Contextual consistency and adolescent smoking: testing the indirect effect of home indoor smoking restrictions on adolescent smoking through peer smoking.

The present study tested the indirect effect of home indoor smoking restrictions on adolescent smoking through peer smoking. Based on a bioecological perspective of development, we hypothesized that forbidding indoor smoking would reduce the likelihood of adolescent smoking by decreasing exposure to peer smoking, even when adolescents live with at least one household member who smokes. Participants were 163 adolescents (mean age = 16 years) from a suburban southeastern Pennsylvania community. Participants completed a self-report survey evaluating home indoor smoking restrictions, smoking behavior, peer smoking, alcohol use, and demographics. Structural equation modeling indicated that forbidding smoking indoors was associated with having fewer peers who smoke, which was associated with a lower level of smoking. The indirect effect was significant (beta = -.569, 95% CI -.90 to -.24), offering some preliminary ideas about why home indoor smoking restrictions reduce the risk of adolescent smoking. However, the nature and stability of these effects on adolescent smoking behavior remain to be investigated.     

Associations between parental smoking restrictions and adolescent smoking.

The purpose of this study was to examine the cross-sectional relation between reported levels of parental smoking restriction and several behavioral and cognitive variables in a sample of 757 (363 males, 394 females) adolescent smokers. Experimenters administered surveys to students in the homerooms of three Florida high schools. After controlling for student age, gender, and parental smoking status, results revealed that more restrictive parental smoking policies were significantly associated with less smoking on weekdays and weekend days, greater latency to smoking the first cigarette of the day, greater motivation to quit smoking, greater confidence in ability to quit smoking, and higher estimated risk perception regarding the health consequences of smoking. Results also revealed that 44% of adolescent smokers reported that their parents or legal guardians did not know that they smoked tobacco. These findings suggest that parental smoking restrictions may have the potential to impede adolescent progression to adult smoking behavior by reducing smoking rates and nicotine dependence, and increasing motivation to quit, self-confidence to quit, and health risk perception. Parental restrictions on smoking may present obstacles and inconveniences to adolescent smoking behavior that make smoking cessation a more attractive option.     

Sociometric status as a predictor of onset and progression in adolescent cigarette smoking.

The relation between sociometric status and adolescent cigarette smoking was examined in a 1-year longitudinal study. Students in 6th, 7th, and 8th grades (N=1,630) were asked to nominate peers in their grade at school whom they liked and peers whom they disliked. These nominations were used to classify participants into one of five sociometric categories (popular, rejected, controversial, neglected, and average). Participants also reported their lifetime cigarette use at two measurements in consecutive school years. The results indicated that rejected and controversial adolescents were more likely than average adolescents to (a) report lifetime smoking at time 1 (T1) and (b) report onset of smoking at time 2 (T2). However, among adolescents who had already tried cigarettes at T1, rejected and controversial youth were not at increased risk for progression in total lifetime cigarette smoking (i.e., higher levels of total lifetime cigarette use at T2). Thus the results confirm that controversial youth are similar to rejected youth in their risk for onset of cigarette smoking during adolescence.     

Personality and smoking status: a meta-analysis.

We used meta-analytic techniques in an attempt to clarify the strength and direction of the association between smoking status and personality, which narrative reviews have indicated remains a largely inconsistent literature. Included were cross-sectional studies that reported personality data for healthy, adult smokers and nonsmokers using measures of personality traits derived from Eysenck's tripartite taxonomy of human personality. Of the 25 studies that contributed to the meta-analysis, 22 reported data on smoking status and extraversion and 22 reported data on smoking status and neuroticism. Meta-analysis using a fixed-effects framework indicated a significant difference between smokers and nonsmokers on both extraversion (p<.001) and neuroticism (p<.001) traits, which remained significant when a random-effects framework was used to accommodate significant between-study heterogeneity. These data from cross-sectional observational studies published between 1972 and 2001 indicate that both increased extraversion and increased neuroticism are associated with an increased likelihood of being a smoker rather than a nonsmoker, although in both cases the effect sizes indicated by the meta-analysis were small. We found no evidence that the strength of these associations varied with year of publication.     

Overcoming barriers to recruitment and retention in adolescent smoking cessation.

Participant recruitment and retention have been identified as challenging aspects of adolescent smoking cessation interventions. Problems associated with low recruitment and retention include identifying smokers, obtaining active parental consent, protecting participants' privacy, respecting participants' autonomy, and making participation relevant and accessible to adolescents. This paper describes nine strategies for minimizing these recruitment and retention problems via a proactive telephone counseling intervention, and reports on their simultaneous implementation among 1,058 smokers from 25 high schools in Washington state. Results are as follows: (a) 85.9% of parents of minor-age seniors provided active consent for their teen's participation, (b) 89.8% of eligible smokers were successfully contacted by counselors, (c) 86.5% of contacted smokers consented to participate in the cessation counseling, (d) 93.8% of consented smokers participated in smoking cessation counseling calls, and (e) 72.2% of participating smokers completed their full intervention. These results demonstrate that older teens who smoke, and their parents, are receptive to confidential cessation counseling that is personally tailored, supportive of their autonomy, and proactively delivered via the telephone.     

