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CORK Bibliography: Adolescents and Nicotine

124 citations. January 2008 to present

Prepared: December 2008

Abasiubong F; Atting I; Bassey E; Ekott J. A comparative study of use of psychoactive substances amongst secondary school students in two local government areas of Akwa Ibom State, Nigeria. Nigerian Journal of Clinical Practice 11(1): 45-51, 2008. (16 refs.)

Background: The use and abuse of psychoactive substances is very rampant, even in our secondary schools. In recent times, there has been a growing concern about negative effects of these substances on youths. The high incidence of school dropouts and other nefarious activities are the resultant impacts on the students. Objectives: The objectives of the study were: (1) To determine the prevalence of substance use amongst secondary school students. (2) Compare the findings in two different local settings. (3) To determine the sociodemographic variables. Materials and Methods: Four hundred secondary school students from two Local Government Areas were assessed for use of psychoactive substances, during the second term of 2004/2005 school session, using a Youth Survey Questionnaire. Results: A total of 254 (63.5%) students, consisting of 119 from Uyo and 135 from Eket were analyzed. The mean age of the students in both schools was 17.1 +2.0 and 16.6 + 1.7 years respectively. The difference in the mean was statistically significant (t=l. 14; df= 3, p > 0.05). More students from Uyo, 37 (31.1%) used kolanuts, 54 (45.4%) sedatives, while more students from Eket, 47 (34.8%) used tobacco/cigarettes, 76 (56.3%) alcohol, 21 (15.6%) Indian hemp, 5 (3.7%) cocaine and 1 (0.7%) heroin. Class level (P=0.04), upbringing (P=0.02) and parents' marital status (P=0.01) was statistically significant in the use of tobacco/cigarettes. Also, class level (P=0.02) parents' marital status (P=0.00) was statistically significant in the use of alcohol, while family type (P=0.00) and parents' marital status was significant in the use of sedatives. Similarly, parents' marital status (p=0.05) was statistically significant in the use of Indian hemp, while family type (P=0.00), upbringing (P=0.03) was significant in cocaine. Conclusion: The findings of this study confirm the presence and use of psychoactive substances in varying proportions among students. Therefore, there is need to strengthen the monitoring and preventive programmes aimed at reducing their spread in schools.

Agirbasli M; Tanrikulu B; Arikan S; Izci E; Ozguven S; Besimoglu B et al. Trends in body mass index, blood pressure and parental smoking habits in middle socio-economic level Turkish adolescents. Journal of Human Hypertension 22(1): 12-17, 2008. (39 refs.)

Patterns of cardiovascular risk factors in populations are not static over time. We examined trends in body mass index (BMI), parental smoking and blood pressure over a 15-year period in Turkish children aged 15-17 years. Two cross-sectional studies were performed in secondary schools in Turkey in 1989-1990 and 2004-2005. Study participants were 673 children in 1989-1990 and 640 adolescents in 2004-2005. Main outcome measures were weight, height, BMI, presence and amount of parental smoking, systolic and diastolic blood pressure. Age and sex matched comparisons were performed to assess temporal trends in these measures. Children in 2004-2005 had increased weight, height, BMI and decreased systolic and diastolic blood pressure in all age groups compared with children in 1989-1990. According to the international criteria, 3.4% of children were obese and 15.8% were overweight in 2005, compared to 0.7% obese and 4.2% overweight in 1990 (P<0.001). However, a decrease was noted in blood pressure; 16% were classified as hypertensive in 1989-1990 versus 8% in 2004-2005 (P<0.001). The prevalence and amount of parental smoking also decreased over the last 15 years. We observed significant changes in BMI and blood pressure in Turkish children over the last 15 years. Temporal trends in these parameters may indicate a change in the pattern of cardiovascular disease in this population.

Ames SC; Rock E; Hurt RD; Patten CA; Croghan IT; Stoner SM et al. Development and feasibility of a parental support intervention for adolescent smokers. Substance Use & Misuse 43(3/4): 497-511, 2008. (31 refs.)

