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CORK Bibliography: Adolescents and Nicotine

125 citations. June 2009 to present

Prepared: December 2009

Ajdacic-Gross V; Landolt K; Angst J; Gamma A; Merikangas KR; Gutzwiller F et al. Adult versus adolescent onset of smoking: How are mood disorders and other risk factors involved? Addiction 104(8): 1411-1419, 2009. (53 refs.)

Aims: To examine the strength of association between smoking and mood disorders and the association between smoking and its traditional risk factors, comparing those who started smoking in adolescence with those who started smoking in early adulthood. Design and participants The analyses relied on prospective data from the Zurich Study. This longitudinal community study started in 1979 with a stratified sample of 591 participants aged 20/21 years, weighted towards those with mental disorders. Follow-up interviews were conducted at ages 23, 28, 30, 35 and 41. Measurements: In this analysis the adult versus adolescent onset of smoking was regressed on the cumulative prevalence of mood disorders, personality characteristics measured by the Freiburg Personality Inventory, common risk factors such as parental smoking, conduct and school problems, troubles with the family and basic socio-demographic variables (sex, education). Findings: In the Zurich Study cohort we found that 61.6% were former or current smokers, of whom 87% started smoking before the age of 20 and 13% after the age of 20. Adolescent onset of smoking was associated strongly with later major depression, dysthymia or bipolar disorders and, furthermore, with parental smoking, extroverted personality and discipline problems and rebelliousness in youth. However, only depression and dysthymia were associated with adult onset smoking and other risk factors associated with smoking were not so associated in this group. Conclusions: Correlates of smoking onset in adolescence are mainly not applicable to the onset of smoking in young adulthood. Smoking onset beyond adolescence is an open research issue.

Aklin WM; Moolchan ET; Luckenbaugh DA; Ernst M. Early tobacco smoking in adolescents with externalizing disorders: Inferences for reward function. Nicotine & Tobacco Research 11(6): 750-755, 2009. (32 refs.)

Tobacco smoking is the leading preventable cause of mortality in the United States, and 90% of regular smokers initiate smoking before age 18 years. Factors that confer risk for chronic smoking include psychiatric factors, such as externalizing disorders, and potentially related neurobiological substrates, such as reward function. The present study examined the relationship between the externalizing disorders and the temporal progression of smoking among adolescent smokers. Data were from 64 adolescents who requested smoking cessation treatment and included information on developmental smoking trajectory, number of cigarettes per day, and Fagerstrom Test for Nicotine Dependence score. This sample was assessed carefully for psychiatric disorders. Analyses examined the relationships between externalizing psychiatric disorders and smoking trajectory. Adolescents with an externalizing disorder consumed more tobacco in the first 2 years of smoking than those without a disorder. There were no differences in speed of progression between groups, which may index a distinct functional pattern of reward systems that confers vulnerability for tobacco dependence. These data are discussed in terms of potential predictors of early smoking behavior that can inform interventions for adolescents with externalizing behaviors and tobacco dependence. They also provide some hypotheses for how the development of chronic smoking can be influenced by specific patterns of reward responses.

Alamian A; Paradis G. Correlates of multiple chronic disease behavioral risk factors in Canadian children and adolescents. American Journal of Epidemiology 170(10): 1279-1289, 2009. (64 refs.)

The authors assessed individual, social, and school correlates of multiple chronic disease behavioral risk factors (physical inactivity, sedentary behavior, tobacco smoking, alcohol drinking, and high body mass index) in a representative sample of Canadian youth aged 10-15 years (mean = 12.5 years) attending public schools. Cross-sectional data (n = 1,747) from cycle 4 (2000-2001) of the National Longitudinal Survey of Children and Youth were used. Ordinal regression models were constructed to investigate associations between selected covariates and multiple behavioral risk-factor levels (0/1, 2, 3, or 4/5 risk factors). Older age (odds ratio (OR) = 1.95, 95% confidence interval (CI): 1.21, 3.13), caregiver smoking (OR = 1.49, 95% CI: 1.09, 2.03), reporting that most/all of one's peers smoked (OR = 7.31, 95% CI: 4.00, 13.35) or drank alcohol (OR = 3.77, 95% CI: 2.18, 6.53), and living in a lone-parent family (OR = 1.94, 95% CI: 1.31, 2.88) increased the likelihood of having multiple behavioral risk factors. Youth with high self-esteem (OR = 0.92, 95% CI: 0.85, 0.99) and youth from families with postsecondary education (OR = 0.58, 95% CI: 0.41, 0.82) were less likely to have a higher number of risk factors. Although several individual and social characteristics were associated with multiple behavioral risk factors, no school-related correlates emerged. These variables should be considered when planning prevention programs.

Albers AB; Biener L; Siegel M; Cheng DM; Rigotti NA. Impact of parental home smoking policies on policy choices of independently living young adults. Tobacco Control 18(3): 245-248, 2009. (14 refs.)

Objective: To determine whether adolescents living in parental homes where smoking is banned are more likely to move into smoke-free living quarters when they leave home. Methods: We analysed data on 693 youths from a 4-year, three-wave prospective study of a representative sample of Massachusetts adolescents (aged 12-17). All youths resided in independent living quarters at follow-up. The primary outcome was presence of a smoking ban in the living quarters at follow-up. The primary predictor was presence of a household smoking ban in the parental home, assessed 2 years before the outcome. Generalised linear mixed effects models examined the effect of a parental household smoking ban on the odds of moving into smoke-free living quarters at follow-up overall and stratified by smoking status at follow-up. Results: Youths leaving home had much higher odds of moving to smoke-free living quarters if their parental household had had a smoking ban (odds ratio (OR)= 12.70, 95% CI, 6.19 to 26.04). Other independent predictors included moving into a school or college residence (OR=3.88, 95% CI 1.87 to 8.05), and not living with smokers at follow-up (OR=3.91, 95% CI 1.93 to 7.92). Conclusions: A household smoking ban in the parental home appears to lead youths to prefer smoke-free living quarters once they leave home.

Alesci NL; Forster JL; Erickson DJ. Did youth smoking behaviors change before and after the shutdown of Minnesota Youth Tobacco Prevention Initiative? Nicotine & Tobacco Research 11(10): 1196-1204, 2009. (48 refs.)

No previous studies document the effects of both comprehensive tobacco control and its defunding on youth smoking. This study tests the effect of the youth-focused Minnesota Youth Tobacco Prevention Initiative (MYTPI) and its shutdown on youth smoking and determines whether these effects differed by age. The Minnesota Adolescent Community Cohort is a population-based, observational study designed to evaluate the MYTPI. The sample included cohorts of youth aged 12-16 years at baseline in Minnesota (N = 3,636) and a comparison group in six other Midwestern states (n = 605). Biannual surveys assessed youth smoking from October 2000, 5 months after the MYTPI launch, through October 2005, 2 years postshutdown. Adjusted piecewise linear trajectories predicted smoking stage (measured on a 1-6 continuum) comparing Minnesota with a comparison group during the MYTPI (Slope 1) and postshutdown (Slope 2) for each baseline age cohort. Analysis then compared baseline age cohorts with each other by centering their intercepts on age 16. Neither slope of smoking stage differed between Minnesota and comparison groups, showing no period effects for the MYTPI or shutdown. However, younger cohorts, with early teen experience of MYTPI, smoked less than older cohorts by the same age. Mean smoking stage at age 16 differed by almost a half stage from the youngest (2.04) to the oldest (2.46) age cohort. The study offers no evidence of period effects for the MYTPI or its shutdown. Design limitations, national or continued post-MYTPI statewide tobacco control efforts, or program flaws could explain the findings.

Ali MM; Dwyer DS. Estimating peer effects in adolescent smoking behavior: A longitudinal analysis. Journal of Adolescent Health 45(4): 402-408, 2009. (18 refs.)

Purpose: To empirically quantify the role of peer social networks in explaining smoking behavior among adolescents. We follow adolescents over time to examine whether the role of adolescent peers persists in affecting individual behaviors as adolescents transition into adulthood. Methods: Using longitudinal data of a nationally representative sample of adolescents we use a multi-variate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects, and peer selections to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends but also from classmates. Smoking prevalence among the peer groups were constructed using the peers' own reports of their cigarette consumption. Results: Controlling for parent level characteristics and other demographic parameters, we find that a 10% increase in the proportion of classmates who smoke will increase the likelihood of smoking by more than 3%. Also, an increase in smoking rates among an individual's close friends by 10% will increase the likelihood of smoking by 5%. We find evidence to show that the influence of close friends from adolescence years continue to have an impact on smoking propensities even when a transition into adulthood is made. Conclusions: Our findings support the literature reporting that peer effects are important determinants of smoking even after controlling for potential biases in the data and that these effects persist into adulthood. Effective policy aimed at reducing smoking rates among adolescents would consider these long-lasting peer effects.

Audrain-McGovern J; Rodriguez D; Kassel JD. Adolescent smoking and depression: Evidence for self-medication and peer smoking mediation. Addiction 104(10): 1743-1756, 2009. (96 refs.)

Aims: The nature of the relationship between adolescent smoking and depression is unclear and the mechanisms that account for the comorbidity have received little investigation. The present study sought to clarify the temporal precedence for smoking and depression and to determine whether these variables are linked indirectly through peer smoking. Participants: The sample was composed of 1093 adolescents participating in a longitudinal study of the behavioral predictors of smoking adoption. Design and measurements In this prospective cohort study, smoking, depression, peer smoking and other covariates were measured annually from mid-adolescence (9th grade; age 14) to late adolescence (12th grade, age 18). Findings: Parallel processes latent growth curve models supported a bidirectional relationship between adolescent smoking and depression, where higher depression symptoms in mid-adolescence (age 14) predicted adolescent smoking progression from mid- to late adolescence (ages 14-18). A significant indirect effect indicated that higher depression symptoms across time predicted an increase in the number of smoking peers, which in turn predicted smoking progression from mid-adolescence to late adolescence. In addition, smoking progression predicted a deceleration of depression symptoms from mid- to late adolescence. A significant indirect effect indicated that greater smoking at baseline predicted a deceleration in the number of smoking peers across time, which predicted a deceleration in depression symptoms from mid-adolescence to late adolescence. Conclusions: The current study provides the first evidence of bidirectional self-medication processes in the relationship between adolescent smoking and depression and highlights peer smoking as one explanation for the comorbidity.

Audrain-McGovern J; Rodriguez D; Epstein LH; Cuevas J; Rodgers K; Wileyto EP. Does delay discounting play an etiological role in smoking or is it a consequence of smoking? Drug and Alcohol Dependence 103(3): 99-106, 2009. (72 refs.)

Although higher delay discounting rates have been linked to cigarette smoking, little is known about the stability of delay discounting, whether delay discounting promotes smoking acquisition, whether smoking contributes to impulsive choices, or if different relationships exist in distinct subgroups. This study sought to fill these gaps within a prospective longitudinal cohort study (N=947) spanning mid-adolescence to young adulthood (age 15-21 years old). Smoking and delay discounting were measured across time. Covariates included peer and household smoking, academic performance, depression, novelty seeking, inattention and hyperactivity/impulsivity symptoms, and alcohol and marijuana use. The associated processes latent growth curve modeling (LGCM) with paths from the delay discounting level factor (baseline measure) and the trend factor (slope) to the smoking trend factor (slope) fit the data well, chi(2)((19, n=947)) = 15.37 p=.70, CFI=1.00, RMSEA=0, WRMR=.36. The results revealed that delay discounting did not change significantly across time. Baseline delay discounting had a significant positive effect on smoking trend (beta=.08, z=2.16, p=.03). A standard deviation (SD=1.41) increase in baseline delay discounting resulted in an 11% increase (OR=1.11, 95% Cl = 1.03, 1.23) in the odds of smoking uptake. The alternative path LCGM revealed that smoking did not significantly impact delay discounting (p's > .05). Growth mixture modeling identified three smoking trajectories: nonsmokers, early/fast smoking adopters, and slow smoking progressors. Delay discounting was higher in the smoking versus nonsmoking trajectories, but did not discriminate between the smoking trajectories, despite different acquisition patterns. Delay discounting may provide a variable by which to screen for smoking vulnerability and help identify subgroups to target for more intensive smoking prevention efforts that include novel behavioral components directed toward aspects of impulsivity.

Bailey SR; Harrison CT; Jeffery CJ; Ammerman S; Bryson SW; Killen DT et al. Withdrawal symptoms over time among adolescents in a smoking cessation intervention: Do symptoms vary by level of nicotine dependence? Addictive Behaviors 34(12): 1017-1022, 2009. (27 refs.)

Nicotine dependence may be expressed differently in teens than in adults. Thus, it may not be sufficient to build diagnostic and cessation treatment strategies for teens based on adult-derived clinical and research data. This is the first study to prospectively examine the development of withdrawal symptoms by level of nicotine dependence among adolescent smokers. Forty-seven adolescent smokers completed nicotine withdrawal symptoms measures during 10 weeks of cessation treatment. Nicotine dependence was assessed at baseline using the mFTQ. Change in withdrawal symptoms over time by level of nicotine dependence was examined via mixed model ANOVA. Nicotine withdrawal in daily adolescent smokers was strongly and prospectively associated with the level of nicotine dependence. Craving was rated as the most problematic symptom at the baseline assessment. The results of this study may help guide the development of future research on diagnostic and cessation treatment strategies for teens.

Barra S; Gaeta G; Del Castello E; Capozzi G; Cuomo V; Effuso L et al. Age-related differences in factors associated with cigarette smoking among Italian high school students. Journal of Cardiovascular Medicine 10(7): 529-534, 2009. (42 refs.)

Introduction: Adolescents' cigarette smoking is related to several factors. The aim of this study among high school students was to test the hypothesis that factors related to smoking behavior could differ in early (14-16-year-old students, younger age group) vs. late (17-21-year-old students, older age group) adolescence. Methods: The smoking behavior of 910 students was evaluated by a questionnaire. Students were categorized on the basis of their lifetime smoking behavior as never, former, occasional and regular smoker. Data were analyzed using Student's t-test, chi-square test and multinomial logistic regression analysis. Results: In multinomial logistic regression analysis, variables related to adolescents' smoking behavior for both age groups were: positive attitude toward smoking (P<0.001), illicit drug use (younger age group, P<0.001; older age group, P=0.003), smoking at home with parents (younger age group, P=0.038; older age group, P<0.001) and get drunk at least once (younger age group, P=0.002; older age group, P=0.026). In the younger age group, a significant association was also found between students' smoking behavior and having smoked a cigar at least once (P=0.006) and smoking behavior of the best friend of the same sex (P=0.001), whereas the relationship with the hours spent with friends of the opposite sex was of borderline significance (P=0.058). In the older age group, other factors related to adolescent's smoking behavior were minimizing health consequences of smoking (P=0.002) and the hours spent with friends of the same sex (P=0.026). Conclusion: Our study demonstrates that, as adolescence advances, factors related to smoking behavior can vary.

Bennett DS; Mohamed FB; Carmody DP; Bendersky M; Patel S; Khorrami M et al. Research inhibition among early adolescents prenatally exposed to tobacco: An fMRI study. Neurotoxicology and Teratology 31(5): 283-290, 2009. (77 refs.)

Children prenatally exposed to tobacco have been found to exhibit increased rates of behavior problems related to response inhibition deficits. The present study compared the brain function of tobacco-exposed (n = 7) and unexposed (n = 11) 12-year-olds during a Go/No-Go response inhibition task using an event-related functional MRI (fMRI) design. Prenatal alcohol exposure, neonatal medical problems, environmental risk, IQ, current environmental smoke exposure, and handedness were statistically controlled. Tobacco-exposed children showed greater activation in a relatively large and diverse set of regions, including left frontal, right occipital, and bilateral temporal and parietal regions. In contrast, unexposed but not exposed children showed activation in the cerebellum, which prior research has indicated is important for attention and motor preparation. The diversity of regions showing greater activation among tobacco-exposed children suggests that their brain function is characterized by an inefficient recruitment of regions required for response inhibition.

Bernburg JG; Thorlindsson T; Sigfusdottir ID. The neighborhood effects of disrupted family processes on adolescent substance use. Social Science & Medicine 69(1): 129-137, 2009. (55 refs.)

In the current paper, we argue that the neighborhood-level of disrupted family processes (weak social ties to parents and coercive family interaction) should have a contextual effect on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), because adolescents living in neighborhoods in which disrupted family processes are prevalent should be more likely to associate with deviant (substance using) peers. We use nested data on 5491 Icelandic adolescents aged 15 and 16 years in 83 neighborhoods to examine the neighborhood-contextual effects of disrupted family processes on adolescent substance use (cigarette smoking, heavy drinking, and lifetime cannabis use), that is, whether neighborhoods in which disrupted family processes are common have more adolescent substance use, even after partialling Out the individual-level effects of disrupted family processes on substance use. As predicted, we find that the neighborhood-levels of disrupted family processes have significant, contextual effects on all the indicators of substance use, and that association with substance using peers mediates a part of these contextual effects. The findings illustrate the limitation of an individual-level approach to adolescent substance use.

Binns HJ; Forman JA; Karr CJ; Paulson JA; Osterhoudt KC; Roberts JR et al. Policy Statement -- Tobacco Use: A pediatric disease. (review). Pediatrics 124(5): 1474-1487, 2009. (100 refs.)

Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

Blokland EAWD; Engels RC; Harakeh Z; Hale WW; Meeus W. If parents establish a no-smoking agreement with their offspring, does this prevent adolescents from smoking? Findings from three Dutch studies. Health Education & Behavior 36(4): 759-776, 2009. (29 refs.)

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their parents were used to test whether establishing a no-smoking agreement prevents adolescents from smoking. Third, the authors tested among 856 early-and mid-adolescents and their parents, whether in addition to the establishment of a no-smoking agreement, the frequency and quality of communication on smoking issues had an effect on adolescent smoking. The findings do not support that establishing a no-smoking agreement is an effective deterrent with regard to adolescent smoking. Parents who want to prevent smoking might consider focusing their efforts on establishing a good quality of communication on smoking issues whereas parents who just talk a lot about smoking issues without considering the quality of their communication might do more harm than good.

Botello-Harbaum MT; Haynie DL; Iannotti RJ; Wang J; Gase L; Simons-Morton B. Tobacco control policy and adolescent cigarette smoking status in the United States. Nicotine & Tobacco Research 11(7): 875-885, 2009. (52 refs.)

Tobacco policies that limit the sale of cigarettes to minors and restrict smoking in public places are important strategies to deter youth from accessing and consuming cigarettes. We examined the relationship of youth cigarette smoking status to state-level youth access and clean indoor air laws, controlling for sociodemographic characteristics and cigarette price. Data were analyzed from the 2001 to 2002 U.S. Health Behavior in School-Aged Children survey, a cross-sectional survey conducted with a nationally representative sample of 13,339 students in the United States. Compared with students living in states with strict regulations, those living in states with no or minimal restrictions, particularly high school students, were more likely to be daily smokers. These effects were somewhat reduced when logistic regressions were adjusted for sociodemographic characteristics and cigarette price, suggesting that higher cigarette prices may discourage youth to access and consume cigarettes independent of other tobacco control measures. Strict tobacco control legislation could decrease the potential of youth experimenting with cigarettes or becoming daily smokers. The findings are consistent with the hypothesis that smoking policies, particularly clean indoor air provisions, reduce smoking prevalence among high school students.

