Smoking, body image and reducing diet. A three-year follow-up of adolescents aged 15-18 years

Several studies indicate that the differences in smoking habits which have hitherto prevailed between the sexes are decreasing, partly because of the increase in smoking among young Norwegian women. It has been suggested that concern about body image and weight gain is of particular relevance to women taking up smoking. In this article we present findings from a cohort study among 646 adolescents between the ages of 15 and 18 years. The results indicate that boys start smoking later than girls, and that concern about weight gain, body image and dieting plays a more important role in girls' than in boys' smoking habits at the age of 15. These factors are unrelated to boys' smoking habits at the age of 18, whereas they contribute significantly in predicting girls' smoking habits three years later. Furthermore, the results show that among girls, those who smoke are more concerned about gaining weight. Our findings emphasize the importance of implementing smoking prevention programmes at different age levels, using different motivating factors for boys and girls.     

Smoking, body image and dieting habits among adolescents. A 3-year follow-up of adolescents aged 15-18 years

Several studies indicate that the differences in smoking habits which have hitherto prevailed between the sexes are decreasing, partly because of the increase in smoking among young Norwegian women. It has been suggested that concern about body image and weight gain is of particular relevance to women taking up smoking. In this article we present findings from a cohort study among 646 adolescents between the ages of 15 and 18 years. The results indicate that boys start smoking later than girls, and that concern about weight gain, body image and dieting plays a more important role in girls' than in boys' smoking habits at the age of 15. These factors are unrelated to boys' smoking habits at the age of 18, whereas they contribute significantly in predicting girls' smoking habits three years later. Furthermore, the results show that among girls, those who smoke are more concerned about gaining weight. Our findings emphasize the importance of implementing smoking prevention programmes at different age levels, using different motivating factors for boys and girls.     

Hormonal events during female puberty in relation to breast cancer risk

Cigarette smoking among adolescents continues to be a major public health problem in the United States. Smoking trends from 1976-1977 to 1992-1994 were examined in the Bogalusa Heart Study, an investigation of cardiovascular disease risk factors among black and white, male and female adolescents in a semirural town in the southern United States. Age-race-sex specific chi 2 tests for trends over five survey periods were conducted. In almost every age group, black boys and girls were less likely to be current smokers or to have ever smoked or tried cigarettes, as compared with white boys and girls, respectively (P < 0.01). Within age groups, few significant trends in smoking status from 1976-1977 through 1992-1994 were observed among white boys and girls. Among black males and females, however, sharp decreases were observed among all age groups in the prevalence of having ever smoked or tried cigarettes (P = 0.0001) and among the older age groups in the prevalence of being a current smoker (P = 0.0001). Thus, substantial declines in the prevalence of smoking were observed among black children but not among white children. Further research is required to understand why these ethnic differences in smoking occurred so that public health programs may target further the smoking behaviors in children.     

Unemployment and change of tobacco habits: a study of young people from 16 to 21 years of age

In a cohort study of 1080 pupils who were followed for 5 years from when they left compulsory school (from age 16 to age 21 years), smoking habits were found to correlate with unemployment among both boys and girls. Pupils who were smokers in school had a higher risk of becoming unemployed than non-smokers. Irrespective of early smoking, smoking habits developed more unfavourably among unemployed young people than among those with no unemployment during the period studied. The odds ratio of being a smoker at the age of 21 years when unemployed more than 20 weeks during the observation period, compared with those without or with short unemployment, was 2.44 for men and 3.45 for women. When adjusted for the influence of socio-economic background, education, economy and smoking habits at the start of the period, the odds ratio was 1.7 (95% CI 1.01-2.86) for men and 2.0 (1.13-3.53) for women. The adjusted odds ratio for increasing or starting smoking during the period was 1.5 (95% CI 0.89-2.56) for men and 2.0 (1.18-3.35) for women. No significant correlation was found between snuffing and unemployment. Thus, it seems that unemployment is a risk factor for development of tobacco smoking in young people, especially among women.     