Relation between access to tobacco and adolescent smoking

Objective: To examine the relation between rates of sales of tobacco to minors and youth smoking prevalence.

Design: Repeated annual cross sectional surveys.

Setting: Seventy five communities in Oregon.

Participants: A random sample of students in grades 8 and 11 (ages 13 and 17 years) and retail outlets in each participating community.

Main outcome measures: Thirty day and daily smoking prevalence.

Results: The rate of illegal merchant sales in the communities was related to the smoking rate for 11th graders in those communities, but not for 8th graders. For every 10% increase in illegal sales rates there was an estimated 0.8% increase in 11th grade 30 day smoking prevalence and a 0.4% increase in daily smoking. Communities with lower illegal merchant sales rates had expanded use of social sources and reduced use of commercial sources by 11th graders, with the opposite pattern seen in 8th graders.

Conclusions: There appears to be a relatively small positive linear relation between the community rate of sales to minors and 11th grade youth smoking prevalence in those communities. Youth adjust their tobacco sources depending on the level of commercial availability.

     

Personality and smoking status: a longitudinal analysis.

We attempted to clarify the strength and nature of the association between personality and smoking status in early and middle adulthood, using a longitudinal study design. Data from the Medical Research Council National Survey of Health and Development, based on a stratified sample of all single, legitimate births occurring in England, Wales, and Scotland in one week of March 1946 (N = 5,362), were analyzed using generalized estimating equations methods to account for the correlation between the smoking status variables for the same individual over time. The unadjusted estimates indicated that the odds of being a current smoker increased with higher personality score for both extraversion (p<.0001) and neuroticism (p<.0001) traits. Sex was significantly associated with being a current smoker (p<.0001), with males more likely than females to be current smokers. Current smoking decreased with increasing age (p<.0001). These relationships were maintained in the fully adjusted model. These data indicate that both higher levels of extraversion and higher levels of neuroticism, as measured at age 16, are independently associated with an increased likelihood of subsequently being a current smoker rather than a nonsmoker at all time points, although the observed effect sizes were small. Males also were more likely than females to be current smokers, and increasing age reduced the likelihood of being a current smoker, which is consistent with an attempt by a subset of smokers in the cohort to subsequently stop smoking.     

Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark

OBJECTIVE: To determine whether adolescent smoking behaviour is associated with their perceived exposure to teachers or other pupils smoking at school, after adjustment for exposure to smoking at home, in school, and best friends smoking. DESIGN: Logistic regression analysis of cross sectional data from students in Denmark. SUBJECTS: 1515 grade 9 students (mean age 15.8) from 90 classes in 48 Danish schools. Outcome measure: Self reported smoking behaviour; daily smoking and heavy smoking, defined as those smoking more than 20 cigarettes per week. RESULTS: Of the students in this study, 62% of boys and 60% of girls reported being exposed to teachers smoking outdoors on the school premises. The proportion of boys and girls reporting to have been exposed to teachers smoking inside the school building were 86% and 88%, respectively. Furthermore, 91% of boys and 92% of girls reported that they had seen other students smoking outdoors on the school premises. Adolescents' perceived exposure to teachers smoking outdoors on the school premises was significantly associated with daily smoking, having adjusted for sex, exposure to teachers smoking indoors at school and pupils smoking outdoors at school, as well as the smoking behaviour of mother, father, and best friend (odds ratio (OR) 1.8, 95% confidence interval 1.2 to 2.8). Adolescents' perceived exposure to teachers smoking inside the school building was not associated with daily smoking (OR 0.9, 95% CI 0.5 to 1.6) and perceived exposure to pupils smoking outdoors was not associated with daily smoking (adjusted OR 1.5, 95% CI 0.5 to 4.4). There were similar findings with heavy smoking as the outcome variable. CONCLUSIONS: Teachers smoking during school hours is associated with adolescent smoking. This finding has implications for future tobacco prevention strategies in schools in many countries with liberal smoking policies where it might provide support for those working to establish smokefree schools.     

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.     

Reactivity to in vivo smoking cues in older adolescent cigarette smokers.