Bottom TL; Adams ML; Jason LA; Topliff A. Youth smoking status: Perceptions versus measurements. American Journal of Health Behavior 33(6): 760-768, 2009. (24 refs.)

Objective: To determine whether youths who have smoked cigarettes in the past 30 days perceive themselves as smokers. Methods: Sensitivity and specificity for 3 classifications were analyzed and compared to youths' perceptions of smoking status. Results: The common criterion of having smoked cigarettes in the past 30 days reflected youths' perceptions of their smoking status with modest accuracy although adding a second criterion of having also smoked 100 or more cigarettes in a lifetime more accurately reflects youths' perceptions of their smoking status. Conclusions: Youths frequently determine smoking status based on behavioral criteria that differ from the standard criterion of 30-day point prevalence.

Bowles H; Maher A; Sage R. Helping teenagers stop smoking: Comparative observations across youth settings in Cardiff. Health Education Journal 68(2): 111-118, 2009. (8 refs.)

Objective: This paper presents comparative observations between schools/colleges, youth centres, and specialist youth provision, in relation to delivery of the 2tuff2puff six-week smoking cessation and awareness programme to young people in Cardiff. Design A six-week smoking cessation programme was delivered to 12-23 year olds in various youth venues, using weekly records of attendance and compulsory questionnaires delivered by the group facilitator at week one and week six. Setting Twenty-two groups were delivered in 14 youth settings across Cardiff. These settings were categorized into three types: schools/colleges; youth centres; and specialist youth provisions. Method Data collected from 179 young people at week one and 84 young people at week six were used to measure changes in weekly smoking behaviour, weekly expenditure on cigarettes, knowledge about smoking and smoking cessation, attitudes toward smoking, motivation to quit/cut down, and attrition. These were compared across the three different setting types. Youth Health Development Officers rated the three setting types on five factors (ease of access/communication with venue; suitability for sessions/acceptability to young people; supportiveness of environment for making a quit attempt; recruitment of young people; and data collection and evaluation) to reflect their practical experiences of delivering the six-week smoking cessation programme across the different youth settings. Results: Schools/colleges and specialist youth provision had the highest levels of attendance, and positive change in attitude toward quitting was greatest in specialist youth settings (79 per cent of attendees were more determined to quit). Conclusion: Overall, when both practical delivery issues and young peoples' outcome measures were considered, specialist youth provisions were the most effective settings for delivery of this programme. Delivery of smoking awareness as part of a wider health curriculum for groups of excluded young people is also recommended.

Bricker JB; Rajan KB; Zalewski M; Andersen MR; Ramey M; Peterson AV. Psychological and social risk factors in adolescent smoking transitions: A population-based longitudinal study. Health Psychology 28(4): 439-447, 2009. (37 refs.)

Objective: This study longitudinally investigated psychological and social risk factors consistent with the Theory of Triadic Influence (TTI) as predictors of adolescent smoking transitions. Design: Among 4218 adolescents, five psychological risk factors (i.e., parent-noncompliance, friend-compliance, rebelliousness, low achievement motivation, and thrill seeking) were assessed in 9th grade (age 14), two social influence risk factors (i.e., parents' and close friends' smoking) were assessed in Grades 3 (age 8) and 9 (age 14), respectively. Main Outcome Measures: Adolescent smoking transitions occurring between the 9th and 12th (ages 14-17) grade interval. Results: The probabilities contributed by each of the five psychological risk factors to the overall probability of making a specific smoking transition were: 22% to 27% for the transition from never to trying smoking, 10% to 13% for the transition from trying to monthly smoking, and, for three of the five risk factors, 11% to 16% for the transition from monthly to daily smoking. For predicting trying smoking, the probability contributed by these psychological factors was greater than the probability contributed by each parent's and close friend's smoking. Parent-compliance had a higher contribution to the probability of trying smoking when an adolescent's parent smoked (p < .05), whereas friend-compliance had a higher contribution to the probability of trying smoking when an adolescent's friend smoked (p < .001). Conclusion: These psychological and social factors have an important influence on adolescent smoking transitions. Implications for TTI and smoking prevention interventions are discussed.

Brook J; Pahl K; Morojele NK. The relationship between receptivity to media models of smoking and nicotine dependence among South African adolescents. Addiction Research & Theory 17(5): 493-503, 2009. (34 refs.)

The purpose of this study is to determine the association of receptivity to media models of smoking and nicotine dependence among South African adolescents from four ethnic groups. A stratified random sample of 731 adolescents aged 12-17 years (mean = 14.55, SD = 1.68) was drawn from Johannesburg, South Africa. A structured questionnaire was administered to the participants in their homes by trained interviewers. Receptivity to media models of smoking was assessed with a three-item Likert scale. The dependent variable, nicotine dependence, was assessed with the Fagerstrom Test for Nicotine Dependence (FTND). Regression analyses showed a positive relationship between media receptivity and nicotine dependence, with control on demographic variables and hours of TV watched by the adolescent. This relationship was found to be strongest among White adolescents and weakest among Black adolescents. Though equally receptive to media models of smoking, Black adolescents have lower FTND scores than their peers from other South African ethnic groups. This may be related to the low prevalence of images in South Africa depicting Black people smoking cigarettes. Cultural norms against smoking among Black adolescents may also serve as a protective factor.

Brown A; Moodie C. The influence of tobacco marketing on adolescent smoking intentions via normative beliefs. Health Education Research 24(4): 721-733, 2009. (56 refs.)

Using cross-sectional data from three waves of the Youth Tobacco Policy Study, which examines the impact of the UK's Tobacco Advertising and Promotion Act (TAPA) on adolescent smoking behaviour, we examined normative pathways between tobacco marketing awareness and smoking intentions. The sample comprised 1121 adolescents in Wave 2 (pre-ban), 1123 in Wave 3 (mid-ban) and 1159 in Wave 4 (post-ban). Structural equation modelling was used to assess the direct effect of tobacco advertising and promotion on intentions at each wave, and also the indirect effect, mediated through normative influences. Pre-ban, higher levels of awareness of advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, was positively related to intentions. Independent paths from perceived prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions mid- and post-ban. Advertising awareness indirectly affected intentions via the interaction between perceived prevalence and benefits pre-ban, whereas the indirect effect on intentions of advertising and promotion awareness was mediated by the interaction of perceived prevalence and benefits mid-ban. Our findings indicate that policy measures such as the TAPA can significantly reduce adolescents' smoking intentions by signifying smoking to be less normative and socially unacceptable.

Brown RA; Strong DR; Abrantes AM; Myers MG; Ramsey SE; Kahler CW. Effects on substance use outcomes in adolescents receiving motivational interviewing for smoking cessation during psychiatric hospitalization. Addictive Behaviors 34(10, Special Issue): 887-891, 2009. (39 refs.)

The purpose of this study was to compare substance involvement among psychiatrically hospitalized adolescent smokers who had received motivational interviewing (MI) versus brief advice (BA) for smoking cessation. One hundred and ninety-one (191) adolescent smokers (62.3% female; 15.4 years of age) were randomly assigned to MI (n = 116) or BA (n = 75). All patients were assessed at baseline, immediately after hospitalization, and at 1-. 3-, 6-. 9-, and 12-month follow-ups. Rates of substance use in the MI condition during follow-up increased from a low of 8.2% (SD = 18.5) to a high of 15.4% (SD = 30.0) substance use days, whereas in BA, substance use days increased from a low of 8.4% (SD = 20.8) to a high of 21.4% (SD = 35.2). The results of this study suggest that MI, relative to BA, for smoking cessation was associated with better substance use outcomes during the first 6 months following psychiatric hospitalization among adolescents. This finding is consistent with previous studies that have shown that smoking cessation does not have a detrimental effect on substance abuse treatment outcomes among youth.

Burton D; Chakravorty B; Weeks K; Flay BR; Dent C; Stacy A et al. Outcome of a tobacco use cessation randomized trial with high-school students. Substance Use & Misuse 44(7): 965-980, 2009. (18 refs.)

This study analyzed quantitative data on tobacco use and dependency for 3,589 high-school students, qualitative data for 448 students, and outcome data for a randomized trial comparing the efficacy of two cessation interventions and a control condition for 337 students. Data were collected from 1988 through 1992 in California and Illinois as part of a larger longitudinal study. Smokeless tobacco users, but not smokers, were more likely than controls to maintain cessation for 4 months: biochemically validated cessation at 4 months was 6.5% versus 3.2% for smokers and 14.3% versus 0.0% for smokeless tobacco users. Implications and limitations are discussed.

Callaghan RC; Veldhuizen S; Leatherdale S; Murnaghan D; Manske S. Use of contraband cigarettes among adolescent daily smokers in Canada. Canadian Medical Association Journal 181(6-7): 384-386, 2009. (10 refs.)

Current tobacco-control strategies seek to inhibit and reduce smoking among adolescents. However, such strategies are probably undermined by the contraband tobacco market. Using data from Canada's 2006/2007 Youth Smoking Survey, we found that 13.1% of respondents who were daily smokers reported that contraband cigarettes were their usual brand. They consumed significantly more cigarettes than respondents who smoked other brands. Contraband cigarettes accounted for about 17.5% of all cigarettes smoked by adolescent daily smokers in Canada overall, and for more than 25% in the provinces of Ontario and Quebec.

Caris L; Anthony CB; Rios-Bedoya CF; Anthony JC. Behavioral problems and the occurrence of tobacco, cannabis, and coca paste smoking in Chile: Evidence based on multivariate response models for school survey data. Drug and Alcohol Dependence 104(1-2): 50-55, 2009. (26 refs.)

Background: In this study we estimate suspected links between youthful behavioral problems and smoking of tobacco, cannabis, and coca paste. Methods: In the Republic of Chile, school-attending youths were sampled from all 13 regions of the country, with sample size of 46,907 youths from 8th to 12th grades. A Generalized Estimating Equations (GEE) approach to multiple logistic regression was used to address three interdependent response variables, tobacco smoking, cannabis smoking, and coca paste smoking, and to estimate associations. Results: Drug-specific adjusted slope estimates indicate that youths at the highest levels of behavioral problems are an estimated 1.1 times more likely to have started smoking tobacco, an estimated 1.6 times more likely to have started cannabis smoking, and an estimated 2.0 times more likely to have started coca paste smoking, as compared to youths at the lowest level of behavioral problems (p < 0.001). Conclusion: In Chile, there is an association linking behavioral problems with onsets of smoking tobacco and cannabis, as well as coca paste; strength of association is modestly greater for coca paste smoking.

Carpenter MJ; Garrett-Mayer E; Vitoc C; Cartmell K; Biggers S; Alberg AJ. Adolescent nondaily smokers: Favorable views of tobacco yet receptive to cessation. Nicotine & Tobacco Research 11(4): 348-355, 2009. (41 refs.)

Favorable views of cigarette use may be a potentiating factor that influences the progression of nicotine dependence among adolescents. Using data from the South Carolina Youth Tobacco Survey (2005-2007), a statewide two-stage cluster sample of students in Grades 6-12 (N = 7,385), we examined attitudes toward smoking and quit behaviors among adolescent smokers across a range of smoking frequencies. Compared with past-30-day nonsmokers, adolescents who smoked 1-2 days in the past month were more likely} to believe that (a) smokers have more friends, (b) smoking looks cool, and (c) it is safe to smoke in the short term and then quit, but less likely to think that (d) tobacco is as addictive as other drugs and (e) smoking few cigarettes per day is harmful. Those who smoked 1-2 days in the past month were similar to more frequent smokers, including those who smoked daily. Similar findings were found for lifetime exposure to smoking. Among those who smoked 1-2 days in the previous month, motivation to quit (54%) and incidence of quit attempts (52% in past year) were slightly higher compared with heavier smokers. Even minimal levels of cigarette use are associated with favorable views of smoking, and adolescents with minimal levels of cigarette use resemble chronic smokers in several key ways. Adolescents at very early stages of cigarette use are at significant risk for chronic use. Tobacco control efforts should capitalize on motivation to quit with focused prevention strategies that arrest the progression from nondaily to daily smoking.

Chaiton MO; Cohen JE; O'Loughlin J; Rehm J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. (review). BMC Public Health 9: 356, 2009. (77 refs.)

Background: It is well-established that smoking and depression are associated in adolescents, but the temporal ordering of the association is subject to debate. Methods: Longitudinal studies in English language which reported the onset of smoking on depression in non clinical populations (age 13-19) published between January 1990 and July 2008 were selected from PubMed, OVID, and PsychInfo databases. Study characteristics were extracted. Meta-analytic pooling procedures with random effects were used. Results:: Fifteen studies were retained for analysis. The pooled estimate for smoking predicting depression in 6 studies was 1.73 (95% CI: 1.32, 2.40; p < 0.001). The pooled estimate for depression predicting smoking in 12 studies was 1.41 (95% CI: 1.21, 1.63; p < 0.001). Studies that used clinical measures of depression were more likely to report a bidirectional effect, with a stronger effect of depression predicting smoking. Conclusion: Evidence from longitudinal studies suggests that the association between smoking and depression is bidirectional. To better estimate these effects, future research should consider the potential utility of: (a) shorter intervals between surveys with longer follow-up time, (b) more accurate measurement of depression, and (c) adequate control of confounding.

Chen PL; Huang WG; Chuang YL; Warren CW; Jones NR; Lee J et al. Exposure to and attitudes regarding secondhand smoke among secondary students in Taiwan. Asia-Pacific Journal of Public Health 21(3): 259-267, 2009. (17 refs.)

The 2003 School Health Act of Taiwan stipulated that school campuses of senior high and below should be smoke free, but data from the Global Youth Tobacco Survey show that the majority of students are exposed to smoke in public and at home. More than 50% of nonsmokers indicated that they had been exposed to secondhand smoke (SHS) in public places, with the exposure rate as high as 90% among smokers. More than 40% of junior and senior high school students were exposed to SHS at home. Support for banning smoking in public places ranged from almost 60% to almost 80%. More than 60% of current smokers and almost 90% of never smokers think that smoke from others is harmful to them. With a clear body of evidence detailing the harmful effects, reduction and eventual elimination of exposure to SHS should be the goal of the tobacco control community.

Davis KC; Farrelly MC; Messeri P; Duke J. The impact of national smoking prevention campaigns on tobacco-related beliefs, intentions to smoke and smoking initiation: Results from a longitudinal survey of youth in the United States. International Journal of Environmental Research and Public Health 6(2): 722-740, 2009. (27 refs.)

The National Truth (R) campaign has exposed U. S. youth to antismoking messages since 2000. Tobacco industry-sponsored campaigns, such as. Think. Don't Smoke. (TDS), have also aired nationally. We examine the effects of recall of the truth (R) and TDS campaigns on changes in tobacco-related beliefs, intentions, and smoking initiation in a longitudinal survey of U. S. youth. Recall of truth (R) was associated with increased agreement with antismoking beliefs, decreased smoking intentions, and lower rates of smoking initiation. Recall of TDS was associated with increased intentions to smoke soon but was not significantly associated with tobacco beliefs or smoking initiation among youth overall.

de Dios MA; Vaughan EL; Stanton CA; Niaura R. Adolescent tobacco use and substance abuse treatment outcomes. Journal of Substance Abuse Treatment 37(1): 17-24, 2009. (31 refs.)

This study investigated the relationship between cigarette-smoking status and 12-month alcohol and marijuana treatment outcomes in a sample of 1,779 adolescents from the Drug Abuse Treatment Outcomes Study for Adolescents. Participants were classified into four groups based on change in cigarette-smoking status from intake to the 12-month follow-up: persistent smokers, nonsmokers, quitters, and smoking initiators. Logistic regression was used to predict likelihood of relapse to alcohol, marijuana, and other drugs after controlling for intake levels and demographic/treatment characteristics. Results found persistent smokers and smoking initiators to have significantly greater odds of alcohol and marijuana relapse compared with quitters, Furthermore, persistent smokers and smoking initiators were also found to have distinctively shorter periods to marijuana relapse at follow-up. Implications for the implementation of tobacco cessation treatment in the context of substance abuse treatment for adolescents are discussed.

de Leeuw RNH; Engels RCME; Vermulst AA; Scholte RHJ. Relative risks of exposure to different smoking models on the development of nicotine dependence during adolescence: A five-wave longitudinal study. Journal of Adolescent Health 45(2): 171-178, 2009. (40 refs.)

Purpose: Many studies have focused upon predictors of smoking onset and continuation in adolescents. However, less is known about the development of nicotine dependence (ND) and how smoking in the interpersonal environment relates to this. To examine which smoking models have the largest impact on the development of ND, we examined the relative impact of current smoking from fathers, mothers, siblings, best friends, and friend groups on the development of ND in adolescents. Methods: Data were used from five annual waves of the "Family and Health" survey project. At baseline 428 adolescents (mean age = 15.2 years; SD = .60), both their parents, and their siblings were participating. In this study we included only smoking adolescents (n = 175). To assess the individual development of ND of each adolescent, and whether current smoking exposure affected changes from baseline across time, we used latent growth curve modeling (LGC). Results: Findings revealed that smoking of sibling and best friend were related to baseline levels of ND, but not to the rates of change over time. Of all models, only having smoking friends in the friend group was related to a faster development of ND. Conclusions: The current findings highlight the key role of smoking friends in the development of ND and suggest that interventions targeting at peers are probably effective in reducing the prevalence of ND symptoms among adolescents.

Dickmann PJ; Mooney ME; Allen SS; Hanson K; Hatsukami DK. Nicotine withdrawal and craving in adolescents: Effects of sex and hormonal contraceptive use. Addictive Behaviors 34(6-7): 620-623, 2009. (26 refs.)

While sex differences in the nicotine withdrawal (NW) symptoms and craving (NC) have been extensively described in adult cigarette smokers, few studies have investigated these phenomena in adolescents. We investigated the effect of gender and hormonal contraception (HC) on NW and NC during the first 14 days of cessation in adolescent smokers using data from a randomized, placebo-controlled, double-blind trial of the transdermal nicotine replacement therapy for smoking cessation. Analyses showed similar levels of NW severity in males and females, regardless of HC use. However, significantly higher NC was observed in females compared to males, (2.22 +/- 0.12 vs. 1.65 +/- 1.14; p = 0.003). Further. females not using HC reported the highest level of NC (2.38 +/- 0.16) followed by females using HC (2.08 +/- 0.25) and males (1.71 +/- 0.16; p = 0.007). The current findings suggest that adolescent females experience similar NW severity to males, but have stronger NC. Further, the use of hormonal contraceptives may impact the severity of craving. Addressing these different symptoms in adolescents may be useful in increasing smoking cessation rates in this special population of smokers.

DiNapoli PP. Early initiation of tobacco use in adolescent girls: Key sociostructural influences. Applied Nursing Research 22(2): 126-132, 2009. (14 refs.)