Smokers on Bloemfontein schools: profile and standpoint

Primary prevention is now the first priority of research on smoking. A study was made of 1 505 children of 12 high schools situated in a conservative Afrikaans-speaking community in an attempt to determine the characteristics of the smoking and non-smoking groups. Of the total group 16% were smokers. The male/female ratio was 3:1. The mean age at which smoking commenced was 15,5 years. A positive relationship was found between the smoking habits of the smokers and those of their parents and best friends. The majority of pupils think that smoking is addictive. In addition, they believe that it is unhealthy and leads to poor sporting achievements. The great majority of smokers and non-smokers agree that non-smokers do better at school. Fathers of both smokers and non-smokers do not favour the habit. Ninety per cent of the boys and 83% of the girls started smoking between 12 and 18 years of age. The critical age for a preventive programme is thus 11 years.     

Prevalence and correlates of early smoking among elementary schoolchildren in multiethnic, low-income inner-city neighborhoods

PURPOSE: The prevalence and correlates of early smoking were investigated among schoolchildren in grades 4-6 living in multiethnic, low-income neighborhoods in Montreal. METHODS: As part of the evaluation of a school-based heart health promotion program, baseline data on the prevalence of early smoking were collected from 2285 students aged 9-13 years in 24 inner-city elementary schools during May-June 1993. RESULTS: Overall, 28.7% of boys and 20.3% of girls had smoked. Girls began trying later than boys, but by age 13 the prevalence of experimental or regular smoking by girls overtook that of boys. Univariately, ever smoking varied considerably by family origin, from 2.1% among Vietnamese girls, to 35.8% among Portuguese boys. In multivariate analysis, age, perceived smoking habits of friends, and smoking by family members, were strong correlates of smoking. Being of Asian family origin was negatively associated with smoking. None of the indicators of social class were significantly associated with ever smoking. CONCLUSIONS: Smoking prevention should begin with children even younger than age 9 in multiethnic, low-income, inner-city neighborhoods. With the exception of a lower prevalence of smoking among Asian children, ethnicity and social class were not strong influences on early smoking behavior in this population.     

Acupuncture in the treatment of asthma: a critical review

OBJECTIVES: This study was undertaken in the mid-1990s (1994) to describe the use of tobacco, alcohol, and non-institutionalized drugs among pre-adolescent and adolescent Spanish students. METHODS: Information was collected within the framework of a periodic transversal study of life styles among European students, with particular emphasis on health-related habits. In the current study we present the results of the last survey carried out in Spain within the context of this study (1994), which involved a representative sample of Spanish students 11, 13, 15, 17 and 18 years-old (n = 6,711). An anonymous questionnaire was completed by the students in class. The survey sampling uses proportionate stratification and multistage sampling. RESULTS: In 1994, 49% of the Spanish students in this age group had tried tobacco. Twenty-four percent were sporadic or regular smokers. There was a large proportion of female smokers than male smokers (27% vs 20%). The overall proportion of smokers increased from 3% at 11 years to 47% at 18 years. One third (33%) of the 18-year-old students smoked daily. Eighty-four percent of the students of this age indicated that they had tried one or more types of alcoholic beverage. Twenty-one percent consumed alcohol regularly (at least once a week). Regular alcohol use was somewhat more common among males (24%) than among females (19%). Forty-six percent of the 18-year-old students consumed alcoholic beverages regularly and 66% had been intoxicated one or more times. Almost one fifth (18%) of the 13-to-18 year-old students indicated that they had tried some type of non-institutionalized drug, although the current rate of consumption was 8%. Cannabis was the drug most frequently tried (18%) and the drug most often consumed at present (8%), followed by cocaine and heroin. More males than females had tried non-institutionalized drugs. DISCUSSION: Analysis of the data revealed that adolescent tobacco use is increasingly frequent among females. Alcohol use continues to be widespread among Spanish pre-adolescents and adolescents. Alcohol use begins in childhood and becomes consolidated in adolescence. The results suggest, in relation to gender differences in the use of tobacco, alcohol, and non-institutionalized drugs, that there is a strong tendency toward the homogenization of these habits between genders. It is necessary to emphasize the preventive measures of drug dependence among Spanish pre-adolescents and adolescents.     

