated significant heterogeneity, the effects were in all cases no longer statistically significant. The evidence for a contribution of specific genes to smoking behavior remains modest. Implications for the design of future studies are discussed, such as the need for the development of more specific phenotypes to increase the genetic signal in candidate gene studies.     

Association of post-treatment smoking change with future smoking and cessation efforts among adolescents with psychiatric comorbidity.

Little is known about how initial change following a smoking intervention relates to longer-term smoking outcomes among adolescent smokers with psychiatric comorbidity. The present study investigated this relationship among psychiatrically hospitalized adolescents (N = 183) who participated in a controlled trial comparing motivational interviewing to brief advice. Quit attempters (n = 37), reducers (n = 45), and maintainers (n = 101) were assembled based on, respectively, having made a quit attempt, having reduced smoking by at least 50%, and having reduced smoking by less than 50% in the first week after hospital discharge. Hierarchical linear models and generalized estimating equations were conducted to test group differences in average number of cigarettes per smoking day and odds of making a quit attempt during subsequent weeks of a 12-month continuous follow-up, and in cotinine-verified abstinence rates at 1, 6, and 12 months posthospitalization. Baseline smoking levels and presence of a substance use disorder or anxiety disorder were predictive of outcomes. After controlling for covariates, we found that quit attempters smoked less during follow-up than did the other change groups and that reducers smoked less than maintainers. Quit attempters evidenced a higher percentage of quit attempts during follow-up than did the other change groups. Reducers had a greater average percentage of quit attempts during follow-up than did maintainers. However, groups did not differ on cotinine-verified abstinence rates across the follow-up period. Findings have implications for initial post-treatment change as it relates to subsequent smoking and cessation outcomes among adolescent smokers at especially high risk for smoking persistence.     

Prevalence and predictors of smoking behavior among Vietnamese men living in California.

Vietnamese populations in Vietnam and the United States have a high prevalence of smoking. The associations among behavioral risk factors, acculturation, and smoking among the Vietnamese population living in the United States are not well documented. The present study aimed to identify the factors associated with smoking behavior among Vietnamese men living in Santa Clara County, California. A cross-sectional random-digit-dialed telephone survey was conducted. The sampling frame consisted of 27 Vietnamese surnames from the Santa Clara County telephone directory. A total of 660 adult respondents were interviewed to collect information on general health status, alcohol and tobacco use, HIV/AIDS, sexual behavior, injury control, hypertension, cholesterol screening, and acculturation. Of the 660 adults interviewed, 364 (55.2%) were male and 296 (44.8%) were female. Among males, 31.9% were current smokers, and among females, only one woman reported smoking. Univariate analyses revealed that having less than a college education, having poor English language skills, using Vietnamese at home and with friends, being less acculturated, not having a routine physical or blood cholesterol check, and being a binge drinker were significantly associated with an increased likelihood of smoking. Multivariate analysis revealed two independently associated factors: Respondents who were more acculturated were less likely to smoke (OR = 0.38, 95% CI = 0.18-0.83), and those not having cholesterol checked were more likely to smoke (OR = 2.48, 95% CI = 1.30-4.71). Acculturation level was inversely associated with smoking among Vietnamese adult men in Santa Clara County. Other health risk behaviors coexisted with smoking behavior and should be considered in prevention programs.     

Waterpipe tobacco smoking: knowledge, attitudes, beliefs, and behavior in two U.S. samples.

Despite evidence of increasing waterpipe tobacco smoking prevalence among U.S. young adults, little is known about the knowledge, attitudes, beliefs, and smoking patterns of waterpipe users in this population. To address this lack of knowledge, two convenience samples of U.S. waterpipe users were surveyed--one from a Richmond, Virginia, waterpipe café (n=101), the other from an Internet forum called HookahForum.com (n=100). Sixty percent reported first-time waterpipe use at or before age 18. Daily waterpipe use was reported by 19%, weekly use by 41%, and monthly use by 29%. Waterpipe use was more common during the weekend (75%) than during weekdays (43%). Forty-four percent reported spending >or=60 min smoking tobacco during a waterpipe session. The majority of waterpipe users owned a waterpipe (57%) and purchased it on the Internet (71%). Many waterpipe users smoked the sweetened and flavored tobacco (i.e., maassel), and fruit flavors were the most popular (54%). Past month use of cigarettes, tobacco products other than cigarettes or waterpipe, and alcohol was 54%, 33%, and 80% respectively, and 36% reported past-month marijuana use. Most waterpipe users were confident about their ability to quit (96%), but only a minority (32%) intended to quit. Most waterpipe users believed waterpipe tobacco smoking was less harmful and addictive than cigarettes. These results are from small convenience samples; more detailed study of a larger group of randomly sampled U.S. waterpipe tobacco smokers will be valuable in understanding this behavior and developing effective strategies to prevent it.     