Background: An important developmental task during adolescence is ego development. Millions of adolescents choose to initiate cigarette smoking at a young age as a result of transitional conflicts during this phase of normal developmental progression. Unfortunately, the decision to use tobacco compromises both the short- and long-term health status of smokers as well as the health of those around them. Objective: It was hypothesized that in early adolescence, girls choose to begin smoking cigarettes as a result of sociostructural influences, including media, peers, and family. The purpose of this study was to investigate what modifiable sociostructural variables will decrease the risk of initiating cigarette smoking before the age of 12 years among adolescent girls. The aim of the study was to develop a risk reduction model that increases the likelihood of healthy behavior choices in girls during early adolescence. Method: Data collected for the New Hampshire Teen Assessment Project survey were used for this secondary data analysis. The original study included a multicommunity sample of 7,648 students from eight school districts enrolled in New Hampshire schools between January 2000 and October 2001. This current analysis focused only on the health behavior of the adolescent girls enrolled in the larger study (n = 3,775). With the use of a socioecological theoretical framework as a guide, this secondary data analysis first identified correlates of the early initiation of tobacco use using Pearson's correlations. Then, the data were explored for variables that decreased the relative fisk for the early initiation of cigarette smoking among adolescent girls. The dependent variable of interest (i.e., early initiation of tobacco use) referred to girls who reported having smoked their first cigarette at or before the age of 12 years. Twenty-eight percent of the sample had initiated tobacco use before they were 12 years old. Multiple logistic regression was used to predict the final risk reduction model. Results: The first level of analysis confirmed previously reported evidence that there is a correlation between adolescent girls' initiation of smoking early (n = 1,047) and their engagement in other health risk behaviors such as daily use of alcohol (n = 859), daily use of marijuana (93%), and engaging in unprotected intercourse (15%). Next, logistic regression was used to predict a risk reduction model that demonstrated the importance of community, family, and school variables in decreasing the relative risk for the early initiation of tobacco use. Those sociostructural variables that decrease the relative risk for the initiation of tobacco use were noted in the following: (1) 71% of the girls who feel that it is important to contribute to their community (odds ratio [OR] = 1.71, 95% confidence interval [CI] = 1.31-2.23) are less likely to initiate tobacco use and (2) 54% of the girls are more likely to feel that their community is a good place to live in (OR = 1.54, 95% CI = 1.201.97), are more than twice as likely to have parents who think smoking is wrong (OR = 2.09, 95% CI = 1.77-2.48). are 9% more likely to have parents whom they can talk to when they have personal problems (OR = 1.09, 95% CI = 1.02-1.17), and are 38% more likely to enjoy school. Discussion: The findings of this study may be an important portal for prevention intervention in the area of early adolescent tobacco use. A risk reduction model is presented based on the theory that both the environment and modeling play an important role in the development of health behavior.

Dwyer JB; McQuown SC; Leslie FM. The dynamic effects of nicotine on the developing brain. (review). Pharmacology & Therapeutics 122(2): 125-139, 2009

Nicotinic acetylcholine receptors (nAChRs) regulate critical aspects of brain maturation during the prenatal, early postnatal, and adolescent periods. During these developmental windows, nAChRs are often transiently upregulated or change subunit composition in those neural structures that are undergoing major phases of differentiation and synaptogenesis, and are sensitive to environmental stimuli. Nicotine exposure, most often via tobacco smoke, but increasingly via nicotine replacement therapy, has been shown to have unique effects on the developing human brain. Consistent with a dynamic developmental role for acetylcholine, exogenous nicotine produces effects that are unique to the period of exposure and that impact the developing structures regulated by acetylcholine at that time. Here we present a review of the evidence, available from both the clinical literature and preclinical animal models, which suggests that the diverse effects of nicotine exposure are best evaluated in the context of regional and temporal expression patterns of nAChRs during sensitive maturational periods, and disruption of the normal developmental influences of acetylcholine. We present evidence that nicotine interferes with catecholamine and brainstem autonomic nuclei development during the prenatal period of the rodent (equivalent to first and second trimester of the human), alters the neocortex, hippocampus, and cerebellum during the early postnatal period (third trimester of the human), and influences limbic system and late monoamine maturation during adolescence.

Evans WD; Uhrig J; Davis K; McCormack L. Efficacy methods to evaluate health communication and marketing campaigns. Journal of Health Communication 14(4): 315-330, 2009. (53 refs.)

Communication and marketing are growing areas of health research, but relatively few rigorous efficacy studies have been conducted in these fields. In this article, we review recent health communication and marketing efficacy research, present two case studies that illustrate some of the considerations in making efficacy design choices, and advocate for greater emphasis on rigorous health communication and marketing efficacy research and the development of a research agenda. Much of the outcomes research in health communication and marketing, especially mass media, utilizes effectiveness designs conducted in real time, in the media markets or communities in which messages are delivered. Such evaluations may be impractical or impossible, however, imiting opportunities to advance the state of health communication and marketing research and the knowledge base on effective campaign strategies, messages, and channels. Efficacy and effectiveness studies use similar measures of behavior change. Efficacy studies, however, offer greater opportunities for experimental control, message exposure, and testing of health communication and marketing theory. By examining the literature and two in-depth case studies, we identify advantages and limitations to efficacy studies. We also identify considerations for when to adopt efficacy and effectiveness methods, alone or in combination. Finally, we outline a research agenda to investigate issues of internal and external validity, mode of message presentation, differences between marketing and message strategies, and behavioral outcomes.

Fields S; Collins C; Leraas K; Reynolds B. Dimensions of impulsive behavior in adolescent smokers and nonsmokers. Experimental and Clinical Psychopharmacology 17(5): 302-311, 2009. (53 refs.)

Robust associations have been identified between impulsive personality characteristics and cigarette smoking during adolescents, indicating that impulsive behavior may play an important role in the initiation of cigarette smoking. The present study extended this research by using laboratory behavioral assessments to explore relationships between three specific dimensions of impulsive behavior (impulsive decision-making, inattention, and disinhibition) and adolescent cigarette smoking. Participants were male and female adolescent smokers (n = 50) and nonsmokers (n = 50). Adolescent smokers were more impulsive on a measure of decision-making; however, there were significant smoking status by gender interaction effects for impulsive inattention and disinhibition. Male smokers were most impulsive on the measure of inattention, but male smokers were least impulsive on the measure of disinhibition. Correlations between biomarkers of smoking and impulsive inattention and disinhibition were found for females but not males. The current findings, coupled with previous findings (Reynolds et al., 2007), indicate there may be robust gender difference in associations between certain types of impulsive behavior and cigarette smoking during adolescence.

Gallus S; Tramacere I; Zuccaro P; Colombo P; La Vecchia C. Tobacco sales to minors in Italy. Tumori 95(3): 283-285, 2009. (14 refs.)

Aims and background. One of the strategies to control tobacco is to limit purchase of cigarettes to minors. To understand the attitudes of Italian adults towards regulations to prevent minors from purchasing tobacco products, we added specific questions to the annual Survey on Smoking in Italy. Methods. During March-April 2007, we conducted a survey on smoking on 3,057 Subjects representative of the Italian population aged >= 15 years. Two specific questions were included, one investigating the attitudes towards the proposed legislation prohibiting purchase of tobacco to individuals under 18 years of age (instead of 16 years) as a policy to reduce smoking prevalence and consumption. The second question asked whether the current tobacco sales-to-minors law was observed. Results. Overall, 78% of Italians believed that a restriction of the current tobacco sales-to-minors law Could be moderately to extremely effective as a strategy to decrease smoking prevalence and consumption. More than 90% of Italians reported that they had never seen in their lifetime a retailer refusing to sell cigarettes to an adolescent or requesting the minor's identification or age. Conclusions. A restriction of the legislation, increasing to 18 years the minimum age for purchasing tobacco, would limit access to tobacco products by minors, only if adopted together with systematic and effective enforcement measures.

Gansky SA; Ellison JA; Kavanagh C; Isong U; Walsh MM. Patterns and correlates of spit tobacco use among high school males in rural California. Journal of Public Health Dentistry 69(2): 116-124, 2009. (39 refs.)

Objective: To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California. Methods: An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator. Results: Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with < 6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity x smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking. Conclusion: Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.

Gardner PD; Tapper AR; King JA; DiFranza JR; Ziedonis DM. The neurobiology of nicotine addiction: Clinical and public policy implications. (review). Journal of Drug Issues 39(2): 417-441, 2009. (103 refs.)

Clinicians, social scientists, researchers, and policy makers appreciate the need to understand the neurobiology of nicotine addiction and how this information can lead to new treatments and provide support for public policy debates on parity and preventing adolescent tobacco use. In a "bench-to-bedside" manner, this review covers both clinical and basic science perspectives. Both the reward and sensitization-homeostasis theories of nicotine addiction are supported by new understanding of clinical issues of rapid tolerance, withdrawal, sensitization, and craving when examined by functional brain imaging, genetics, and basic science studies of nicotinic acetylcholine receptors. This review provides information to help shape public policy, fight stigma, and improve clinical treatment and research. The fight for parity in health care requires education about the neurobiological basis of addiction versus the stigmatized bad habit or simple socialization. Parity must support reimbursement for nicotine replacement medications or other FDA approved medications and psychosocial treatments.

Greene K; Banerjee SC. Examining unsupervised time with peers and the role of association with delinquent peers on adolescent smoking. Nicotine & Tobacco Research 11(4): 371-380, 2009. (52 refs.)

This study explored the association between unsupervised time with peers and adolescent smoking behavior both directly and indirectly through interaction with delinquent peers, social expectancies about cigarette smoking, and cigarette offers from peers. A cross-sectional survey was used for the study and included 248 male and female middle school students. Results of structural equation modeling revealed that unsupervised time with peers is associated indirectly with adolescent smoking behavior through the mediation of association with delinquent peers, social expectancies about cigarette smoking, and cigarette offers from peers. Interventions designed to motivate adolescents without adult supervision to associate more with friends who engage in prosocial activities may eventually reduce adolescent smoking. Further implications for structured supervised time for students outside of school time are discussed.

Guo B; Aveyard P; Fielding A; Sutton S. The factor structure and factorial invariance for the decisional balance scale for adolescent smoking. International Journal of Behavioral Medicine 16(2): 158-163, 2009. (23 refs.)

The transtheoretical model is a framework to explain smoking uptake and cessation in adolescence. Decisional balance is proposed as a driver of stage movement. The purpose of this study was to examine the factor structure and measurement equivalence/invariance (ME/I) of the decisional balance scale. In this study, we used confirmatory factor analysis followed by measurement equivalence/invariance testing to examine the factorial validity of the decisional balance scale in adolescent smokers and nonsmokers. Unlike previous studies, we found that a four-factor solution splitting cons into esthetic and health cons significantly improved the fit of model to the data. ME/I testing showed that the same structure and measurement model held for both smokers and nonsmokers, girls and boys, and across the three occasions the scale was administered. Cons showed strong evidence that it constituted two separate first order factors. Decisional balance for smoking in adolescence has good evidence of factorial validity.

Heikkinen AM; Broms U; Pitkaniemi J; Koskenvuo M; Meurman J. Key factors in smoking cessation intervention among 15-16-year-olds. Behavioral Medicine 35(3): 93-99, 2009. (52 refs.)

The authors aimed to investigate factors associated with smoking cessation among adolescents after tobacco intervention. They examined smokers (n = 127), from one birth cohort (n = 545) in the city of Kotka in Finland. These smokers were randomized in 3 intervention groups the dentist (n = 44) and the school nurse (n = 42 groups), and a control group (n = 39). After 2 months, the authors sent a follow-up questionnaire to the initial smokers to find out who had quit. The authors found that those whose best friend was a nonsmoker were more likely to stop smoking (relative risk RR 7.0 95% Cl 4.6-10.7). Moreover, the nicotine-dependent participants (measured according to the Fagerstrom Test for Nicotine Dependence(36)) were less likely to stop (RR 0.1 95% Cl 0.08-0.11) compared to non-nicotine dependent participants. Last, of the diurnal types, the morning types found it easier to quit smoking than the evening types (RR 2.2 95% Cl 1.4-3.6). Thus, the authors concluded that the best friend's influence, nicotine dependence, and diurnal type could be taken more into account in individual counseling on smoking cessation.

Huang CL; Cheng CP; Lin HH; Lu CC. Psychometric testing of the Chinese version of the Hooked on Nicotine Checklist in adolescents. Journal of Adolescent Health 45(3): 281-285, 2009. (33 refs.)

Purpose: To examine the psychometric properties of the Hooked on Nicotine Checklist (HONC) on a Taiwanese sample. The HONC as a measure of nicotine dependence in adolescents is in worldwide use. Less is known regarding its psychometric properties for a Chinese population. Methods: A cross-sectional, descriptive study was conducted from January to May 2008 with 373 male adolescent smokers aged 15 to 20 years. The criterion validity of the Chinese HONC was determined using the Fagerstrom Test of Nicotine Dependence (FTND) and saliva cotinine. Because the responses to the items are dichotomous, the validity and factorial structures were examined using tetrachoric and biserial techniques by PRELIS 2 and LISREL 8.7. Results: Most of interitem correlations are between 0.3 and 0.7. Each item is highly associated with the full scale (r > .7). The HONC total score is significantly associated with the FTND (r = .58, p < .01) and with saliva cotinine levels (r = .27, p < .05). Confirmatory factor analyses were performed to compare the relative fit of three competing models. The three-correlated factor model has a better fit than other models, according to the cutoff criteria for relatively good fit. The coefficient alpha of the full scale is .83. Conclusions: The Chinese version of the HONC is a reliable and valid measure of tobacco dependence in adolescent smokers. Studies involving female adolescent and younger smokers will be needed to evaluate the applicability of the scales to the different genders and age populations.

Hublet A; Schmid H; Clays E; Godeau E; Gabhainn SN; Joossens L et al. Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries. Addiction 104(11): 1918-1926, 2009. (44 refs.)

Aims: To investigate the associations between well-known, cost-effective tobacco control policies at country level and smoking prevalence among 15-year-old adolescents. Design: Multi-level modelling based on the 2005-06 Health Behaviour in School-aged Children Study, a cross-national study at individual level, and with country-level variables from the Tobacco Control Scale and published country-level databases. Setting: Twenty-nine European countries. Participants: A total of 25,599 boys and 26,509 girls. Main outcome measures: Self-reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous). Findings: Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross-national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi-level model for boys, besides the significance of the individual variables such as family affluence, country-level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = -0.010; b(partial restriction vending machines) = -0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = -0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = -0.372, P = 0.06]. Conclusions: For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.

Huizink AC; Greaves-Lord K; Oldehinkel AJ; Ormel J; Verhulst FC. Hypothalamic-pituitary-adrenal axis and smoking and drinking onset among adolescents: The longitudinal cohort TRacking Adolescents' Individual Lives Survey (TRAILS). Addiction 104(11): 1927-1936, 2009. (46 refs.)

Aims: We examined within a prospective longitudinal study whether cortisol levels were associated with smoking or drinking behaviours, taking parental substance use into account. Design: The influence of parental substance use on cortisol levels of their adolescent offspring at age 10-12 years was examined. Next, cortisol levels of adolescents who initiated smoking or drinking at the first data collection (age 10-12) were compared to non-users. Finally, we examined whether cortisol levels could predict new onset and frequency of smoking and drinking 2 years later. Setting and participants First and second assessment data of the TRacking Adolescents' Individual Lives Survey (TRAILS) were used, including 1768 Dutch adolescents aged 10-12 years, who were followed-up across a period of 2 years. Measurements: Cortisol was measured in saliva samples at awakening, 30 minutes later, and at 8 p.m. at age 10-12. Self-reported substance use at age 10-12 and 13-14, and parental self-reported substance use were used. Findings: Only maternal substance use was related to slightly lower adolescent cortisol levels at 8 p.m. Both maternal and paternal substance use were associated with adolescent smoking and drinking at age 13-14, although fathers' use only predicted the amount used and not the chance of ever use. Finally, higher cortisol levels were related moderately to current smoking and future frequency of smoking, but not to alcohol use. Conclusions: In a general population, parental heavy substance use does not seem to affect cortisol levels consistently in their offspring. We found some evidence for higher, instead of lower, hypothalamic-pituitary-adrenal axis activity as a predictor of smoking in early adolescence.

Jarrett T; Horn K; Zhang JJ. Teen perceptions of facilitator characteristics in a school-based smoking cessation program. Journal of School Health 79(7): 297-303, 2009. (27 refs.)

Facilitators are often responsible for the implementation of public health programs, yet little is known about how they influence outcomes. Not-On-Tobacco (N-O-T) is a youth smoking-cessation program implemented by trained facilitators. The purpose of this study was to investigate teens' perceptions of facilitator characteristics and the relationship between those perceptions and program outcomes. Data were collected from N-O-T participants aged 14 to 19 who completed a survey about perceptions of facilitator characteristics that were linked to program outcomes 3 months post-baseline (n = 769). Eight facilitator characteristics were ordered, based on importance to participants. Chi-square tests measured differences in perceptions of facilitator characteristics according to race and sex, and an aggregate facilitator favorability score was created and analyzed in relation to program outcomes (smoking reduction or cessation vs increase/no change). Logistic regression was used to analyze facilitator characteristics' relationship to outcomes, controlling for race and sex. Participants rated facilitator characteristics of trustworthy, cares about students, and confidential as most important. Girls consistently ranked facilitator characteristics as more important than did boys. There were few significant differences based on race, except that white students rated nonjudgmental to be more important than did nonwhite students. There were no significant findings from the logistic regression, but there was a significant relationship between the aggregate facilitator favorability score and favorable changes in smoking outcomes (reduction or cessation). This study provides insights into the facilitator characteristics that are important to teen participants. It demonstrates that teens' overall perceptions of facilitators contribute to their perception of how the program contributes to their success and program outcomes.

Joffe A; McNeely C; Colantuoni E; An MW; Wang WW; Scharfstein D. Evaluation of school-based smoking-cessation interventions for self-described adolescent smokers. Pediatrics 124(2): E187-E194, 2009. (21 refs.)

OBJECTIVE: The goal was to compare the efficacy of school-based, multisession, group smoking-cessation interventions versus a single group session in increasing quit rates among adolescent smokers. METHODS: Eight schools were assigned randomly to use 1 of 2 group smoking-cessation programs previously shown to increase quit rates among adolescents (Not on Tobacco [NOT] or Kickin' Butts). We reformatted the programs to twice-weekly 25- to 30-minute sessions delivered during lunch periods. Smoking status was assessed at end of program (EOP) and 1, 3, 6, and 12 months later. Self-reported quit status was confirmed with salivary cotinine levels. RESULTS: A total of 407 students (56% black and 52% female; mean age: 16 years) participated. Kickin' Butts participants were no more likely to quit than control subjects. In the conservative analysis (students with missing follow-up data classified as smokers), NOT participants were 1.92 times (95% confidence interval [CI]: 1.09-3.40 times) more likely to self-report quitting at 1 month. In the Bayesian analysis ( missing follow-up data imputed by using all available data), NOT participants were significantly more likely than control subjects to self-report quitting at EOP (relative risk [RR]: 1.26 [95% CI: 1.10-1.43]), 1 month (RR: 2.07 [95% CI: 1.68-2.56]), and 12 months (RR: 1.58 [95% CI: 1.22- 2.04]). Cotinine-confirmed quit rates were significantly greater among NOT participants, compared with control subjects, at EOP and 1 month. CONCLUSIONS: The reformatted NOT program had a modest effect on adolescents interested in quitting. Kickin' Butts, as reformatted for this project, did not have any effect on quit rates.