Trends in cigarette smoking: the Minnesota Heart Survey, 1980 through 1992

OBJECTIVES: The purpose of this study was to describe trends in the prevalence of cigarette smoking between 1980 through 1982 and 1990 through 1992 in Minneapolis and St. Paul, Minn. METHODS: Three population-based surveys were conducted among adults 25 to 74 years of age in 1980 through 1982, 1985 through 1987, and 1990 through 1992. RESULTS: Overall age-adjusted prevalences of cigarette smoking declined significantly between 1980-1982 and 1985-1987 and between 1985-1987 and 1990-1992. Serum thiocyanate, a biochemical marker for tobacco use, also declined significantly over the 3 periods. CONCLUSIONS: Favorable trends in smoking prevalence and cigarette consumption among smokers were observed, but disturbing trends in some smoking behaviors were also noted.     

Lymphadenitis associated with the administration of clindamycin

In a questionnaire study concerning voiding habits among seven year-old children starting school the prevalence of enuresis nocturna was 13.4% among girls and 22.2% among boys. For 5.4% of girls and 8.2% of boys the symptom occurred at least once a week. Half of the children had secondary enuresis. Forty-six percent had consulted their doctor about the problem and 44% had received some kind of treatment. Ten percent had tried an alarm bell and 33% had tried desmopressin.     

Smoking in secondary school students in Zagreb

Prevalence of smoking was studied in two secondary schools in Zagreb. Data were collected from 637 pupils by questionnaires. Depending on school, between 31 to 45% pupils smoke. Different trends were observed in boys and girls. In boys from the families of a higher parental education prevalence is 28%; in those from lower 42% (p < 0.02). Smoking in girls still increases: in both populations girls surpassed boys (p < 0.001): observed frequencies are 47% in lower and 40% in a group with higher parental education. Higher frequency of smoking was observed in smoking families (p < 0.001). A majority of smokers begin smoking in the last grade of primary school, mostly because of peer group pressure and curiosity. Approximately 50% of regular smokers smoke more than half a pack daily. They comprise 12% of the surveyed population. Smokers do not assign low risk to smoking any more, but knowledge about diseases connected with smoking is insufficient. To reduce smoking among adolescents it is necessary to create negative attitude toward smoking and social-resistance skills during primary school education.     

Cigarette advertising and onset of smoking in children: questionnaire survey

OBJECTIVE: To investigate uptake of smoking in a cohort of 11 to 12 year olds related to awareness of advertised cigarette brands named. DESIGN: Self completed questionnaires administered to whole classes of schoolchildren in June 1993 and June 1994. SETTING: Primary, middle, and secondary schools in the north and south of England. SUBJECTS: 1450 pupils aged 11 and 12 years at the time of the first survey. MAIN OUTCOME MEASURES: Onset of smoking and brands smoked by the second survey related to cigarette brands named in the first one. Less advertised brands were used as the base for calculating odds ratios. RESULTS: Girls who named the most advertised brands-namely, Benson and Hedges alone (odds ratio = 2.50, 95% confidence interval = 1.18 to 5.30) or Benson and Hedges and Silk Cut (2.15, 1.04 to 4.42) in the first survey were at greatest risk of taking up smoking by the second one. The difference was similar but not significant for boys. Boys and girls who named the least advertised brands in the first survey were at no greater risk of taking up smoking by the second survey than those who named no brands (boys odds ratio = 0.49 (0.24 to 1.01); girls 0.79 (0.38 to 1.62)). New smokers were more likely to smoke any available brand (29.5%) or a less advertised brand such as Embassy (24.6%) than the most advertised ones, Benson and Hedges (19.7%) and Silk Cut (14.8%). Established smokers were more selective, only 15% smoking any available brand and 38.3% smoking Benson and Hedges. CONCLUSIONS: Cigarette advertising appears to increase children's awareness of smoking at a generic level and encourages them to take up the behaviour, beginning with any cigarettes which are available and affordable.     