广东卷烟消费者吸烟行为分析

通过对广东地区卷烟消费者自然状态下吸烟行为的街头调查,分析其吸烟行为特点。结果显示,广东地区消费者的吸烟行为具有以下规律性:(1)消费者抽吸卷烟时,极少出现滤嘴通风孔被完全封闭的情形,而通风孔50%封闭的情形也不足34%。(2)局促环境下广东消费者单支烟的吸入烟气总量,会远高于其放松状态下的烟气吸入量。(3)街头调查结果验证了访谈调查数据可在一定程度上反映消费者的吸烟行为。(4)广东省内卷烟消费者的吸烟行为表现为“快(高抽吸频率)且浅(低抽吸容量)”,其单支烟吸入烟气总量远远低于欧美消费者的。(5)马萨诸塞方法设定的机器抽吸卷烟条件与广东地区卷烟消费者的习惯性吸烟行为最为接近,而WHO官方方法则显著高估广东消费者烟气吸入量的平均水平。      

Cotinine levels in relation to smoking behavior and addiction in young adolescent smokers.

The goal of this study was to identify associations among self-reported nicotine exposure, nicotine addiction, and actual nicotine intake as measured by salivary cotinine levels in adolescent smokers. A total of 170 adolescent smokers with a mean age of 15 years were recruited from seven northern Californian public high schools. Data were collected on smoking behaviors, addiction, craving, and withdrawal. Nicotine dependence was assessed using a modified teen Fagerstr?m Tolerance Questionnaire (mtFTQ), a modified Nicotine Dependence Syndrome Scale (mNDSS), and a simple self-rating. Withdrawal was assessed using the Minnesota Withdrawal Questionnaire, and craving was assessed using a survey created by the authors. Salivary cotinine levels were collected from and analysed in participants who self-identified as smokers; data from the 54 participants who smoked in the past 4 days and whose salivary cotinine levels were greater than 0.1 ng/ml were used in the analysis. Among this group of adolescent smokers, the mean number of cigarettes smoked per day was 3.51 (SD = 3.44) and the mean level of salivary cotinine was 44.1 ng/ml (Mdn = 24.2). Even at this low level of nicotine exposure, cotinine was highly correlated with measures of nicotine dependence such as the mtFTQ (r = 0.497, p = .001), NDSS (r = 0.439, p = .002), timing of craving in the morning (r = -0.601, p = .000), and self-rated addiction (r = 0.562, p = .000). Most interesting, cotinine levels reached a plateau at around 4-5 cigarettes/day.     

Adolescent to emerging adulthood smoking trajectories: when do smoking trajectories diverge, and do they predict early adulthood nicotine dependence?

This study evaluated the adolescent tobacco-use trajectories that predict nicotine dependence in early adulthood and when these trajectories start to diverge. As part of a follow-up to a large prevention trial, the present study evaluated 1,017 individuals from early adolescence (age 12) to early adulthood (age 28). Participants were recruited from eight middle schools in Kansas City, Missouri. Students were entering 6th grade or 7th grade at baseline. Smoking was evaluated at baseline, 6 months, at annual follow-ups through high school, and every 18 months thereafter until age 28. The study goals were to determine (a) whether distinct weekly tobacco-use trajectories could be identified between early adolescence and emerging adulthood (ages 12-24); (b) when during development these trajectories diverged; and (c) which trajectories could predict nicotine dependence in early adulthood (ages 26-28). A four-trajectory mixed model (abstainers, low users, late stable users, and early stable users) demonstrated the best fit to the data. Membership in increasingly high-use trajectories placed participants at greater relative risk for becoming nicotine dependent than did membership in lower-use trajectories. General linear models showed greater weekly cigarette consumption for early stable users as early as the first wave of data collection (age 12) and significant differences among all other trajectories by age 15. The findings support the implementation of smoking prevention programs early in middle or junior high school and suggest that adolescents who are already smoking at least two cigarettes per week by age 12 may benefit from additional addiction prevention efforts.     

Development and validation of an adolescent smoking consequences questionnaire.

Several researchers have investigated the role of outcome expectancies in the initiation and maintenance of smoking behavior. Empirical studies with adults, using a validated self-report instrument, have shown that smokers identify higher levels of positive smoking expectancies and lower levels of negative smoking expectancies compared with nonsmokers and ex-smokers. Studies examining smoking outcome expectancies among adolescents have yielded similar findings, but many of these studies did not use a self-report expectancy measure validated with teens. Therefore, the present study sought to modify a well-known adult smoking expectancy instrument, the Smoking Consequences Questionnaire (SCQ), and to validate its factor structure with a community sample of adolescent nonsmokers and current smokers (aged 11-19 years). Results of a confirmatory factor analysis provided support for a seven-latent-factor structure modeled after the SCQ-Adult. As expected, smoking behavior and the intent to smoke in the future were associated with the endorsement of positive and negative smoking outcome expectancies. The psychometric data provide early support for the validity and reliability of this modified SCQ, renamed the Adolescent Smoking Consequences Questionnaire, for the assessment of smoking expectancies among smoking inexperienced and experienced teens.