Johnson JL; Eaton DK; Pederson LL; Lowry R. Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students. Journal of School Health 79(8): 355-360, 2009. (22 refs.)

BACKGROUND: Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States. METHODS: Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2). RESULTS: In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not. CONCLUSION: Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Kaestle CE. How girls and boys get tobacco: Adults and other sources. Journal of Adolescent Health 45(2): 208-210, 2009. (10 refs.)

This study of current tobacco users from the 2005 Virginia Youth Tobacco Survey (N = 426) finds that girls were significantly more likely to receive cigarettes for free, particularly from adults, and were also more likely to receive cigars or cigarillos for free, but were more likely to buy smokeless tobacco from a store compared to boys.

Kandel DB; Hu MC; Yamaguchi K. Sequencing of DSM-IV criteria of nicotine dependence. Addiction 104(8): 1393-1402, 2009. (25 refs.)

Aims: To determine whether there is a sequence in which adolescents experience symptoms of nicotine dependence (ND) as per the DSM-IV. Design: A two-stage design was implemented to select a multi-ethnic target sample of adolescents from a school survey of 6th-10th graders from the Chicago Public Schools. The cohort was interviewed at home five times with structured computerized interviews at 6-month intervals over a 2-year period. Participants: Subsample of new tobacco users (n = 353) who had started to use tobacco within 12 months prior to wave 1 or between waves 1 and 5. Measurements and statistical methods Monthly histories of DSM-IV symptoms of ND were obtained. Log-linear quasi-independence models were estimated to identify the fit of different cumulative models of progression among the four most prevalent dependence criteria (tolerance, impaired control, withdrawal, unsuccessful attempts to quit), indexed by specific symptoms, by gender and race/ethnicity. Findings: Pathways varied slightly across groups. The proportions who could be classified in a progression pathway not by chance ranged from 50.7% to 68.8%. Overall, tolerance and impaired control appeared first and preceded withdrawal; impaired control preceded attempts to quit. For males, tolerance was experienced first, with withdrawal a minor path of entry; for females withdrawal was experienced last, tolerance and impaired control were experienced first. For African Americans, tolerance by itself was experienced first; for other groups an alternative path began with impaired control. Conclusions: The prevalence and sequence of criteria of ND fit our understanding of the neuropharmacology of ND. The order among symptoms early in the process of dependence may differ from the severity order of symptoms among those who persist in smoking.

Kaplan CP; Nguyen TT; Weinberg V. Longitudinal study of smoking progression in Chinese and Vietnamese American adolescents. Asian Pacific Journal of Cancer Prevention 9(2): 335-341, 2008. (41 refs.)

The use of tobacco remains a significant public health concern among Asian American (AA) adolescents. Understanding the factors that affect smoking progression among Chinese and Vietnamese adolescents in particular, may help in illuminating potential interventions that can be implemented to maximize scarce programming and resources. This study is a longitudinal cohort study with data collected in California via telephone over a two-year period. 1,270 Chinese and Vietnamese American adolescents were recruited via telephone listings from one southern and four northern California counties. Main outcomes were smoking susceptibility and change in smoking status. Examination of these adolescents indicated that in both groups: boys were more likely than girls to become susceptible to smoking, risk behaviors were associated with becoming smokers, having been susceptible at baseline was associated with susceptibility and smoking at follow-up, and the influence of friends was a predictor of susceptibility and smoking.

Kealey KA; Ludman EJ; Marek PM; Mann SL; Bricker JB; Peterson AV. Design and implementation of an effective telephone counseling intervention for adolescent smoking cessation. Journal of The National Cancer Institute 101(20): 1393-1405, 2009. (85 refs.)

Effective smoking cessation for youth is urgently needed, but the literature guiding such efforts is nascent. We evaluated the implementation of a proactive intervention for adolescent smoking cessation that incorporated motivational interviewing (MI) and cognitive behavioral skills training (CBST). We proactively identified 1058 smokers via classroom survey of enrolled juniors in 25 experimental high schools. After parental consent was obtained, trained counselors telephoned participants to invite their participation and deliver personalized smoking cessation counseling that combined MI and CBST. Implementation quality was assessed via weekly supervision of counselors, monitoring of counselor adherence to protocol via review of 5% of each counselor's calls, and formal evaluation of counselor fidelity to MI via review of a random sample of 19.8% of counseling calls using the Motivational Interviewing Treatment Integrity Code. Among identified smokers, 948 (89.6%) were eligible for intervention by age (>= 18 years) or parental consent, 736 (70%) agreed to participate in telephone counseling, 691 (65%) completed one or more counseling calls, and 499 (47%) completed all planned calls. Telephone delivery of the personalized MI and CBST counseling intervention to a general population of adolescents was done with greater than 90% adherence to the intervention protocol. Review of the random sample of counselors' calls demonstrated that more than 85% of counselors' calls met or exceeded benchmark scores for four of six evaluated behaviors: MI spirit (99.1%), empathy (96.2%), ratio of reflections to questions (97.2%), and MI adherent (85.7%). An effective proactive telephone counseling intervention consisting of MI and CBST can be successfully implemented with reach and fidelity in a general population of adolescent smokers.

Khader A; Shaheen Y; Turki Y; el Awa F; Fouad H; Warren CW et al. Tobacco use among Palestine refugee students (UNRWA) aged 13-15. Preventive Medicine 49(2-3): 224-228, 2009. (14 refs.)

Objective. The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon. Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation. Methods. Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population. Results. In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%. Conclusions. The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.

Kim MJ; Fleming CB; Catalano RF. Individual and social influences on progression to daily smoking during adolescence. Pediatrics 124(3): 895-902, 2009. (33 refs.)

OBJECTIVES: The goal was to identify individual and social predictors of progression to daily smoking by the end of high school among youths who initiated smoking by grade 8. METHODS: The analysis sample of 270 adolescent smokers was taken from the Raising Healthy Children project. Data were taken from annual interviews in grades 7 and 12. Daily smoking was defined as having smoked >= 1 cigarette per day in the past 30 days at the time of each interview. Discrete-time survival analysis was used to assess associations with individual, family, peer, and school predictors. RESULTS: A total of 58% (n = 156) of the analysis sample made the transition to daily smoking by grade 12. The likelihood of onset of daily smoking among those who had not yet demonstrated onset was smallest in grade 9 (probability: 0.12) and greatest in grade 12 (probability: 0.25). Youth depression, prosocial beliefs, and antisocial behavior had overall associations with risk of smoking escalation. In addition, parents' and peers' smoking, family management, academic grades, and school commitment had significant univariate associations with smoking progression. After adjustment for gender, low-income status, and other potential predictors, youths' antisocial behavior and parents' and peers' smoking predicted greater likelihood of escalation to daily smoking, whereas parental use of positive family management predicted lower likelihood of escalation. CONCLUSIONS: This study supports preventing escalation in adolescent smoking by targeting parents' and peers' smoking and involvement in other forms of antisocial behavior and working with parents to improve their use of positive family management practices.

Knudsen HK. Smoking cessation services in adolescent substance abuse treatment: Opportunities missed? Journal of Drug Issues 39(2): 257-276, 2009. (54 refs.)

The majority of adolescents receiving substance abuse treatment also use tobacco, yet there are few data regarding the adoption of tobacco use assessment and smoking cessation services by adolescent treatment programs. Using data from a national sample of adolescent-only treatment programs (n = 154), this research measures the adoption of aspects of assessment and treatment from the Public Health Service's (2000) guideline, Treating Tobacco Use and Dependence. When adoption of four intake/assessment practices was measured, adoption appeared high, but only 45% of programs had adopted all four practices. About 43% of programs offered some type of smoking cessation services. However, there was no association between adoption of intake procedures and the odds of availability of smoking cessation services, suggesting a lack of connection between the identification of treatment needs and the availability of services. The lack of smoking cessation services may represent a missed opportunity for early intervention with this population.

Lai HK; Ho SY; Wang MP; Lam TH. Secondhand smoke and respiratory symptoms among adolescent current smokers. Pediatrics 124(5): 1306-1310, 2009. (13 refs.)

OBJECTIVE: No study has ever reported the association between persistent respiratory symptoms and exposure to secondhand smoke (SHS) in adolescent smokers. The impact of SHS exposure on child health could be largely underestimated by not taking into account such effects. We investigated the association between exposure to SHS and respiratory symptoms among adolescent current smokers. METHODS: A total of 32 506 students aged 11 to 20 years from 85 randomly selected secondary schools in Hong Kong completed a self-administered questionnaire that included persistent respiratory symptoms (for 3 consecutive months in the past 12 months), number of days of SHS exposure per week at home and outside home, smoking status, amount of active smoking, and other basic demographic characteristics and socioeconomic status. RESULTS: Adolescent current smokers who were exposed to SHS at home 1 to 4 and 5 to 7 days/wk were 50% (95% confidence interval [CI]: 3%-121%) and 77% (95% CI: 5%-199%) more likely, respectively, to report respiratory symptoms compared with those who were unexposed (P = .01 for trend). The corresponding figures for exposure outside home were 41% (95% CI: 3%-94%) and 85% (95% CI: 31%-161%; P = .004 for trend). Such associations were also observed among never-smokers, but they were weaker than those among current smokers (P = .01 for interaction). CONCLUSIONS: This is the first evidence that SHS exposure is associated with increased risks for persistent respiratory symptoms among adolescent current smokers. Health promotion programs should aim at SHS reduction as well as smoking cessation among adolescent smokers.

Lee A; Wong SYS; Tsang KK; Ho GSM; Wong CW; Cheng F. Understanding suicidality and correlates among Chinese secondary school students in Hong Kong. Health Promotion International 24(2): 156-165, 2009

Suicide has become a leading cause of mortality and morbidity for adolescents in Hong Kong. This study investigated the factors associated with suicidal ideation and attempt among the secondary school students in Hong Kong by studying a representative sample of 3383 students with a self-administered questionnaire and analysed by multiple logistic regressions analysis. Youth risk behaviours, such as heavy smoking, episodic heavy alcohol drinking, early sexual experience, and feeling hopeless, were found to be associated with both suicidal thoughts and attempts, with 'misuse of drugs' as discriminating factor that solely related to attempt and 'involvement in physical fight' solely related to suicidal thoughts. Addition of suicidal ideation is a significant explanatory variable of suicidal attempt over and above health risk behaviours. Stratified analysis of upper and lower secondary students would give better understanding of significance of various risk factor for different age groups. The disturbing prevalence of suicidal behaviour and its coexistence with other high-risk behaviour in secondary school students have implications for teachers, youth workers and public health practitioners to develop and evaluate programmes for suicide prevention.

Lim KH; Sumarni MG; Amal NM; Hanjeet K; Rozita WMW; Norhamimah A. Tobacco use, knowledge and attitude among Malaysians age 18 and above. Tropical Biomedicine 26(1): 92-99, 2009. (24 refs.)

This study aims to determine the level of knowledge and to understand their attitude towards smoking and secondly to determine how sociodemographic background, smoking status and knowledge on the health risks of smoking contribute toward the development of such attitude. A total of 10,545 respondents age 18 years and above across Malaysia were interviewed. Results indicated that level of knowledge and attitude varied by gender, education level, smoking status, age, ethnicity and smoker category. Smokers' low education, poor knowledge on the dangers of smoking and being males had more positive or greater impact on their attitudes towards smoking. Formulation and implementation of a holistic programme aimed at increasing knowledge and attitude change that accounts for sociodemographic background of the population is recommended in order to bring down smoking rates and thus reduce smoking related health problems in this country.

Lipperman-Kreda S; Grube JW. Students' perception of community disapproval, perceived enforcement of school antismoking policies, personal beliefs, and their cigarette smoking behaviors: Results from a structural equation modeling analysis. Nicotine & Tobacco Research 11(5): 531-539, 2009. (37 refs.)

Introduction: School tobacco use policies are often considered to be part of a comprehensive approach to preventing or reducing adolescent cigarette smoking. However, little is known about the relationships between such policies and adolescents' smoking behaviors or the mechanisms by which any such influence may occur. The present study tested a conceptual model that specifies possible direct and indirect relationships among community norms, school antismoking policies, adolescents' personal smoking beliefs, and cigarette smoking behaviors. Methods: This study used data from 17,256 middle and high school students who participated in the 2006 Oregon Health Teens Survey. Results: Structural equation modeling indicated that perceived enforcement of school policy was directly and positively related to perceived community norms. In addition, adolescents' personal beliefs appeared to mediate the relationship between perceived enforcement of school antismoking policies and past-30-day cigarette smoking. School policies, in turn, partially mediated the relationship between community norms and smoking beliefs. Discussion: The results of this study provide a better understanding of how community norms and school antismoking policies may affect adolescents' cigarette smoking.

Lipperman-Kreda S; Paschall MJ; Grube JW. Perceived enforcement of school tobacco policy and adolescents' cigarette smoking. Preventive Medicine 48(6): 562-566, 2009. (28 refs.)

Objectives. School tobacco use policies are part of a comprehensive strategy for preventing or reducing adolescent cigarette smoking. This study examines the relationship between perceived tobacco policy enforcement at the school level and smoking behaviors among students. Methods. 21,281 middle and high school students of 255 schools participated in the 2006 Oregon Health Teens Survey. Multilevel logistic regression was conducted, using a school-level policy enforcement measure based on aggregated student reports, and individual-level characteristics (e.g., age, gender, cigarette smoking before age 12, personal beliefs about smoking) as predictors of past-30-day cigarette smoking behaviors (e.g., any smoking, daily smoking, heavy episodic smoking, smoking on school property). Results. Higher levels of perceived enforcement of anti-smoking policy at the school level were inversely associated with the prevalence of past-30-day smoking behaviors, independent of individual-level predictors. Conclusions. Stricter enforcement of school policies against tobacco use may help prevent or reduce adolescents' cigarette smoking on and outside of school property.

Liu H; Tan W. The effect of anti-smoking media campaign on smoking behavior: The California experience. Annals of Economics and Finance 10(1): 29-47, 2009. (22 refs.)

This paper evaluates the effectiveness of California anti-smoking media campaign in changing smoking behavior of adults and adolescents, in the short run as well as in the long run, through individual self-reported exposure to the media message. We construct Pseudo panel data using repeated cross sections, and employ instrumental variables method to address the endogeneity problem. Overall, the results suggest that, the anti-smoking media campaign not only significantly reduces the prevalence of smoking among adults and adolescents, but also brings significant long term benefits in smoking reduction, by inducing more future attempts to quit among adult smokers and deterring more initiating intentions among adolescents.

Lotrean LM; Kremers S; Ionut C; de Vries H. Gender differences regarding the alcohol/tobacco relationship among Romanian adolescents: A longitudinal study. European Journal of Public Health 19(3): 285-289, 2009. (39 refs.)

Background: The objective of this study was to assess cross-sectional and prospective relations between alcohol and tobacco use among Romanian adolescents, giving special attention to possible gender differences. Methods: The data were obtained from a two-wave 1-year longitudinal study carried out among 403 Romanian high school students aged 1517 years (mean age 15.9; SD 0.3). Questionnaires were used to assess smoking behaviour and alcohol use. Both behaviours were classified into two categories, that of adolescents who used the substance (at least once/month) and that of those who did not use the substance or used it less than monthly. Logistic regression was used to determine which substance was the best predictor of the subsequent use of the other substance. Results: Alcohol and cigarette use were found to be linked reciprocally and this interrelationship differed across genders. Among girls smoking predicted alcohol use better than the converse, while for the boys it was the other way around. Conclusion: It is important for future studies of adolescent substance use to systematically investigate the gender differences in the tobaccoalcohol relationship.

Marano C; Schober SE; Brody DJ; Zhang C. Secondhand tobacco smoke exposure among children and adolescents: United States, 2003-2006. Pediatrics 124(5): 1299-1305, 2009. (18 refs.)

OBJECTIVE: The implementation of policies that prohibit tobacco smoking in public places has resulted in a significant reduction in secondhand smoke (SHS) exposure in the US population; however, such policies do not extend to private homes, where children continue to be exposed. Our objective was to assess SHS exposure among US children and adolescents by using serum cotinine measures to compare those who were exposed to SHS in the home and those without home exposure. METHODS: We analyzed serum cotinine data from the 2003-2006 National Health and Nutrition Examination Survey for 5518 children (3-11 years) and nonsmoking adolescents (12-19 years). We calculated geometric mean serum cotinine levels by sociodemographic and household characteristics according to self-reported home SHS exposure. Multiple regression analysis was conducted to evaluate independent predictors of serum cotinine levels. RESULTS: Geometric mean serum cotinine levels were 1.05 ng/mL among those with home SHS exposure and 0.05 ng/mL among those without home exposure. Among children who were exposed to SHS at home, serum cotinine levels were inversely associated with age and were similar for non-Hispanic black and non-Hispanic white children. Conversely, among children without SHS exposure at home, serum cotinine levels were higher among non-Hispanic black compared with non-Hispanic white children, and there was no relationship with age. Mexican American children had the lowest level of SHS exposure. CONCLUSIONS: Serum cotinine levels were an order of magnitude higher among children with reported SHS exposure at home compared with those with no exposure in the home.

Marcinkova D; Majdan M; Gergelova P; Rusnak M; Pekarcikova J; Baska T. Socioeconomic predictors of smoking behaviour among school-aged children, in the Slovakia. Bratislava Medical Journal 110(6): 345-349, 2009. (17 refs.)

Objective: The aim of this study was to describe the relationship between smoking habits and socioeconomic determinants among adolescents. Background: Tobacco use among young people is a formidable social health concern. The aim of this paper is to describe the situation in selected localities surveyed, and to elucidate the relations among experiments with tobacco in adolescent youth and behaviour of parents, friends and teachers and media influence. The objectives of this study are to describe patterns of self-reported smoking and to describe the association of trying smoking with other variables, such as social, or socio-demographics among a sample of young students. Methods: Global Youth Tobacco Survey to track tobacco use among youth across countries using a common methodology and core questionnaire. In Slovakia, GYTS was carried out at the turn of 2002 to 2003. A total of 4.594 students participated in the study. Results: The results indicate that the majority of the students (74.3 %) have tried smoking where both parents are smokers. We found that gender, parents', friends' and teachers' smoking had a significant influence on whether the children ever tried smoking. A parent who smokes was found as a strong significant predictor for trying smoking in the group of students [OR=1.6 (1.39-1.92)]. Conclusion: Predictors of smoking behaviour include parents', teachers' and friends' smoking. Public health interventions aim at conducting effective health promotion programs tailored to specific population groups and known predictors should be central to the design of such endeavours (Tab. 5, Ref. 18). Full Text (Free, PDF) www.bmj.sk.