Most smokers initiate smoking in adolescence, and craving for cigarettes may play an important role in maintenance of smoking behavior and relapse to smoking during a quit attempt. Although a significant body of literature explores cue-reactivity in adult smokers, little has been published on cue-reactivity among adolescent smokers. In a previously published work, we found that videotaped smoking cues may not be robust in eliciting craving among adolescent smokers. Hence, in this preliminary study, we examined reactivity to in vivo smoking cues among adolescent smokers (N = 11, average age = 18.1 years, range = 15-19 years, predominantly female). Participants were presented with in vivo smoking and neutral cues (counterbalanced). We recorded subjective craving and real-time heart rate in response to each type of cue. Adolescent smokers had a significantly greater "desire" to smoke (p < .05) in response to smoking cues vs. both baseline and neutral cues. Participants had faster heart rates after the smoking cues during the epochs of 21-30 s and 31-40 s (p values<.05) as compared with baseline, and mean heart rate was higher during the smoking cues relative to neutral cues among participants who received the smoking cues first (p < .05). Results of this preliminary study further demonstrate the feasibility of conducting cue-reactivity studies with adolescent cigarette smokers. Findings from this study suggest that adolescent smokers may show patterns of responding to smoking cues similar to those of adult smokers. Implications for future laboratory studies with adolescent smokers are discussed.     

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.     

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.     

Rural consumers' attitudes towards nutrition labelling.

PURPOSE: Consumer workshops in rural and remote locations were evaluated for their efficacy in changing participants' self-perceived attitudes and behaviours related to nutrition labelling. METHODS: Project-trained community health educators used pilot-tested workshop resources to facilitate 18 workshops across the country. Participants completed pre-workshop questionnaires to permit the identification of demographic characteristics and attitudes and behaviours related to nutrition labelling at point-of-purchase. RESULTS: The majority of the 259 consumers who submitted questionnaires were women (81%), and aged 35 to 54 (35%); 51% reported more than a high school education and 34% had less than $25,000 as a yearly family income. Self-perceived attitudes and behaviours related to nutrition labelling differed only slightly by family income before the workshop. Workshops were rated positively (mode=4 [range 2 to 5]). Thirty-five consumers were surveyed three months after the workshop; the majority were women (89%), were aged 35 to 54 (43%), and had completed high school (51%). Self-perceived attitudes and behaviours for all respondents (n=35) had improved. Use of acquired knowledge and skills at point-of-purchase was high for all respondents (mode=4 [range 2 to 5]; five-point Likert scale). CONCLUSIONS: Providing in-person consumer workshops with pilot-tested materials in rural and remote locations had positive impacts on attitudes and behaviours related to the use of nutrition labelling.     

Ecological momentary assessment of adolescent smoking cessation: a feasibility study.

Attempts to quit smoking by adolescents typically fail, even when aided by psychosocial and pharmacological treatments. Gaining a better understanding of the process of smoking cessation and relapse in this population could lead to improved treatments and increases in cessation rates. Ecological momentary assessment (EMA) has been used to describe the relapse process among adults, but not among adolescents. This study examined the feasibility of using EMA to examine relapse among adolescent smokers. Participants (N = 13) used a hand-held computer for 3 weeks to report on their smoking behavior, affect state, and exposure to smoking cues during a quit attempt (7 days prequit, 14 days postquit). All of the participants recorded a quit attempt and at least one lapse during the monitoring interval. Compliance with the protocol was generally high but decreased slightly over time. As with adults, evidence indicated that lapses were associated with craving, negative affect, and smoking cues. These data support the feasibility and potential value of using EMA with adolescent smokers.     

Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment.

Previous research indicates that tobacco craving predicts relapse to smoking among adult smokers attempting to quit. We hypothesized a similar relationship between craving and lapse (any smoking following a period of abstinence) among adolescent smokers during the treatment phase of a clinical trial. A visit was considered a lapse visit if the participant reported smoking or had a carbon monoxide level of 7 ppm or greater subsequent to an abstinent visit. A total of 34 participants (mean age = 14.9 years [SD = 1.3]; mean cigarettes/day = 18.0 [SD = 7.6]; mean Fagerstr?m Test for Nicotine Dependence score = 6.8 [SD = 1.34]; 65% female), were included in the present analysis of 167 treatment visits. Logistic regression analyses showed a positive relationship between degree of craving, measured by the Questionnaire on Smoking Urges, and lapse during smoking cessation treatment (p = .013). Additionally, linear regression analyses demonstrated a strong positive association between cigarettes smoked per day and craving scores (p<.001). Taken together with other data, these findings suggest that degree of craving might influence tobacco abstinence for adolescent smokers. Thus monitoring and addressing craving appears useful to increase the success of adolescent smoking cessation.     

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.     

Commercial weight loss products and programs: what consumers stand to gain and lose. A public conference on the information consumers need to evaluate weight loss products and programs

A Public Conference on the Information Consumers Need to Evaluate Weight Loss Products and Programs REPORT OF THE PRESIDING PANEL This is the Presiding Panel's report of the conference proceedings. The views expressed herein by individual government participants do not necessarily reflect the views of their respective government agencies.