Notes on the intermediary form of incontinentia pigmenti

In a survey of a representative sample of 900 persons in Switzerland (excluding the Italian speaking parts comprising some 4-5 percent of the population), the smoking habits of the adult population were studied. Smokers were defined as persons smoking at least one cigarette or an equivalent weight of pipe tobacco or cigars per day. 51.8% of men and 29.0% of women over age 15 are smokers. Among male smokers of cigarettes only (42% of all men), over three quarters (77.6%) smoke ten cigarettes or more per day, i.e., a quantity found harmful to health; over one half (55.8%) smoke twenty or more cigarettes per day. Half of all female smokers smoke ten or more cigarettes, more than one in every four female smokers (28.8%) smoke twenty or more cigarettes per day. It is calculated that almost two thirds of all cigarettes sold in Switzerland are smoked by smokers of twenty or more cigarettes per day, and that almost three quarters are smoked by smokers of ten or more cigarettes. Among men, smoking habits are independent of social status, whereas among women, those with higher family incomes show more frequent smoking, but also more widespread cessation of smoking than with lower incomes. Thirty percent of adults having been smokers have given up the habit, so that among men and women above age 15, theree are now some 20% and 14% respectively, of ex-smokers. This corresponds to at least 700,000 former smokers in all of Switzerland. The trend to give up starts already in the group aged 15-24 (over 20% of men and women having ever smoked have given up) and becomes more marked with increasing age. A large part of male and female smokers would like to free themselves of the habit. 30% of male and 34% of female smokers indicate that they had tried seriously to stop smoking during the twelve months preceding the interview. Trying to give up was not significantly associated with intensity of smoking or social status. According to this survey, a majority of the population (57.6%) is in favor of reserving certain parts of restaurants to non-smokers, following the example of non-smokers-compartments in railway trains. In a situation where a non-smoker asks a co-worker in a closed room not to smoke, 78.3% take sides with the non-smoker, either by conceding to him a right to smoke-free air, or by demanding from the smoker to show consideration for the non-smoker. Only 10.9% demand from the non-smoker understanding for the smoker, or concede to the smoker a right to smoke at work. Women show more understanding for cause of the non-smoker than men. This difference is more marked among smokers and former smokers than among non-smokers. Inasmuch as the results of this study are comparable to those of earlier surveys conducted in Switzerland, ther is good agreement. The only exception is a significant increase of the proportion of former smokers in the past years.     

Age and sex differences in health habits and beliefs of schoolchildren.

Surveyed 1,981 boys and 1,952 girls in Grades 3–12 about health habits and beliefs, including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. Factors that emerged were smoking habits, family discussion of health, family thinking about health, nutritional habits, and health locus of control. Girls generally reported healthier food habits than did boys. However, adolescent girls reported more cigarette smoking than did adolescent boys. Also, boys consistently reported higher levels of exercise. There were also changes in habits and belief with age; trends that emerged in junior high school continued through high school. Adolescence also seems to be a transitional time for health habits, as suggested by personal experimentation and individual variation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benign symmetrical lipomatosis: Madelung''s disease

The relationship between smoking and bladder cancer risk was investigated using data from a case-control study conducted between January 1994 and July 1996 in Alexandria, Egypt. Cases were 151 males with incident, histologically confirmed invasive cancer of the bladder, and controls were 157 males admitted to hospital for acute, non-neoplastic, non-urinary tract, non-smoking-related conditions. With reference to never smokers, ex-smokers had a multivariate odds ratio (OR) of 4.4 [95% confidence interval (CI) 1.7-11.7] and current smokers of 6.6 (95% CI 3.1-13.9). The ORs were 5.4 for < 20 and 7.6 for > or = 20 cigarettes per day. After adjustment for cigarette smoking, the ORs were 0.8 for waterpipe and 0.4 for hashish smokers. The risk was significantly related to duration of smoking (OR of 16.5 for > 40 years), and inversely related to age at starting (OR of 8.8 for starting < 20 years), and inversely related to time since quitting smoking. Compared with never smokers who did not report a clinical history of schistosomiasis, the OR was 9.4 for smokers with a history of schistosomiasis, and 10.7 for smokers ever employed in high-risk occupations compared with non-smokers not reporting such a history. Thus, our results, while not giving indications of an increased bladder cancer risk with habits other than cigarette smoking, found a remarkably strong association with various measures of cigarette smoking that could explain 75% of bladder cancer cases among males from Alexandria. The prevalence of smoking was very low among women, and consequently tobacco was not a relevant risk factor for female bladder cancer.     