Markham WA; Lopez ML; Aveyard P; Herrero P; Bridle C; Comas A et al. Mediated, moderated and direct effects of country of residence, age, and gender on the cognitive and social determinants of adolescent smoking in Spain and the UK: a cross-sectional study. BMC Public Health 9: article 173, 2009. (29 refs.)

Background: European trans-national adolescent smoking prevention interventions based on social influences approaches have had limited success. The attitudes-social influences-efficacy (ASE) model is a social cognition model that states smoking behaviour is determined by smoking intention which, in turn, is predicted by seven ASE determinants; disadvantages, advantages, social acceptance, social norms, modelling, perceived pressure, self-efficacy. Distal factors such as country of residence, age and gender are external to the model. The ASE model is, thus, closely related to the Theory of Planned Behaviour. This study assessed the utility of the ASE model using cross-sectional data from Spanish and UK adolescents. Methods: In 1997, questionnaires were simultaneously administered to Spanish (n = 3716) and UK adolescents (n = 3715) who were considered at high risk of smoking. Participants' age, gender, smoking intentions and ASE determinant scores were identified and linear regression analysis was used to examine the mediated, moderated and direct effects of country of residence, age and gender on participants' smoking intentions. Results: All UK participants were aged 12 or 13 and most Spanish participants were aged between 12 and 14 ( range 12-16 years). Amongst 12 and 13 year olds, regular smoking was more common in Spain. Almost half the participants were female (47.2% in Spain; 49.9% in the UK). Gender did not vary significantly according to age. The distribution of ASE determinant scores varied by country and predicted intention. The influence of each ASE determinant on intention was moderated by country. Country had a large direct influence on intention (1.72 points on a 7 point scale) but the effects of age and gender were mediated by the ASE determinants. The findings suggest resisting peer pressure interventions could potentially influence smoking amongst UK adolescents but not Spanish adolescents. Interventions that promote self-efficacy, on the other hand, would possibly have a greater influence on smoking amongst Spanish adolescents. Conclusion: The ASE model may not capture important cultural factors related to adolescent smoking and the relative contribution of particular ASE determinants to adolescent smoking intentions may differ between countries. Future European trans-national adolescent smoking prevention programmes may benefit from greater undestanding of country-level cultural norms.

McCarthy WJ; Mistry R; Lu Y; Patel M; Zheng H; Dietsch B. Density of tobacco retailers near schools: Effects on tobacco use among students. American Journal of Public Health 99(11): 2006-2013, 2009. (37 refs.)

Objectives. We examined the relationship between students' tobacco use and the density and proximity of tobacco retailers near their schools. Methods. We used data from the 2003-2004 California Student Tobacco Survey and California retail licensing data. Measures included students' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors. Results. Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources. Conclusions. Our results support the plausibility of reducing rates of students' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.

Melanko S; Leraas K; Collins C; Fields S; Reynolds B. Characteristics of psychopathy in adolescent nonsmokers and smokers: Relations to delay discounting and self reported impulsivity. Experimental and Clinical Psychopharmacology 17(4): 258-265, 2009. (39 refs.)

This research compared impulsive behavior in adolescent nonsmokers with low ratings of psychopathy (n = 25) and daily smokers with low (n = 25) and high (n = 25) ratings of psychopathy. Assessments of impulsive behavior included question-based and real-time measures of delay discounting and a self report assessment of impulsivity (Barratt Impulsiveness Scale-Adolescent). Smokers with low psychopathy ratings discounted more by delay (i.e., more impulsively) than nonsmokers on both assessments of discounting; however, smokers with high psychopathy ratings did not differ from nonsmokers on either measure. Inversely, from the self report assessment of impulsivity, smokers with low psychopathy ratings did not differ from nonsmokers, but smokers with high psychopathy ratings were more impulsive than nonsmokers. These findings indicate that delay discounting and self reported impulsivity relate differently to characteristics of psychopathy in adolescent nonsmokers and smokers. Also, these findings demonstrate that there are definable subgroups of smokers for whom the frequently observed relationship between cigarette smoking and delay discounting does not apply.

Mermelstein RJ; Colvin PJ; Klingemann SD. Dating and changes in adolescent cigarette smoking: Does partner smoking behavior matter? Nicotine & Tobacco Research 11(10): 1226-1230, 2009. (18 refs.)

Adolescents' relationships can play an influential role in adopting, maintaining, or changing health behaviors. Previous research has suggested that adolescent dating is a risk factor for both concurrent and prospective tobacco use. This study extends previous research by examining whether a partner's smoking status moderated the relationship between dating and adolescent smoking. Participants were 1,263 9th and 10th grade students who took part in a longitudinal study investigating the social and emotional contexts of adolescent smoking patterns. Adolescents were recruited into the longitudinal study based on prior smoking history. The presence of a romantic partner, the partner's smoking status, and the adolescents' smoking behavior were assessed at baseline and at 15 months. Our findings indicated that a change in dating status from not dating to having a partner significantly increased the odds of the adolescent smoking at 15 months but significantly only for those who dated a smoker. This effect was especially pronounced among boys. All boys who dated a smoker smoked themselves. Among adolescents who smoked at 15 months, there was also a strong protective effect among boys for dating a nonsmoker, compared with either those who did not have partners or those with smoking partners; boys with nonsmoking partners smoked significantly less than those with partners who smoked or those without partners. These results highlight the importance of considering the smoking status of the romantic partner in the smoking-dating relationship in adolescents.

Murnaghan DA; Blanchard C; Rodgers W; La Rosa J; Macquarrie C; Maclellan D et al. The influence of student-level normative, control and behavioral beliefs on staying smoke-free: An application of Ajzen's theory of planned behavior. Addiction Research & Theory 17(5): 469-480, 2009. (40 refs.)

This study, the first to examine the utility of the Theory of Planned Behavior (TPB) in explaining intentions and behavior to remain smoke-free, generated smoke-free related beliefs in adolescents and examined their association to the TPB global constructs (i.e., attitudes, subjective norm, perceived behavioral control (PBC), intention, and behavior) 1 month later in a population of intermediate students (N = 214) in Prince Edward Island, Canada. The results showed that intentions to remain smoke-free were significantly predicted by attitudes and PBC, whereas smoke-free behavior was determined by PBC. From a global TPB perspective, PBC appears to be the dominant variable within the TPB framework on which to guide a smoke-free adolescent intervention. These results have the potential to inform new interventions that address remaining smoke-free that are relevant to adolescents. However, the preliminary nature of these findings warrant further study before any firm conclusions can be drawn.

Murnaghan DA; Leatherdale ST; Sihvonen M; Kekki P. School-based tobacco-control programming and student smoking behaviour. Chronic Diseases In Canada 29(4): 169-177, 2009. (53 refs.)

The study examined the association of a school-based tobacco-control program with students' smoking behaviour over time using three cross-sectional, provincial census datasets (grade 10 students in 1999, grade 11 students in 2000, grade 12 students in 2001). Data were collected from all secondary schools in Prince Edward Island (Canada) using the Tobacco module of the School Health Action, Planning and Evaluation System (SHAPES). The proportion of regular smokers increased from grade 10 (22.3%) to grade 12 (27.8%, chi(2) = 10.35, df = 1, p < 0.001). Being exposed to different school-based tobacco programs and policies in grades 10 and 11 was not associated with the smoking behaviour of grade 12 students. The strongest predictors of smoking behaviour were having friends or close family members who smoke. This preliminary evidence suggests that programs and policies associated with banning smoking and enforcing smoking restrictions at school may be insufficient unless they also address the influence of smoking peers and family members and link to comprehensive programming within the broader context of other community and policy level interventions.

Myers MG; MacPherson L. Coping with temptations and adolescent smoking cessation: An initial investigation. Nicotine & Tobacco Research 11(8): 940-944, 2009. (32 refs.)

Introduction: Although a great deal of research focuses on adolescent cigarette smoking, little is known about the process by which adolescents attempt to stop smoking. Resisting temptations to smoke is one of the key challenges encountered by individuals who attempt smoking cessation. A large body of literature has examined coping with temptation among adult smokers, and research on this issue for adolescents is lacking. To further our understanding in this area, the present study reports on an initial examination of the Smoking Temptation Coping Questionnaire (STCQ). The STCQ, which assesses coping in a social pressure situation involving cigarettes, was adapted from the Temptation Coping Questionnaire, a brief self-report measure of adolescent coping with temptations to use alcohol and other drugs. Methods: The present study included 109 adolescent participants (aged 14-19 years) in a naturalistic study of smoking self-change. Participants completed baseline and 6-month follow-up interviews. Results: Exploratory factor analysis of the STCQ coping scale yielded a single factor including six strategies for coping with temptations. Analyses provided support for the concurrent, predictive, and construct validity of the STCQ. In particular, the coping scale score significantly predicted prospective duration of abstinence for adolescents who engaged in smoking cessation efforts. Discussion: These results provide preliminary support for the utility of the STCQ. In addition, findings support the role of temptation coping in the adolescent smoking cessation process.

Nasim A; Belgrave FZ; Corona R; Townsend TG. Predictors of tobacco and alcohol refusal efficacy for urban and rural African-American adolescents. Journal of Child & Adolescent Substance Abuse 18(3): 221-242, 2009. (69 refs.)

This study sought to determine the relative contributions of individual, family, peer, and community risk and promotive factors in explaining alcohol and tobacco refusal attitudes among 227 African-American adolescents (ages 12 to 17) from urban and rural areas. Hierarchical linear regression (HLR) results revealed differences in the predictive value of risk and promotive factors with respect to tobacco and alcohol refusal attitudes. Specifically, individual and peer risk factors were predictive of tobacco refusal attitudes among youths. Individual, peer, and family risk, and promotive factors were predictive of adolescents' alcohol refusal attitudes. Community factors were not significant predictors of youths' ability to refuse tobacco and alcohol, after controlling for more proximal influences. Future research should consider other psychosocial influences within an ecological framework that may account for additional variance in substance use altitudes among African-American adolescents.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Cigar Use among Young Adults Aged 18 to 25. (January 15, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (2 refs.)

Cigar use increases the risk of many health problems, including several types of cancer. This issue of "The NSDUH Report" examines past month cigar use among young adults aged 18 to 25, the age group with the highest rates of cigar use. More young adults used cigars in the past month in 2007 (11.8%) than in 2002 (11.0%). However the rate peaked in 2004 at 12.7%. Overall trends in past month cigar use were primarily driven by trends among males, who were 3 times as likely as females to have smoked cigars. Rates of past month cigar use generally declined with age among young adults; for example, the rate was 14.5% for those aged 18 or 19 compared with 8.5% for those aged 24 or 25 . Nearly two-thirds (65.9%) of young adults who used cigars in the past month also used cigarettes, 15.3% had used smokeless tobacco, and 5.8% also pipe tobacco. There are also geographic differences. Rates of cigar use are higher for those who live outside of large and small metropolitan area. The rate of use was higher among those living in the Midwest and the South (13.8% and 12%) than those living in the West and Northeast (10.9% and 10.4%).

Public Domain

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Exposure to Substance Use Prevention Messages and Substance Use among Adolescents: 2002 to 2007. (April 2, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (6 refs.)

This issue examines trends in the rate of exposure of adolescents to prevention messages from 2002 to 2007. It also examines the ages of those exposed to prevention messages by key demographic characteristics and the relationship between message exposure and substance use.5 All findings presented in this report are based on trends and annual averages in the NSDUH data for 2002 through 2007. Summary: From 2002 to 2007, there were decreases in the percentages of adolescents aged 12 to 17 reporting exposure to drug or alcohol use prevention messages through media sources (from 83.2 to 77.9%) and prevention programs outside of school (from 12.7 to 11.3%), but the percentage who had talked with their parents about the dangers of alcohol, drug, or tobacco use in the past year increased (from 58.1 to 59.6%). Combined data from 2002 to 2007 indicate that talking with a parent about the dangers of substance use decreased with age (61.6 percent of those aged 12 or 13, 59.5% of those aged 14 or 15, and 57.1% of those aged 16 or 17), whereas the age receiving prevention messages through media sources increased with age (77.0, 82.7, and 84.2%, respectively). In general, adolescents who reported having been exposed to substance use prevention messages in the past year were less likely than those who were not exposed to have used cigarettes, alcohol, and illicit drugs in the past month.

Public Domain

Okoli CTC; Richardson CG; Ratner PA; Johnson JL. Non-smoking youths' "perceived" addiction to tobacco is associated with their susceptibility to future smoking. Addictive Behaviors 34(12): 1010-1016, 2009. (45 refs.)

Smoking initiation places adolescents at risk for adult onset diseases, including heart disease, respiratory illness, and cancer. Adolescents that smoke have levels of 'perceived' tobacco addiction that are associated with several measures of nicotine dependence. Nonsmoking adolescents also report feeling addicted to tobacco even with minimal or no prior tobacco use, suggesting some vulnerability to tobacco use. The purpose of this study was to examine the association between perceived tobacco addiction and smoking susceptibility among adolescents with very minimal tobacco use. A cross-sectional analysis was conducted of data obtained from 5155 nonsmokers who completed the British Columbia Youth Survey of Smoking and Health 11, a school-based survey conducted during 2004. Measures included demographics, tobacco use (ever puffed a cigarette), substance use (marijuana and alcohol), exposure to family members' smoking in the home, peers' tobacco use, depressive symptoms, perceived physical and mental addiction to tobacco, and smoking susceptibility. The adolescents who were most susceptible to smoking were female, younger and in a lower school grade: had ever puffed a cigarette, had used alcohol or marijuana; had family members or peers who smoked; had higher depression scores, and higher perceived physical and mental addiction to tobacco. In multivariate logistic regression analysis, perceived mental addiction but not perceived physical addiction to tobacco was significantly associated with smoking susceptibility. Understanding factors associated with smoking initiation, and ways to identify "at-risk" adolescents can enhance early intervention and prevention programs. Perceived mental addiction to tobacco appears to be an important indicator of smoking susceptibility.

O'Loughlin J; Karp I; Koulis T; Paradis G; DiFranza J. Determinants of first puff and daily cigarette smoking in adolescents. American Journal of Epidemiology 170(5): 585-597, 2009. (65 refs.)

Few prospective studies of smoking initiation have investigated a wide range of time-varying and invariant predictor variables at the individual and contextual levels concurrently. In this study (1999-2005), 877 Canadian students (mean age = 12.7 years) who had never smoked at baseline completed self-report questionnaires on cigarette smoking and 32 predictor variables in 20 survey cycles during secondary school. Height and weight were measured in survey cycles 1, 12, and 19. School administrators completed questionnaires on school tobacco control policies/activities, and trained observers collected data on access to tobacco products in commercial establishments near schools. Younger age, single-parent family status, smoking by parents, siblings, friends, and school staff, stress, impulsivity, lower self-esteem, feeling a need to smoke, not doing well at school, susceptibility to tobacco advertising, alcohol use, use of other tobacco products, and attending a smoking-tolerant school were independent determinants of smoking initiation. Independent determinants of daily smoking onset among initiators of nondaily smoking included smoking by siblings and friends, feeling a need to smoke, susceptibility to tobacco advertising, use of other tobacco products, and self-perceived mental and physical addiction. Adolescent tobacco control programs should address multiple individual and contextual-level risk factors. Strategies that address nicotine dependence symptoms are also needed for adolescents who have already initiated smoking.

Owusu-Dabo E; Lewis S; McNeill A; Gilmore A; Britton J. Smoking uptake and prevalence in Ghana. Tobacco Control 18(5): 365-370, 2009. (41 refs.)

Background: Developing countries are at high risk of epidemic increases in tobacco smoking, but the extent of this problem is not clearly defined because few collect detailed smoking data. We have surveyed tobacco smoking in the Ashanti region of Ghana, a rapidly developing African country with a long-established tobacco industry. Methods: We took a random sample of 30 regional census enumeration areas, each comprising about 100 households, and a systematic sample of 20 households from each. These were visited, a complete listing of residents obtained and questionnaire interviews on current and past smoking, age at smoking uptake, sources of cigarettes and other variables carried out in all consenting residents aged 14 or over. Results: of 7096 eligible individuals resident in the sampled households, 6258 (88%; median age 31 (range 14-105) years; 64% female) participated. The prevalence of self-reported current smoking (weighted for gender differences in response) was 3.8% (males 8.9%, females 0.3%) and of ever smoking 9.7% (males 22.0%, females 1.2%). Smoking was more common in older people, those of Traditionalist belief, those of low educational level, the unemployed and the less affluent. Smokers were more likely to drink alcohol and to have friends who smoke. About 10% of cigarettes were smuggled brands. About a third of smokers were highly or very highly dependent. Conclusions: Despite rapid economic growth and a sustained tobacco industry presence, smoking prevalence in Ghana is low, particularly among younger people. This suggests that progression of an epidemic increase in smoking has to date been avoided.

Ozawa M; Washio M; Kiyohara C. Factors related to starting and continuing smoking among senior high school boys in Fukuoka, Japan. Asian Pacific Journal of Cancer Prevention 9(2): 239-245, 2008. (49 refs.)

The purpose of this study was to identify factors that influence starting and quitting smoking among Japanese male adolescents aged 15-18. Two thousand and twelve senior high school boys in Fukuoka City, Japan, answered unsigned self-administrated anonymous questionnaires in July 2001. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed to assess the strength of associations between students' smoking status and alcohol consumption habits. Additionally, the link between a students' smoking status and parental influence (parental smoking) was also assessed. Approximately 90% of the students, both current and ex-smokers, had ever smoked prior to senior high school while 77% of the students (smokers and non-smokers) had the experience of drinking alcohol prior to admission to senior high school. After adjustment for school year (i.e., freshman, sophomore, junior, senior), academic education level, after-school club activities, time of first drinking experience and the frequency of drinking, there was a significant increased risk to become a smoker when one parent is a smoker (OR = 1.67, 95% CI = 1.18-2.37) or when both parents are smokers (OR = 2.94, 95% CI = 1.66-5.18) compared to both parents being non-smokers. The consumption of alcohol prior to entering senior high school was significantly associated with more than 2.5-fold greater risk for the onset of smoking when compared to the risk of becoming a smoker when alcohol consumption started after entering senior high school. An increased frequency of drinking was also associated with starting smoking (OR = 14.00, 95% CI = 8.08-24.26; 2-3 times/week vs. never). Similarly, an increase in drinking frequency resulted in less likelihood of smoking cessation. For instance, the data showed that, the subjects were 1/3 less likely to quit smoking. Paternal smoking had a significant impact on whether or not a child would quit smoking (OR = 0.55, 95% CI = 0.38-0.81) as compared to a child that had paternal and maternal non-smokers. This study suggested that drinking habits started earlier than smoking habits among adolescents. Many students had already experienced drinking before admission to senior high school, while the experience of smoking mostly typically started after admission to high school. These data show the urgency of developing anti-smoking educational programs that could be developed and introduced prior to admission to high school.

Park S. The causal association between smoking and depression among South Korean adolescents. Journal of Addictions Nursing 20(2): 93-103, 2009. (38 refs.)

This study used a longitudinal design to explore the causal inference between smoking and depression, which are prevalent health problems in adolescence. To answer the research question, existing data from the Korea Youth Panel Survey were analyzed. Data contain four Waves, and two samples were selected in Wave 3: teens who did not smoke (Sample 1) and teens who were not depressed (Sample 2). The effect of depression in Wave 3 on smoking in Wave 4 was examined with Sample 1; the effect of smoking in Wave 3 on depression in Wave 4 was examined with Sample 2. In the analyses, factors that may influence the association between the two conditions were controlled. Those factors were characteristics relative to demographics, family, school, friends, and individuals. The results indicated that after adjusting for the other factors, depression was a successful predictor of smoking but not the other way around. The findings have two crucial implications for nursing practice. Nursing professionals need to provide alternatives for depressed teens to change their negative moods in a timely manner, which could help prevent smoking initiation. Also, nursing professionals should take into account depression-related problems when they develop strategies for smoking cessation, considering the crucial link between depression and smoking.

Parkinson CM; Hammond D; Fong GT; Borland R; Omar M; Sirirassamee B et al. Smoking beliefs and behavior among youth in Malaysia and Thailand. American Journal of Health Behavior 33(4): 366-375, 2009. (32 refs.)

Objective: To characterize smoking beliefs among Thai and Malaysian youth and to examine associations with gender, antismoking media exposure, and smoking status. Methods: Nationally representative samples of youth completed self-administered questionnaires. Results: A substantial proportion of youth reported positive beliefs about smoking. Those reporting positive beliefs were more likely to be susceptible to smoking. Youth who noticed antismoking media were less likely to report positive beliefs about smoking. Conclusions: As in Western countries, beliefs about smoking held by youth in Southeast Asia are associated with smoking status. Antismoking media may be an important means of targeting beliefs about smoking among youth.

Patten CA; Enoch C; Renner CC; Offord KP; Nevak C; Kelley SF et al. Focus groups of Alaska native adolescent tobacco users: Preferences for tobacco cessation interventions and barriers to participation. Health Education & Behavior 36(4): 711-723, 2009. (24 refs.)

Tobacco cessation interventions developed for Alaska Native adolescents do not exist. This study employed focus group methodology to explore preferences for tobacco cessation interventions and barriers to participation among 49 Alaska Natives (61% female) with a mean age of 14.6 (SD = 1.6) who resided in western Alaska. Using content analysis, themes from the 12 focus groups were found to be consistent across village, gender, and age groups. Program location or site (e. g., away from the village, hunting, fishing), a group-based format, and inclusion of medication and personal stories were reported to be important attributes of cessation programs. Motivators to quit tobacco were the perceived adverse health effects of tobacco, improved self-image and appearance, and the potential to be a future role model as a non-tobacco user for family and friends. Parents were perceived as potentially supportive to the adolescent in quitting tobacco. The findings will be used to develop tobacco cessation programs for Alaska Native youth.

Paynter J; Edwards R; Schluter PJ; McDuff I. Point of sale tobacco displays and smoking among 14-15 year olds in New Zealand: A cross-sectional study. Tobacco Control 18(4): 268-274, 2009. (29 refs.)

Objective: To examine the association between exposure to tobacco displays at the point of sale and teenage smoking and susceptibility to the uptake of smoking. Design: The sample comprised a national cross-section of 14-15 year olds with two measures of exposure to tobacco displays at the point of sale and three outcome measures. The outcome measures were susceptibility to smoking initiation, experimenting with smoking or current smoking. Results: Compared with visiting stores less often than weekly, a greater frequency of store visits was related to increased odds of being susceptible to smoking (daily visits, adjusted OR 1.8, 95% CI 1.6 to 2.2) and experimenting with smoking (daily visits, adjusted OR 2.7, 95% CI 2.4 to 3.1). The likelihood of being a current smoker increased with a greater frequency of store visits among students of medium and high socioeconomic status, but not among those of low socioeconomic status. Conclusion: Although these findings are cross-sectional in nature, they are consistent with the notion that greater exposure to tobacco displays at the point of sale increases youth smoking, and suggest display bans are needed.

Peltzer K. Health behavior and protective factors among school children in four African countries. International Journal of Behavioral Medicine 16(2): 172-180, 2009. (31 refs.)

Increasing trends of non-communicable diseases is a worldwide phenomenon including in the developing countries. Few studies focus on adolescent's positive health and their predictors. The aim of this study was to investigate aspects of adolescent's health enhancing health behaviors and their relationship with potentially protective factors in the home and school environment. The sample included 12,740 students at the ages from 13 to 15 years from four African countries (Kenya, Namibia, Uganda, and Zimbabwe) chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. The measure used was part of the Global School-Based Health Survey questionnaire including various domains of health behavior. More than 70% of the participants scored positively for the items concerning non-tobacco use, limiting alcohol consumption, non-drug use, washing hands before eating, and were abstinent or had used a condom at last sex, while fewer than 50% fulfilled criteria for washing hands with soap, never bullied in the past 30 days, no passive smoking, condom use at last sex, physically active for at least 60 min per day for 3 days in a week, and walk or bike to school. Multiple logistic regression identified school attendance, parental or guardian connectedness, peer support at school, and parental supervision are important for adolescent health in this sample. These findings enable health care professionals and researchers designing intervention studies to promote positive health practices.

Peltzer K. Prevalence and correlates of substance use among school children in six African countries. International Journal of Psychology 44(5): 378-386, 2009. (23 refs.)

An increasing trend of noncommunicable diseases is a worldwide phenomenon, also including the developing countries. Few studies focus on adolescents' substance use in relation to mental distress and protective factors in African countries. The purpose of this study was to assess the prevalence and correlates (mental distress and protective factors) of substance use among school-going adolescents in six African countries. The sample included 20,765 students aged from 13 to 15 years from six African countries (Kenya, Namibia, Swaziland, Uganda, Zambia, Zimbabwe), chosen by a two-stage cluster sample design to represent all students in grades 6, 7, 8, 9, and 10 in each country. The measure used was part of the Global School-Based Health Survey (GSHS) questionnaire, including various domains of health behaviour. Results indicate a prevalence of 12.6% tobacco use (past month), 6.6% risky alcohol use (two or more per day for at least 20 days or more in the past month), and 10.5% of illicit drug use (three or more times ever) in school-going adolescents in six African countries. School truancy, loneliness, sleeping problems, sadness, suicidal ideation, suicide plans, and poverty were associated with substance use (tobacco, alcohol, illicit drugs), while school attendance and parental supervision and connectedness were protective factors for substance use, and peer support protective for tobacco use. It is concluded that tobacco use, risky drinking and illicit drug use were common, clustered together and were associated with school truancy, mental distress, and lack of parental and peer support among adolescent African school children. These findings stress the need for early and integrated prevention programmes.

Peterson AV; Kealey KA; Mann SL; Marek PM; Ludman EJ; Liu JM et al. Group-randomized trial of a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Journal of The National Cancer Institute 101(20): 1378-1392, 2009. (98 refs.)

The Hutchinson Study of High School Smoking randomized trial was designed to rigorously evaluate a proactive, personalized telephone counseling intervention for adolescent smoking cessation. Fifty randomly selected Washington State high schools were randomized to the experimental or control condition. High school junior smokers were proactively identified (N = 2151). Trained counselors delivered the motivational interviewing plus cognitive behavioral skills training telephone intervention to smokers in experimental schools during their senior year of high school. Participants were followed up, with 88.8% participation, to outcome ascertainment more than 1 year after random assignment. The main outcome was 6-months prolonged abstinence from smoking. All statistical tests were two-sided. The intervention increased the percentage who achieved 6-month prolonged smoking abstinence among all smokers (21.8% in the experimental condition vs 17.7% in the control condition, difference = 4.0%, 95% confidence interval [CI] = -0.2 to 8.1, P = .06) and in particular among daily smokers (10.1% vs 5.9%, difference = 4.1%, 95% CI = 0.8 to 7.1, P = .02). There was also generally strong evidence of intervention impact for 3-month, 1-month, and 7-day abstinence and duration since last cigarette (P = .09, .015, .01, and .03, respectively). The intervention effect was strongest among male daily smokers and among female less-than-daily smokers. Proactive identification and recruitment of adolescents via public high schools can produce a high level of intervention reach; a personalized motivational interviewing plus cognitive behavioral skills training counseling intervention delivered by counselor-initiated telephone calls is effective in increasing teen smoking cessation; and both daily and less-than-daily teen smokers participate in and benefit from telephone-based smoking cessation intervention.

Primack BA; Fine D; Yang CK; Wickett D; Zickmund S. Adolescents' impressions of antismoking media literacy education: Qualitative results from a randomized controlled trial. Health Education Research 24(4): 608-621, 2009. (72 refs.)

Although media literacy represents an innovative venue for school-based antismoking programming, studies have not systematically compared student impressions of these and traditional programs. This study utilized data from a randomized trial comparing these two types of programs. After each program, students responded to three open-ended questions related to their assigned curriculum. Two coders, blinded to student assignments, independently coded these data. Coders had strong inter-rater agreement (kappa = 0.77). Our primary measures were spontaneously noted overall assessment, enjoyment/interest and the likelihood of changing smoking behavior. Of the 531 participants, 255 (48.0%) were randomized to the intervention (media literacy) group. Intervention participants had more net positive responses [rate ratio (RR) = 1.27, 95% confidence interval (CI) = 1.05, 1.54], more responses rating the program as compelling (RR = 1.63, 95% CI = 1.16, 2.29) and fewer responses rating the program as non-compelling (RR = 0.62, 95% CI = 0.39, 0.97). However, the intervention group was not more likely to suggest that the curriculum was likely to change behavior positively (RR = 0.57, 95% CI = 0.30, 1.06). Findings suggest that although media literacy provides a compelling format for the delivery of antitobacco programming, integration of components of traditional programming may help media literacy programs achieve maximal efficacy.

Prinstein MJ; La Greca AM. Childhood depressive symptoms and adolescent cigarette use: A six-year longitudinal study controlling for peer relations correlates. Health Psychology 28(3): 283-291, 2009

Objective: To examine potential pathways between childhood depressive symptoms and adolescent cigarette use, controlling for potential "third variable" causes. Design: Participants included 250 youth (60% girls) who were in Grades 4 to 6 at study outset and in Grades 10 to 12 (M age = 16.78) at a 6-year follow-up. At Time 1, children completed measures of depressive symptoms, as well as peer nominations of peer acceptance, rejection, and aggressive behavior. Main Outcome Measures: Time 2 measures included adolescents' own and close friends' cigarette use, depressive symptoms, and externalizing behaviors; parents also reported on adolescent behaviors. Results: Higher levels of childhood depressive symptoms and aggressive behavior were associated longitudinally with cigarette use in adolescence. After controlling for other associations, higher levels of childhood depressive symptoms also were associated with higher levels of friends' cigarette use in adolescence and higher levels of adolescent depressive symptoms; each of these adolescent outcomes was concurrently associated with cigarette use. Conclusion: Depressive symptoms in childhood may lead to altered developmental trajectories that either directly or indirectly contribute to adolescent outcomes, including cigarette use.

Rasmussen M; Due P; Damsgaard MT; Holstein BE. Social inequality in adolescent daily smoking: Has it changed over time? Scandinavian Journal of Public Health 37(3): 287-294, 2009. (30 refs.)

Background and aim: In most northern European countries adolescent smoking is most prevalent in lower social classes but there is little information about time trends in social inequality. This paper describes trends in social inequality in daily smoking among adolescents from 1991 to 2006 by both absolute social inequality (prevalence difference between low and high social class) and relative social inequality (prevalence ratio). Methods: We analysed 15-year-olds from the Health Behaviour in School-aged Children (HBSC) study in Denmark in 1991, 1994, 1998, 2002 and 2006, total n = 6703. The surveys were comparable because of similar procedures for sampling, data collection, and measurements of smoking and parents' occupational social class. Findings: From 1991 to 2006 the prevalence of daily smoking decreased from 15.9% to 10.9% among boys and from 20.1% to 10.6% among girls. The social inequality fluctuated over time and was different for boys and for girls. The prevalence difference between boys from low and high social class was 5.2% in 1991 and 9.3% in 2006, corresponding figures for girls were 4.8% and 7.0%. The prevalence ratio among boys was 1.38 (in 1991) and 2.19 (in 2006), among girls 1.28 and 1.95. Conclusions: Daily smoking was most prevalent among students from lower social classes and the level of inequality fluctuated over time. Conclusions on social inequality in adolescent smoking may appear differently when described by absolute and relative measures. The absolute and relative social inequality in adolescent smoking was higher in 2006 than in 1991.

Rhodes N; Roskos-Ewoldsen D; Eno CA; Monahan JL. The content of cigarette counter-advertising: Are perceived functions of smoking addressed? Journal of Health Communication 14(7): 658-673, 2009. (54 refs.)

Media campaigns can be an effective tool in reducing adolescent smoking. To better understand the types of ads that have been used in campaigns in the United States, a content analysis was conducted of ads available at the U.S. Centers for Disease Control and Prevention (CDC) Media Campaign Researchource Center (MCRC; Waves 1 through 7). A total of 487 ads were coded. Ads were coded for target audience, primary theme present in the ad, and sensation valueproduction techniques that have been demonstrated to attract attention and increase arousal. Primary themes extended earlier studies by focusing on the perceived functions of smoking (weight lose, stress management, controlling negative affect) as well as the traditional themes of industry attack, the health consequences of smoking, secondhand smoke, quitting, and the social image of smokers. A majority of ads were rated as having moderate sensation value, and ads targeted at teens and children were, on the average, higher in sensation value than those targeting general audiences. Changes across time suggest that campaigns are focusing more on adolescent smoking and relying more on attacking the tobacco industry. Research indicates that the functions of stress relief, mood regulation, and weight loss are strong reasons for initiating and continuing to smoke cigarettes; however, none of the 487 ads addressed these functional themes. Implications for developing campaigns that more closely relate to the functions of smoking are discussed.

Riala K; Hakko H; Rasanen P. Nicotine dependence is associated with suicide attempts and self-mutilation among adolescent females. Comprehensive Psychiatry 50(4): 293-298, 2009. (28 refs.)

Objective: There are no studies investigating the degree of nicotine dependence (ND) and suicidality among underage adolescents. Our aim was to investigate the relationship between ND,aid various forms of suicidal behavior among adolescent psychiatric inpatients in Finland. Methods: Data were collected from 508 patients (age, 12-17 years) admitted to inpatient psychiatric hospitalization between April 2001 and March 2006. The level of ND was assessed by the modified Fagerstrom Tolerance Questionnaire. Information on adolescents' suicide attempts and self-mutilation as well as psychiatric Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. diagnoses was obtained by using the Schedule for Affective Disorder and Schizophrenia for School-Age Children. Results: After adjusting for adolescents' age and psychiatric diagnoses, a more than 4-fold risk for suicide attempts (odds ratio [OR], 4.7; 95%, confidence interval [CI], 1.3-17.2) and self-mutilative behavior (OR, 4.5; 95% CI, 1.6-13.3) was found among female adolescents with a high level of ND compared to nonsmoking adolescent females. In addition, the risk for suicide attempts was only increased by a high level of ND, whereas the risk for self-mutilation was increased among females with mild ND as well. Among males, the level of ND was not associated with suicide attempts or self-mutilative behavior. Conclusions: The level of ND should be taken into account when evaluating adolescent suicidality. Further sex-specific studies with accurate measurements of nicotine and its metabolites in relation to various suicidal and self-destructive behaviors are needed.

Richter M; Erhart M; Vereecken CA; Zambon A; Boyce W; Gabhainn SN. The role of behavioural factors in explaining socio-economic differences in adolescent health: A multilevel study in 33 countries. Social Science & Medicine 69(3): 396-403, 2009. (63 refs.)

Attempts to describe and explain socio-economic differences in health have mainly focused on adults. Little is known about the mechanisms of the relationship between socio-economic status (SES) and health in adolescence including inconsistent findings between SES and health among young people. Data were derived from representative samples of 13 and 15-year-old students in 33 European and North American countries (n = 97,721) as part of the Health Behaviour in School-aged Children (HBSC) study 2001/2002. Multilevel logistic regression models were used to investigate socio-economic differences in self-rated health among adolescents and the contribution of health-related behaviours to the explanation of such differences. Odds ratios of self-rated health by family affluence were calculated before and after adjustment for behavioural factors (tobacco smoking, physical activity, television use, breakfast intake, consumption of fruits and vegetables). On average, adolescents from low affluent families had an odds ratio for low self-rated health of 1.84 for boys and 1.80 for girls, compared to those from high affluent families. The majority of behavioural factors were significantly associated with family affluence in all countries and explained part of the relationship between self-rated health and family affluence. Smoking, physical activity and breakfast consumption showed the largest independent effect on health. The present study suggests that behavioural factors in early adolescence partly account for the association between self-rated health and socio-economic status. Prevention programmes should target unhealthy behaviours of adolescents from lower socio-economic groups to help prevent future life-course disadvantages in terms of health and social inequalities.

Rosario-Sim MG; O'Connell KA. Depression and language acculturation correlate with smoking among older Asian American adolescents in New York City. Public Health Nursing 26(6): 532-542, 2009. (45 refs.)

Objective: To explore the correlates of smoking status among a sample of Asian American adolescents in New York City (NYC). Design and Sample: This descriptive, correlational study compared current smokers and current nonsmokers in terms of age, gender, ethnicity, academic performance, acculturation, depressive symptoms, smoking history, and parental, sibling, and peer smoking. The convenience sample included 328 Asian American adolescents, ages 16-19, who lived in NYC, and were recruited from members, friends, and affiliates of 6 organizational sources. Measures: The study used demographic, depression (Center for Epidemiological Studies Depression scale), English language acculturation, and smoking opportunity survey questionnaires. Results: Statistical analyses revealed that being older, being more English-language acculturated, having poor academic performance, increased depressive symptoms, and having siblings and peers who smoked were significantly associated with current smoking. Conclusions: Asian American adolescents initiate smoking later than other groups. Depressive symptoms were at high levels in the sample and were correlated with smoking. Thus, for Asian American adolescents, smoking prevention programs should be extended to later grades, with particular attention to low-performing students and those who are more acculturated. Likewise, programs that identify and assist adolescents with depressive symptoms may be useful in smoking prevention.

Rudatsikira E; Muula AS; Siziya S. Prevalence, correlates of and perceptions toward cigarette smoking among adolescents in South Korea. Indian Journal of Pediatrics 76(5): 505-510, 2009. (32 refs.)

To estimate the prevalence of current smoking, correlates of smoking and assess exposure to and perceptions towards smoking by gender. We used data from the South Korea Global Youth Tobacco Survey (GYTS). Frequencies of selected characteristics and their 95% confidence were obtained. Current cigarette smoking was defined as having smoked, even a single puff, within the last 30 days. Logistic regression analysis was conducted to assess the factors that were considered to be associated with current cigarette smoking in bivariate and multivariate analyses. Of the 5615 respondents, 7.4% males and 5.0% females reported being current smokers (p = 0.003). Having smoking friends was strongly associated with smoking after controlling for age, gender, parental smoking status, exposure to anti-smoking media messages, and perception of risks of smoking (OR=69.92; 95% CI [41.24, 118.57] for most friends and OR=11.86; 95% CI [7.26, 19.36] for some friends). Male gender and having one or both smoking parents were associated with smoking (OR=1.43; 95% CI [1.09, 1.89] and OR=1.29; 95% CI [1.00-, 1.71] respectively). Exposure to antismoking media messages was negatively associated with smoking (OR=0.52; 95% CI [0.36, 0.77]. Prevalence of smoking among adolescents in South Korea is lower than in many other Asian countries. There is however, need to strengthen anti-tobacco messages especially among adolescents.