Behavioral symptoms among children and adolescents. Screening with the help of a questionnaire in a group of children aged 4 to 17 years

A Danish translation of "The Child Behavior Checklist" (CBCL), developed by Achenbach and Edelbrock in Vermont, was standardized on 1,300 children aged between four and 17 years in the county of Fyn. The response rate was 61.4% and lowest among boys. Responders were compared to non-responders on different variables generated by the Danish Statistical Institute. No significant differences emerged across the two groups with respect to analysed confounders. We found a mean total CBCL score of 15-20 out of 232 possible points with considerable variation. The 95 percentile reflects a possible cut-off score for behavioural deviance or "psychiatric abnormality". This varied from 35 points in four to five years old girls to 58 points in six to ten years old boys. Parents reported hyperactivity and restlessness in 6.8% of six to ten year-old boys. Depression and sadness were reported in about 2% of all children six years or older. Six point three percent of all girls of 11-16 years selfreported obsessions. The 11-16 year-olds generally reported more symptomatic behaviour than their parents and teachers did about them.     

Why is life expectancy a problem for the Danes? The influence of smoking during the last 50 years

The study quantifies the influence of smoking on mortality in Denmark and computes measures for the individual risk. Mortality due to lung cancer among Danish women is now the highest in Europe. Smoking-attributable deaths among men amounted to 3% in 1945, 26% in 1985, and 25% in 1995; the proportion is lower among women, but is increasing considerably. In 1995 in the age-group 35-69 years such deaths make up the same proportion among men and women. The risk that a 35-year old Dane dies before attaining the age of 70 due to other than smoking-attributable causes has decreased since 1945, most significantly among women. Women have experienced a considerable increase in smoking-attributable mortality over the last 20 years, increasing the total risk of a 35 year-old of dying before reaching the age of 70. In 1995 a little over 13,000 of a total of a little less than 63,000 deaths could be attributed to smoking. Smoking is responsible for a significant part of the adverse development in Danish life expectancy.     

Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths

OBJECTIVE: To assess the hazards at an early phase of the growing epidemic of deaths from tobacco in China. DESIGN: Smoking habits before 1980 (obtained from family or other informants) of 0.7 million adults who had died of neoplastic, respiratory, or vascular causes were compared with those of a reference group of 0.2 million who had died of other causes. SETTING: 24 urban and 74 rural areas of China. SUBJECTS: One million people who had died during 1986-8 and whose families could be interviewed. MAIN OUTCOME MEASURES: Tobacco attributable mortality in middle or old age from neoplastic, respiratory, or vascular disease. RESULTS: Among male smokers aged 35-69 there was a 51% (SE 2) excess of neoplastic deaths, a 31% (2) excess of respiratory deaths, and a 15% (2) excess of vascular deaths. All three excesses were significant (P<0.0001). Among male smokers aged >/70 there was a 39% (3) excess of neoplastic deaths, a 54% (2) excess of respiratory deaths, and a 6% (2) excess of vascular deaths. Fewer women smoked, but those who did had tobacco attributable risks of lung cancer and respiratory disease about the same as men. For both sexes, the lung cancer rates at ages 35-69 were about three times as great in smokers as in non-smokers, but because the rates among non-smokers in different parts of China varied widely the absolute excesses of lung cancer in smokers also varied. Of all deaths attributed to tobacco, 45% were due to chronic obstructive pulmonary disease and 15% to lung cancer; oesophageal cancer, stomach cancer, liver cancer, tuberculosis, stroke, and ischaemic heart disease each caused 5-8%. Tobacco caused about 0.6 million Chinese deaths in 1990 (0.5 million men). This will rise to 0.8 million in 2000 (0.4 million at ages 35-69) or to more if the tobacco attributed fractions increase. CONCLUSIONS: At current age specific death rates in smokers and non-smokers one in four smokers would be killed by tobacco, but as the epidemic grows this proportion will roughly double. If current smoking uptake rates persist in China (where about two thirds of men but few women become smokers) tobacco will kill about 100 million of the 0.3 billion males now aged 0-29, with half these deaths in middle age and half in old age.     