Sabbane LI; Lowrey TM; Chebat JC. The effectiveness of cigarette warning label threats on nonsmoking adolescents. Journal of Consumer Affairs 43(2): 332-345, 2009. (9 refs.)

This experiment investigated three levels of threat in cigarette warning labels: no warning/text warning only/text + graphic warning. Teenagers in Canada and the US were exposed to one of these labels in a web-surfing environment. Participants surfed a website sponsored by a familiar cigarette brand or an unfamiliar cigarette brand. After surfing, three dependent measures were assessed: brand attitude, website attitude, and smoking intent. Results indicated that the graphic label was the most effective for Canadian participants, leading to negative attitudes and lower smoking intentions, but the graphic label was least effective at lowering smoking intentions for US participants.

Sabiston CM; Lovato CY; Ahmed R; Pullman AW; Hadd V; Campbell HS et al. School smoking policy characteristics and individual perceptions of the school tobacco context: Are they linked to students' smoking status? Journal of Youth and Adolescence 38(10): 1374-1387, 2009. (67 refs.)

The purpose of this study was to explore individual- and school-level policy characteristics on student smoking behavior using an ecological perspective. Participants were 24,213 (51% female) Grade 10-11 students from 81 schools in five Canadian provinces. Data were collected using student self-report surveys, written policies collected from schools, interviews with school administrators, and school property observations to assess multiple dimensions of the school tobacco policy. The multi-level modeling results revealed that the school a student attended was associated with his/her smoking behavior. Individual-level variables that were associated with student smoking included lower school connectedness, a greater number of family and friends who smoked, higher perceptions of student smoking prevalence, lower perceptions of student smoking frequency, and stronger perceptions of the school tobacco context. School-level variables associated with student smoking included weaker policy intention indicating prohibition and assistance to overcome tobacco addiction, weaker policy implementation involving strategies for enforcement, and a higher number of students smoking on school property. These findings suggest that the school environment is important to tobacco control strategies, and that various policy dimensions have unique relationships to student smoking. School tobacco policies should be part of a comprehensive approach to adolescent tobacco use.

Saraceno L; Munafo M; Heron J; Craddock N; van den Bree MBM. Genetic and non-genetic influences on the development of co-occurring alcohol problem use and internalizing symptomatology in adolescence: A review. Addiction 104(7): 1100-1121, 2009. (327 refs.)

Alcohol problem use during adolescence has been linked to a variety of adverse consequences, including cigarette and illicit drug use, delinquency, adverse effects on pubertal brain development and increased risk of morbidity and mortality. In addition, heavy alcohol-drinking adolescents are at increased risk of comorbid psychopathology, including internalizing symptomatology (especially depression and anxiety). A range of genetic and non-genetic factors have been implicated in both alcohol problem use as well as internalizing symptomatology. However, to what extent shared risk factors contribute to their comorbidity in adolescence is poorly understood. We conducted a systematic review on Medline, PsycINFO, Embase and Web of Science to identify epidemiological and molecular genetic studies published between November 1997 and November 2007 that examined risk factors that may be shared in common between alcohol problem use and internalizing symptomatology in adolescence. Externalizing disorders, family alcohol problems and stress, as well as the serotonin transporter (5-HTT) S-allele, the monoamine oxidase A (MAOA) low-activity alleles and the dopamine D2 receptor (DDR2) Taq A1 allele have been associated most frequently with both traits. An increasing number of papers are focusing upon the role of gene-gene (epistasis) and gene-environment interactions in the development of comorbid alcohol problem use and internalizing symptomatology. Further research in adolescents is warranted; the increasing availability of large longitudinal genetically informative studies will provide the evidence base from which effective prevention and intervention strategies for comorbid alcohol problems and internalizing symptomatology can be developed.

Savageau JA; Mowery PD; DiFranza JR. Symptoms of diminished autonomy over cigarettes with non-daily use. International Journal of Environmental Research and Public Health 6(1): 25-35, 2009. (25 refs.)

Data from a nationally representative sample of smokers (ages 12-22 years, n=2,091) was examined to investigate the prevalence of symptoms of diminished autonomy over cigarettes. Six symptoms were assessed: failed cessation, smoking despite a desire to quit, and a need or urge to smoke, irritability, restlessness, or disrupted concentration attributed to nicotine withdrawal. One or more of the six symptoms were present in 18.9% of subjects who smoked less often than once per week. Among subjects who had not smoked 20 cigarettes in their lifetime, 12.6% had symptoms of nicotine withdrawal, and 25% had made an unsuccessful quit attempt.

Scales MB; Monahan JL; Rhodes N; Roskos-Ewoldsen D; Johnson-Turbes A. Adolescents' perceptions of smoking and stress reduction. Health Education & Behavior 36(4): 746-758, 2009. (40 refs.)

The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked-namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.

Scheffels J. Stigma, or sort of cool: Young adult's accounts of smoking and identity. European Journal of Cultural Studies 12(4): 469-486, 2009. (41 refs.)

The aim of this article is to explore young adult smokers' constructions of identity, as revealed in accounts of their smoking experiences. A qualitative study was conducted in which interviews were held with 21 male and female smokers aged 18-23. The data were analyzed based on principles from a social constructivist approach to grounded theory, acknowledging the role of language and discourse in the construction of reality. Three key identities were read out of the interviewees' accounts: 1) the performative smoker, a construction related mainly to smoking initiation; 2) the defensive smoker; and, 3) the negotiating smoker. The smoker identities constructed by young adult smokers in this study appear to be characterized by considerable contradiction: a 'split vision' between classical positive meanings of smoking as a symbol of freedom, courage and individuality together with conflicting yet parallel meanings positioned by a strong discourse of smoking as stigmatized, immoral and undistinguished.

Schneider S; Meyer C; Yamamoto S; Solle D. Implementation of electronic locking devices for adolescents at German tobacco vending machines: intended and unintended changes of supply and demand. Tobacco Control 18(4): 294-301, 2009. (35 refs.)

Background: Starting from 1 January 2007, electronic locking devices based on proof-of-age (via electronic cash cards or a European driving licence) were installed in approximately 500 000 vending machines across Germany to restrict the purchase of cigarettes to those over the age of 16. Objective: To examine changes in the number of tobacco vending machines before and after the introduction of these new measures. Design: The total number of commercial tobacco sources in 2 selected districts (70 000 inhabitants) in Cologne were recorded and mapped. This major German city was the ideal setting for this study as investigators were able to use existing sociogeographical data from the area. A complete inventory was compiled in autumn 2005 and 2007. A total of 780 students aged 12 to 15 were also interviewed in the study areas. The main outcome measures were quantities and locations of commercial tobacco sources. Results: Between 2005 and 2007 the total number of tobacco sources decreased from 315 to 277 within the study area. Although the most obvious reduction was detected in the number of outdoor vending machines (248%), the number of indoor vending machines also decreased by 8%. Adolescents changed from vending machines to other sources for cigarettes, particularly kiosks or friends (+31% points usage rate, p<0.001; +35% points usage rate, p<0.001, respectively). Conclusions: Although the number of tobacco vending machines decreased, this has not had a significant impact on cigarette acquisition by underage smokers as they were able to circumvent this new security measure in several different ways.

Seo DC; Jiang N. Associations between smoking and extreme dieting among adolescents. Journal of Youth and Adolescence 38(10): 1364-1373, 2009. (38 refs.)

This study examined the association between cigarette smoking and dieting behaviors and trends in that association among US adolescents in grades 9-12 between 1999 and 2007. Youth Risk Behavior Survey datasets were analyzed using the multivariable logistic regression method. The sample size of each survey year ranged from 13,554 to 15,273 with girls representing 49-51% of the sample (N = 71,854). About 62% of the entire study participants were whites and 14% were blacks. Prevalence estimates of current smoking and corresponding 95% confidence intervals were computed across four comparison groups formed by gender and body weight. Extreme dieting was an independent predictor of smoking. Extreme dieters showed a higher variability of smoking behavior than their peers. The magnitude of the association between smoking and extreme dieting became smaller in recent years among adolescents but remained unchanged among non-overweight girls over that same time period. When adolescent smoking behavior is examined, the intensity of dieting behavior should be considered within its association with other co-occurring unhealthy behaviors.

Shah PB; Pednekar MS; Gupta PC; Sinha DN. The relationship between tobacco advertisements and smoking status of youth in India. Asian Pacific Journal of Cancer Prevention 9(4): 637-641, 2008. (17 refs.)

Objective: To examine the relationship between tobacco advertisements, counter-advertisements, and smoking status among Indian youth. Materials and Methods: Global Youth Tobacco Survey (GYTS) data was used; the data encompassed a representative two-stage probability sample of 60,001 students aged 13-15 years in 24 states in India. These students were interviewed with an anonymous, self-administered questionnaire. Binary logistic regression analyses were performed with smoking status as the dependent variable, and exposure to cigarette advertisements or counter-advertisements as independent variables. Results: Students watching anti-smoking media messages were less likely to be current smokers, which was true for both boys [OR = 0.89, 95% CI (0.81-0.98)] and girls [OR = 0.79, 95% CI (0.69-0.90)]. This relationship was stronger among past smokers for boys [OR = 0.56, 95% CI (0.52-0.60)] and girls [OR = 0.49, 95% CI (0.45-0.53)]. On the other hand, students who were exposed to cigarette brand names during sports events and other televised programs, newspapers or magazines, and being offered free cigarette or cigarette-branded merchandise promotions were significantly more likely to be smokers, with effects ranging from moderate (OR=1.19) to very strong (OR=3.83). Conclusions: This is the first attempt from India to investigate the relationship between smoking and advertising. When the data were collected, cigarette advertising was legal and highly correlated with smoking behavior. Today, indirect surrogate advertising still exists; future research should examine its effect, as it is likely to have the same impact as direct advertising on smoking behavior. Finally, counter-advertising has a protective effect on youth and may function as a cessation aid.

Sherman EJ; Primack BA. What works to prevent adolescent smoking? A systematic review of the National Cancer Institute's research-tested intervention programs. Journal of School Health 79(9): 391-399, 2009. (38 refs.)

BACKGROUND: Cigarette use remains the leading preventable cause of death in the United States. Although school is an ideal setting for antismoking interventions, school-based programs have not been successful in the long term. The purpose of this study was to explore characteristics of programs deemed to be successful short-term Research-Tested Intervention Programs (RTIPs) by the National Cancer Institute (NCI). METHODS: To identify adolescent smoking prevention programs, 2 independently working researchers applied specified selection criteria to all programs in the NCI's RTIP database. Selected programs were abstracted using a structured form for general information, participants, interventions, outcomes, and quality. Extracted data were then assessed for common themes and contrasts in each category. RESULTS: As of June 2008, 18 studies met the NCI's standards for RTIPs preventing smoking among adolescents. After selection criteria were applied, only 5 programs remained. Each independently working researcher arrived at the same pool of programs. In chronological order according to date of publication of outcomes evaluation, the 5 programs ultimately included were Project Towards No Tobacco Use, Pathways to Health, Native FACETS, Kentucky Adolescent Tobacco Prevention Project, and Sembrando Salud. The majority of these programs were targeted toward a particular sociodemographic group (eg, American Indians, Hispanic migrant communities). CONCLUSIONS: New school-based programs are needed to address current issues in tobacco control. To improve chances of success, these programs may wish to target certain specific high-risk demographic groups, use professional health educators and/or trained community members, and build in methods of updating material.

Sichletidis LT; Chloros DA; Tsiotsios AI; Spyratos DG. Prevalence and risk factors for initiation of smoking in Greek high-school students. International Journal of Environmental Research and Public Health 6(3): 971-979, 2009. (25 refs.)

The smoking habits of 9,276 high-school students (15-18 years old) in six cities of Northern Greece were studied using a questionnaire in order to determine the prevalence and possible risk factors for initiation of smoking. We observed that 29.6% of high-school students (32.6% of boys and 26.7% of girls) were current smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive behaviour towards parents' and teachers' advice (40.2%) and the existence of smoking friends (40.1%) were the main reasons of initiation. A well-planned integrated anti-smoking campaign is urgently required, especially among students and teachers.

Sims TH. Tobacco as a substance of abuse. Pediatrics 124(5): E1045-E1053, 2009. (81 refs.)

Tobacco use is the leading preventable cause of morbidity and death in the United States. Because 80% to 90% of adult smokers began during adolescence, and two thirds became regular, daily smokers before they reached 19 years of age, tobacco use may be viewed as a pediatric disease. Every year in the United States, approximately 1.4 million children younger than 18 years start smoking, and many of them will die prematurely from a smoking-related disease. Moreover, there is recent evidence that adolescents report symptoms of tobacco dependence early in the smoking process, even before becoming daily smokers. The prevalence of tobacco use is higher among teenagers and young adults than among older adult populations. The critical role of pediatricians in helping to reduce tobacco use and addiction and secondhand tobacco-smoke exposure in the pediatric population includes education and prevention, screening and detection, and treatment and referral.

Skinner ML; Haggerty KP; Catalano RF. Parental and peer influences on teen smoking: Are White and Black families different? Nicotine & Tobacco Research 11(5): 558-563, 2009. (32 refs.)

Introduction: The health risks associated with smoking disproportionately burden Blacks, and Black adults are more likely to smoke than are White adults. Most adult smokers have their first smoking experience as teenagers; however, rates of smoking initiation during adolescence remain lower among Black compared with White youth. Methods: The level and impact of family and peer risk and protective factors on adolescent smoking across both groups were modeled prospectively from 8th to 10th grade in a sample of 331 (Black n = 162, White n = 168) families using data from self-administered computer-assisted questionnaires. Predictors included parent smoking, guidelines against substance use, monitoring, consistent discipline, attachment to parents, and association with deviant peers. Results: Mean-level differences indicated greater risk for Black teens in some cases and higher protection in others. Multiple-group structural equation modeling indicated no race differences. Several factors affected both groups: (a) parenting factors reduced association with deviant peers, (b) association with deviant peers increased the risk of smoking in the 10th grade, and (c) teens were more likely to smoke if their parents smoked. Discussion: Reduced smoking among Black teens compared with White teens may be due to the protection of clear parental guidelines about substance use and clearly stated consequences for failure to observe those guidelines.

Solomon LJ; Bunn JY; Flynn BS; Pirie PL; Worden JK; Ashikaga T. Mass media for smoking cessation in adolescents. Health Education & Behavior 36(4): 642-659, 2009. (36 refs.)

Theory-driven, mass media interventions prevent smoking among youth. This study examined effects of a media campaign on adolescent smoking cessation. Four matched pairs of media markets in four states were randomized to receive or not receive a 3-year television/radio campaign aimed at adolescent smoking cessation based on social cognitive theory. The authors enrolled 2,030 adolescent smokers into the cohort (n = 987 experimental; n = 1,043 comparison) and assessed them via annual telephone surveys for 3 years. Although the condition by time interaction was not significant, the proportion of adolescents smoking in the past month was significantly lower in the experimental than comparison condition at 3-year follow-up when adjusted for baseline smoking status. The media campaign did not impact targeted mediating variables. A media campaign based on social cognitive constructs produced a modest overall effect on smoking prevalence among adolescents, but the role of theory-based constructs is unclear.

Stein-Seroussi A; Stockton L; Brodish P; Meyer M. Randomized controlled trial of the ACTION smoking cessation curriculum in tobacco-growing communities. Addictive Behaviors 34(9): 737-743, 2009. (27 refs.)

We conducted a group randomized trial of an interactive, games-based tobacco cessation program (ACTION) designed to help adolescents who live in tobacco-growing communities to stop using tobacco. More than 260 high school students participated in this study, in 14 schools across three states. We collected self-reported measures of cigarette and smokeless tobacco use and conducted biochemical validation of self-reported use at three time points (pre-test, immediate post-test, and 90-day follow-up). We used multi-level modeling to account for intraclass clustering at the school and classroom levels, and we analyzed our results using an intent-to-treat approach and a per protocol approach. Using the per protocol analytic approach, ACTION participants were more likely than comparison participants to achieve abstinence at 90-day follow-up. We found no program effects on our secondary outcomes or mediating factors. This study suggests that ACTION has promise as a relatively effective adolescent cessation program, although the overall limited effectiveness of cessation programs for adolescents must be acknowledged.

Sterling KL; Curry SJ; Emery S; Sporer AK; Mermelstein RJ; Berbaum M et al. Internally-developed teen smoking cessation programs: Characterizing the unique features of programs developed by community-based organizations. International Journal of Environmental Research and Public Health 6(3): 1026-1040, 2009. (18 refs.)

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization's initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p <= 0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted.

Sterling KL; Mermelstein R; Turner L; Diviak K; Flay B; Shiffman S. Examining the psychometric properties and predictive validity of a youth-specific version of the Nicotine Dependence Syndrome Scale (NDSS) among teens with varying levels of smoking. Addictive Behaviors 34(6-7): 616-619, 2009. (13 refs.)

Current conceptualizations of nicotine dependence suggest assessing its multidimensional structure, especially for understanding how dependence develops in teen smokers. It is unknown if a multidimensional structure holds for teens with varying levels of smoking. The psychometric properties and predictive validity of the youth-specific, multidimensional Nicotine Dependence Syndrome Scale (NDSS) was assessed among 526 teens (55.5% female; 74.3% Caucasian) who reported smoking in the past 30 days. NDSS and smoking measures were obtained at baseline and six months. Confirmatory factor analysis supported the NDSS-Total (NDSS-T, alpha=0.94) and five factors for the sample: Drive (alpha=0.92), Tolerance (alpha=0.85), Priority (alpha=0.83), Stereotypy (alpha=0.73), and Continuity (alpha=0.64). NDSS-T. Drive, Tolerance, and Priority were predictors of subsequent amount smoked (p<0.01). Drive, Tolerance, and Continuity predicted subsequent cessation (p<0.05). Though the youth-specific NDSS has good psychometric properties, tests of predictive validity for subsequent smoking and cessation behavior suggest only certain dimensions of dependence, particularly Drive and Tolerance, appear to be salient in this sample. Further studies should assess the multidimensional nature of nicotine dependence among teens with varying levels of smoking.

Tanski SE; Stoolmiller M; Dal Cin S; Worth K; Gibson J; Sargent JD. Movie character smoking and adolescent smoking: Who matters more, good guys or bad guys? Pediatrics 124(1): 135-143, 2009. (37 refs.)

OBJECTIVE: To assess the association between smoking onset and exposure to movie smoking according to character type. METHODS: A longitudinal, random-digit-dial telephone survey of 6522 US adolescents was performed with movie exposure assessed at 4 time points over 24 months. Adolescents were asked whether they had seen a random subsample of recently released movies, for which we identified smoking by major characters and type of portrayal (divided into negative, positive, and mixed/neutral categories). Multivariate hazard regression analysis was used to assess the independent effects of these exposures on the odds of trying smoking. RESULTS: By the 24-month follow-up survey, 15.9% of baseline never-smokers had tried smoking. Within the sample of movies, 3848 major characters were identified, of whom 69% were male. Smokers represented 22.8% of 518 negative characters, 13.7% of 2486 positive characters, and 21.1% of 844 mixed/neutral characters. Analysis of the crude relationship showed that episodes of negative character smoking exposure had the strongest influence on smoking initiation. However, because most characters were portrayed as positive, exposure to this category was greatest. When the full population effect of each exposure was modeled, each type of character smoking independently affected smoking onset. There was an interaction between negative character smoking and sensation-seeking with stronger response for adolescents lower in sensation-seeking. CONCLUSIONS: Character smoking predicts adolescent smoking initiation regardless of character type, which demonstrates the importance of limiting exposure to all movie smoking. Negative character portrayals of smoking have stronger impact on low risk-taking adolescents, undercutting the argument that greater exposure is a marker for adolescent risk-taking behavior.

ter Doest L; Dijkstra A; Gebhardt WA; Vitale S. Cognitions about smoking and not smoking in adolescence. Health Education & Behavior 36(4): 660-672, 2009. (33 refs.)

The theory of planned behavior identifies important proximal determinants of behavior, including attitude toward the behavior, perception of subjective norms exerted by significant others, and perception of perceived control over performance of the behavior. Because research in the planned behavior tradition has focused on desirable target behaviors, it is not clear how these determinants can best be conceptualized to account for adolescents' acquisition of health risk behaviors such as smoking. This cross-sectional study compared the explanatory power of planned behavior constructs assessed in relation to "smoking" and "not smoking" in a sample of 248 Dutch secondary students (aged 12 to 17 years; 56% girls). The results indicated that four variables -- attitude toward smoking, perceived subjective norm, and perceived behavioral control over both smoking and not smoking -- best explained the adolescents' smoking intentions and smoking behavior. Methodological and practical implications for smoking interventions are discussed.

Terchek JJ; Larkin EMG; Male ML; Frank SH. Measuring cigar use in adolescents: Inclusion of a brand-specific item. Nicotine & Tobacco Research 11(7): 842-846, 2009. (15 refs.)

This study examined whether the standard measure of cigar use in adolescents could be improved by the addition of a brand-specific example. In 2002, prevalence of tobacco use was assessed in six midwestern U.S. high schools using the Youth Risk Behavior Survey. The survey was readministered to the same schools in 2004, with the brand name "Black and Milds" added to the item measuring cigar use. Changes in local prevalence rates were compared with national rates. Local rates of cigar and cigarette use in 2002 were consistent with national rates reported in 2003. In 2004, when the cigar item was modified to include a brand-specific example, the percentage of students reporting cigar use nearly doubled-from 12.9% to 20.7%. This difference was particularly notable among Black teens. During the same period, local rates of cigarette use remained constant, as did national rates of reported cigar and cigarette use. Results suggest that the current national survey item may not adequately measure cigar use. Accordingly, prevalence of cigar use among adolescents may be greatly underestimated, especially among Black youth.

Thorner-Bantug E; Jaszyna-Gasior M; Schroeder JR; Collins CC; Moolchan ET. Weight gain, related concerns, and treatment outcomes among adolescent smokers enrolled in cessation treatment. Journal of The National Medical Association 101(10): 1009-1014, 2009. (20 refs.)

We examined associations of weight concerns and weight gain with adolescent tobacco cessation treatment and whether these effects differed by gender or ethnoracial group. Participants were 115 urban adolescents recruited for a randomized clinical trial of nicotine replacement therapy. Baseline weight gain concerns were assessed using the Eating Disorders module from the Diagnostic Interview for the Child and Adolescent DICA-IV). The average weight gain during the trial was 0.59 +/- 2.85 kg among the 43.5% of participants who completed the treatment study. As indicated by the DICA, baseline weight gain concerns were not associated with weight gain during treatment, study completion, or abstinence from smoking at 3-month posttreatment follow-up; these results did not vary by gender or ethnoracial group. Adolescents who quit smoking gained no more weight during the trial than those who smoked.

Vallone DM; Allen JA; Xiao HJ. Is socioeconomic status associated with awareness of and receptivity to the truth(R) Campaign? Drug and Alcohol Dependence 104(Supplement 1): S115-S120, 2009. (9 refs.)

Background: The truth (R) campaign is credited with preventing approximately 450,000 youth from starting to smoke, from 2000 through 2004 [Farrelly, M.C., Nonmemaker, J., Davis, K.C., Hussin, A., 2009. The Influence of the National truth (R) Campaign on Smoking Initiation. Am. J. Prev. Medical. February 9 [Epub ahead of print]]. However, no research has been conducted to determine whether lower socioeconomic status (SES)youth benefit equally from the campaign. This study examines whether socioeconomic status is associated with awareness of and receptivity to the truth (R) campaign among youth ages 12-17. Methods: This study is based on seven waves of Legacy Media Tracking Survey (LMTS) data, collected from September 2000 through January 2004 (n = 30,512). LMTS is a nationally representative, cross-sectional telephone survey. Median household income and median household education at the zip code level were appended to the LMTS data. Results: Females had lower levels of confirmed awareness of the truth (R) campaign as compared with males. Youth who lived in lower education zip codes were less likely to have confirmed campaign awareness as compared with those in higher education zip codes. Zip code level median household income was not associated with confirmed awareness. Receptivity to the campaign was not associated with zip code level median household income or education. Conclusions: These findings suggest that the effectiveness of the truth (R) campaign could be enhanced by developing strategies to increase campaign awareness among females and youth from lower education zip codes. Increased campaign exposure within these populations could result in lower smoking rates and, ultimately, lower rates of tobacco-related disease.

Vasudevan V; Etzel CJ; Spitz MR; Wilkinson AV. Maternal current smoking: Concordance between adolescent proxy and mother's self-report. Nicotine & Tobacco Research 11(8): 1016-1019, 2009. (10 refs.)

Introduction: The purpose of this study was to examine the extent to which adolescent reports on mother's smoking status and mother's self-reports on smoking are concordant with one another. Methods: Mothers self-reported on their smoking at two time-points (first query and second query), while the adolescents reported on their mother's smoking status at one timepoint. Kappa values and percent exact agreement as well as sensitivity and specificity were calculated to examine the degree of agreement between child and mother's reports at the two timepoints. Results: Overall, the results indicated good concordance between mothers' self-reports and adolescent reports on smoking. Specifically, higher concordance was observed for mother's first query compared with mother's second query (kappa = 0.69 vs. kappa = 0.51). Younger adolescents and girls provided more concordant reports than older adolescents and boys. Discussion: The results indicate that adolescent reports on mothers' smoking behavior can be used as a proxy to obtain data if mothers' self-report data are not available. Our results further suggest that when reports are not collected concurrently, self-report data obtained from the mothers prior to the proxy report obtained from her adolescent may be more reliable than the other way around.

Verkooijen KT; De Vries N; Nielsen GA. Youth crowds and cigarette smoking: A prospective study. Addiction Research & Theory 17(3): 333-342, 2009. (25 refs.)

This study examined the prospective relationship between crowd affiliation and smoking behavior among a national sample of 16-22 year old Danes (N = 952). Self-reported data were collected by means of a postal questionnaire at baseline and at 18 months follow-up. The sample included participants, who at baseline reported to identify with a crowd with either a low-smoking norm (n = 705) or a high-smoking norm (n = 247). The results showed that participants, who at baseline identified with a crowd with a high-smoking norm were compared to those, who identified with a low-smoking norm crowd, more likely to have started smoking at time of the follow-up (OR = 2.15). Further, discordance between one's behavior and the norm of the crowd resulted more often in a change in smoking behavior (OR = 2.00) and crowd identification (OR = 2.15) than the absence of such discordance. The results confirm the importance of crowds in smoking initiation and call for more attention to this issue in smoking prevention.

Waldron M; Heath AC; Lynskey MT; Nelson EC; Bucholz KK; Madden PAF et al. Smoking and illicit drug use associations with early versus delayed reproduction: Findings in a young adult cohort of Australian twins. (review). Journal of Studies on Alcohol and Drugs 70(5): 786-796, 2009. (105 refs.)

Objective: This article examines relationships between reproductive onset and lifetime history of smoking, regular smoking, and nicotine dependence, and cannabis and other illicit drug use. Method: Data were drawn from a young adult cohort of 3,386 female and 2,751 male Australian twins born between 1964 and 1971. Survival analyses were conducted using Cox proportional hazards regression models predicting age at first childbirth from history of substance use or disorder separately by substance class. Other substance use or disorder, including alcohol dependence, as well as sociodemographic characteristics, history of psychopathology, and family and childhood risks, were included as control variables in adjusted models. Results : Regular smoking and nicotine dependence were associated with earlier reproduction, with pronounced effects for women. For women, use of cannabis was associated with early reproduction before age 20, and with delayed reproduction among women who have not reproduced by age 20 or 25. Adjustment for control variables only partially explained these associations. Conclusions: Consistent with research linking adolescent use with sexual risk taking predictive of early childbearing, regular smokers and nicotine-dependent individuals show earlier reproductive onset. In contrast, delays in childbearing associated with use of cannabis are consistent with impairments in reproductive ability and/or opportunities for reproduction. Continued research on risks both upstream and downstream of substance-use initiation and onset of substance-use disorder is needed for causal mechanisms to be fully understood.

Wallace JM; Vaughn MG; Bachman JG; O'Malley PM; Johnston LD; Schulenberg JE. Race/ethnicity, socioeconomic factors, and smoking among early adolescent girls in the United States. Drug and Alcohol Dependence 104(Supplement 1): S42-S49, 2009. (32 refs.)

Background: This study uses large nationally representative samples of White, Black, Mexican American, Puerto Rican, Other Latina, Asian American, and American Indian 8th-grade girls to examine racial/ethnic differences and similarities in patterns, trends, and socioeconomic correlates of cigarette use. Methods: The data are drawn from the University of Michigan's Monitoring the Future study. Prevalence and trend data (from 1991 to 2007) in girls' cigarette use were examined by racial/ethnic subgroup. Logistic regression analyses were conducted to determine the extent to which socioeconomic factors predict girls' cigarette use, and whether the relationships between socioeconomic status (SES) and smoking differed across racial/ethnic Subgroup. Results: Cigarette use was highest among American Indian girls; at an intermediate level among Mexican American, Puerto Rican, Other Latinas, and White girls; and lowest among Black and Asian American girls, Trend data show that cigarette use has declined for all racial/ethnic subgroups, and that small but consistent racial/ethnic differences in girls' cigarette use have persisted. Generally, girls who did not live in two-parent households, whose parents had lower levels of educational attainment, who attended lower SES schools, and who had more disposable income were more likely than their peers to smoke. That said, however, the relationships between smoking and parental education and school SES were, on average, stronger for White girls than for Black or Hispanic (Mexican American, Other Latina, Puerto Rican) girls. Conclusions: Future research should seek to understand the mechanisms by which low SES impacts smoking.

Wen M; Van Duker H; Olson LM. Social contexts of regular smoking in adolescence: Towards a multidimensional ecological model. Journal of Adolescence 32(3): 671-692, 2009. (56 refs.)

Using data from the Add Health, this study examined multilevel factors of adolescent smoking after controlling for the baseline smoking behavior and individual characteristics. Results showed that peer, family and school were all important life domains contextually influencing Subsequent smoking behavior among adolescents. Time spent with peers, best friend smoking and household member smoking were associated with higher risk. Parent-child closeness, parental control, attending a private school and having a higher percentage of Hispanic Students at school were protective factors. Significant interaction effects were found between parental control and household member smoking and between parent-child closeness and communication. None of the neighborhood- and state-level factors were significant in the filial full model but they were significant in reduced models. More proximate social contexts appear to play a more direct and immediate role in adolescent smoking than macro-level factors. An ecological model incorporating multiple social systems seems more fruitful than single-system models to reveal etiology of adolescent smoking.

Wiium N; Aaro LE; Hetland J. Psychological reactance and adolescents' attitudes toward tobacco-control measures. Journal of Applied Social Psychology 39(7): 1718-1738, 2009. (38 refs.)

The theory of psychological reactance predicts that, to the extent that smoking-control measures are perceived as threatening the individual's freedom to choose among behavioral alternatives, they may be met with resistance. Data were collected from a national representative sample of 2,400 young people (ages 16-20) by telephone interviews. Dispositional reactance was shown to be associated with smoking. Principal components analyses revealed that a distinction should be made between attitudes toward weak and attitudes toward strong smoking-control measures. Attitudes toward strong measures were particularly negative among regular smokers. Among regular smokers, dispositional reactance was found to be significantly associated with attitudes toward strong tobacco-control measures. Processes of psychological reactance deserve attention when designing smoking control programs.

Wiium N; Wold B. An ecological system approach to adolescent smoking behavior. Journal of Youth and Adolescence 38(10): 1351-1363, 2009. (41 refs.)

The aim of the present study was to simultaneously examine the effect of factors related to school, leisure, family and the individual on adolescent smoking. These determining factors occupy the micro- and mesosystems of Bronfenbrenner's Ecological Theory. Data were collected using questionnaires from a nationally representative sample of 15-year-olds (1404 pupils) and 73 staff members from 73 schools in Norway. Males formed 51% of the sample size. Consistent with previous studies, the various factors were linked to adolescent smoking when examined separately. However, in an ecological setting, factors related to the individual and leisure (i.e., attitudes towards smoking, perceived behavioural control and evenings with friends) emerged as the strongest predictors. School and family factors were completely mediated by individual and leisure factors, although when examined alone, they explained quite a substantial amount of the variance and a considerable amount of school difference in adolescent smoking. The implications are discussed.

Wileyto P; O'Loughlin J; Lagerlund M; Meshefedjian G; Dugas E; Gervais A. Distinguishing risk factors for the onset of cravings, withdrawal symptoms and tolerance in novice adolescent smokers. Tobacco Control 18(5): 387-392, 2009. (31 refs.)

Aim: While many studies report determinants of adolescent cigarette smoking, few identify risk factors for nicotine dependence (ND). This study distinguished between risk factors for three hallmarks of ND including cravings, withdrawal symptoms and tolerance. Methods: A total of 319 novice smokers were followed every 3 months from first puff on a cigarette until the end of secondary school. Outcomes included time to first report of cravings, withdrawal symptoms and tolerance. Results: Female sex, inhalation, smoking a whole cigarette, weekly smoking, daily smoking and alcohol use each independently increased the incidence of the onset of cravings. Inhalation, weekly smoking, daily smoking and alcohol use predicted the onset of withdrawal symptoms. Withdrawal symptoms, smoking a whole cigarette, monthly smoking, daily smoking and friends and siblings smoking increased the incidence of the onset of tolerance. None of parental education, impulsivity, novelty seeking, self-esteem, depression, stress, parental smoking, physical activity, or participation in sports teams was associated with the outcomes. Conclusion: The hallmarks of early ND are related to intensity and frequency of cigarette use. Avoidance of daily smoking may be particularly important in preventing the onset of ND symptoms and sustained smoking.

Wong MM; Brower KJ; Zucker RA. Childhood sleep problems, early onset of substance use and behavioral problems in adolescence. Sleep Medicine 10(7): 787-796, 2009. (65 refs.)

Background: Very few prospective studies examine the relationship between childhood sleep problems and subsequent substance use. In this study, we examined how sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use in adolescence. We also investigated the relationships between childhood sleep problems and adolescent internalizing and externalizing problems. Methods: Study participants were 292 boys and 94 girls from a community sample of high risk families and controls in an ongoing longitudinal study. Results: Controlling for parental alcoholism, sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use among boys and onset of alcohol use among girls. Childhood sleep problems were related to maternal ratings of internalizing and externalizing problems during adolescence for both boys and girls. Adjusting for these problems did not weaken the effects of sleep problems on onset of substance use. Conclusions: This is to our knowledge the first study that prospectively examines gender differences in the relationship between sleep problems and early onset of substance use. Childhood sleep problems predicted early onset of substance use for boys but not girls. If childhood sleep problems indeed increase the probability Of Substance use onset, greater attention by parents to sleep problems in children and adolescents would potentially have ameliorative long-term effects. Parents are encouraged to explore different ways to help their children sleep better, including obtaining information and suggestions from their primary care physicians.

Yeung JWK; Chan YC; Lee BLK. Youth religiosity and substance use: A meta-analysis from 1995 to 2007. Psychological Reports 105(1): 255-266, 2009. (50 refs.)

In this meta-analysis, the magnitude of the protective effects of religiosity on Youth involvement in substance use was investigated. Based on 22 studies in peer-reviewed journals published between 1995 and 2007, the average weighted mean correlation was Z(r) = .16, significant regardless of the definitions of religiosity. The homogeneity test of variance showed consistent protective effects of religiosity on four types of substance use, namely, alcohol, cigarette, marijuana, and other illicit drugs.

Yoo S; Kim HB; Lee SY; Kim BS; Kim JH; Yu J et al. Effect of active smoking on asthma symptoms, pulmonary function, and BHR in adolescents. Pediatric Pulmonology 44(10): 954-961, 2009. (39 refs.)

Background: Active smoking is known to increase asthma symptoms and bronchial hyper-responsiveness (BHR) while decreasing pulmonary function in adults, but few studies have addressed these issues in adolescents. Methods: We conducted a cross-sectional survey involving questionnaires and assessment of urinary cotinine levels among 1,492 adolescents from three urban areas of South Korea. Current smoking was defined as having smoked more than 1 day in the prior 30 days or having urine cotinine levels >= 100ng/ml. Spirometry, skin tests, and methacholine challenge tests were performed on adolescents in Seoul (n=724). Results: The prevalence of current smoking was 8.2% in boys and 2.4% in girls. Reports of wheeze and exercise-induced wheeze in the previous 12 months were more frequent in smokers than nonsmokers (15.2% vs. 8.5%, P=0.024, and 20.4% vs. 10.7%, P=0.004, respectively). In multiple logistic regression analysis, current smoking was found to be a significant risk factor for having wheezed in previous 12 months (OR = 4.5, 95% CI 1.5-13.2) and having exercise-induced wheezing in previous 12 months (OR = 8.7, 95% CI, 3.7-20.9). The subgroup analysis revealed that the FEV1/FVC was lower in smokers than nonsmokers (mean +/- SD, 105.1 +/- 8.6% vs. 107.8 +/- 7.8%, P=0.019). In contrast, there was no significant difference in BHR. The effect of smoking on asthma symptoms were more pronounced in non-atopic compared with atopic adolescents. Conclusion: Current smoking was significantly associated with symptoms of asthma, such as having recent wheezing and recent exercise-induced wheezing, especially for non-atopics, in Korean adolescent population. Current smoking was further associated with lower pulmonary function, but not BHR.