Has risk associated with smoking increased? Results from the Copenhagen Center for Prospective Population Studies

BACKGROUND: Two recent much cited publications have raised the concern that risk associated with cigarette smoking has so far been underestimated. In this study we wish to determine whether excess all-cause mortality associated with smoking has increased during the last 20-30 years in a study population representative of the general Danish population and whether any such changes relate to changes in smoking behaviour. METHODS: Pooled data from three prospective population studies conducted in Copenhagen with detailed information on smoking habits. A total of 31,194 subjects, 17,669 males and 13,525 females, initially examined between 1964 and 1992 with examinations repeated at intervals from 1-10 years, were followed until 1995 for all-cause mortality. Relative mortality risk in smokers versus never-smokers was calculated within periods of five calendar years and compared throughout the study period. RESULTS: Male smokers' exposure did not change during the study period whereas female smokers' exposure to tobacco increased in terms of age at smoking onset, quantity smoked and depth of inhalation. During follow-up 5744 males and 2900 females died. In males, death rate ratios (comparing continuous smokers with never-smokers) did not change in the study period. In females, ratios increased from 1964-1978 to 1979-1994 by a factor of 1.3 (95% confidence interval 1.0-1.8). CONCLUSIONS: In agreement with the observed changes in smoking habits, excess mortality in male smokers did not increase whereas excess mortality in female smokers increased slightly.     

Rate control and sinus rhythm maintenance in atrial fibrillation: national trends in medication use, 1980-1996

BACKGROUND: Little is known about national patterns of pharmacological treatment of atrial fibrillation, in particular, use of medications for ventricular rate control and for restoration and maintenance of sinus rhythm. METHODS: We analyzed 1555 visits by patients with atrial fibrillation to randomly selected office-based US physicians included in National Ambulatory Medical Care surveys conducted in 1980, 1981, 1985, and 1989 through 1996. To determine national trends, we evaluated the proportion of atrial fibrillation visits with reported use of rate control medications (digoxin and antiarrhythmics in classes II and IV) and sinus rhythm medications (classes IA, IC, and III). RESULTS: The use of rate control agents decreased from 79% of atrial fibrillation visits in 1980-1981 to 62% in 1994-1996. Declining use was noted for both digoxin (76% in 1980-1981 to 53% in 1994-1996) and beta-blockers (19%-13%). After their introduction, the use of verapamil hydrochloride and diltiazem hydrochloride increased to 15% of atrial fibrillation visits in 1994-1996. Sinus rhythm agent use decreased from 18% of visits in 1980-1981 to 4% in 1992-1993 and then rose to 13% in 1994-1996. The use of class IA agents declined from 18% in 1980-1981 to 3.5% in 1992-1993 and then increased to 8% in 1994-1996. Quinidine remained the most widely used sinus rhythm medication, despite its declining share of this category. Newly available sotalol hydrochloride and amiodarone hydrochloride were used in 3.6% of visits in 1994-1996. CONCLUSIONS: Despite changes in the treatment of atrial fibrillation, digoxin remains the dominant rate control medication. Medications for sinus rhythm maintenance are not widely used. Quinidine use declined prominently in the 1980s, possibly because of concerns about proarrhythmic effects. The use of sinus rhythm agents, however, is now rising.