The aim of this investigation was to develop and evaluate the feasibility and acceptability of a parental support intervention. A new measure of perceived parental support for stopping smoking was also developed. The sample included 59 adolescent-parent pairs recruited from a mid-sized Midwestern town during 2000-2003. The mean SD age of the participants (32 males, 27 females) was 16.3 0.9 (range 14-18) years and 86% were Caucasian, 7% American Indian, 5% African American, and 2% Hispanic. Participants were randomized to parental support or minimum behavioral intervention. Severity of nicotine dependence was evaluated using the Fagerstrm Tolerance Questionnaire, and perceived social support was evaluated using the Family Environment Scale and the new measure of perceived parent support for stopping smoking that was developed as part of this investigation. Treatment attendance, adherence, and acceptability were also evaluated. The parental support intervention was feasible but not superior to the minimum behavioral intervention with respect to attendance, retention, or change in support. This study expands on the knowledge of treating adolescent smokers and presents a new assessment measure. The study's limitations are noted. This investigation was funded by NICHHD.

Andrews JA; Hampson SE; Barckley M; Gerrard M; Gibbons FX. The effect of early cognitions on cigarette and alcohol use during adolescence. Psychology of Addictive Behaviors 22(1): 96-106, 2008. (65 refs.)

The present study predicts cigarette and alcohol use in adolescence from the development of children's cognitions in the elementary years. Using latent growth modeling, the authors examined a model using data from 712 participants in the Oregon Youth Substance Use Project, who were in the 2nd through 5th grade at the 1st assessment and followed for 6 annual or semiannual assessments over 7 years. Growth in children's prototypes and subjective norms in the elementary years (Times I through 4) were related to their substance use in adolescence (Time 6) through their willingness and intentions (Time 5) to smoke and drink. Across the sample, for both substances, the intercept and slope of prototypes were either indirectly related to use through willingness or directly related to use. Both the intercept and slope of subjective norms were indirectly related to use of both substances through both willingness and intentions and directly related to cigarette use. Results suggest that elementary children have measurable cognitions regarding substance use that develop during the elementary years and predict use later in adolescence. These findings emphasize the need for prevention programs targeted at changing children's social images of substance users and encouraging more accurate perceptions of peers' use.

Ayo-Yusuf OA; Reddy PS; van den Borne BW. Adolescents' sense of coherence and smoking as longitudinal predictors of self-reported gingivitis. Journal of Clinical Periodontology 35(11): 931-937, 2008. (44 refs.)

Objective: This study sought to determine the influence of sense of coherence (SOC), a personal stress-coping resource, and smoking on the self-reported gingival health of a cohort of rural black South African adolescents. Methods: This 18-month study involved a three-wave survey of a representative sample of eighth graders from 11 randomly selected high schools in the Limpopo province, South Africa (n=970). Using a generalized estimating equation model, we examined the correlates of recent gingivitis, defined as self-reporting frequent gingival bleeding (GB). Explanatory variables included baseline socio-economic status, age, gender, plaque levels, toothbrushing frequency, tobacco use status and SOC levels. Results: Among our sample, 74.6% reported experiencing gingivitis at some point during follow-up, while 41.9% reported frequent GB at the last survey. Factors that were positively associated with recent gingivitis include living in poor households [odds ratio (OR)=1.49; p < 0.01], having higher plaque levels (OR=1.18; p=0.04) and smoking regularly (OR=1.57; p=0.04). Self-reporting gingivitis was negatively associated with being female (OR=0.76; p=0.02) and having a higher SOC (OR=0.96; p < 0.001). Conclusions: Adolescent smoking and SOC levels are independent predictors of self-reported gingivitis. Therefore, in addition to plaque control, smoking prevention and the teaching of stress-coping skills may be important interventions for promoting adolescents' gingival health.

Baillie LE; Lovato CY; Taylor E; Rutherford MB; Smith M. The pit and the pendulum: The impact on teen smokers of including a designated smoking area in school tobacco control policy. Health Education Research 23(6): 1008-1015, 2008. (31 refs.)

Thirty per cent of school districts in British Columbia do not ban smoking outright on school grounds, and in several instances, smoking is permitted in smoking pits, regardless of school district policy. While there is evidence to suggest that enforcing a tobacco-free environment for students does reduce adolescent smoking rates, the concomitant safety and discipline problems it creates for school staff and administration are demanding and complex, and may override concerns regarding student smoking. This study uses a qualitative approach to explore the meanings that students place on tobacco control policy and the impact that these meanings have on their own smoking behaviours. We found that students were surprised and concerned that smoking was permitted on school property and that it negatively impacted their own tobacco prevention/control/cessation attempts.

Baker OG; Rice V. Predictors of narghile (water-pipe) smoking in a sample of American Arab Yemeni adolescents. Journal of Transcultural Nursing 19(1): 24-32, 2008. (97 refs.)

To explore the predictors of water-pipe smoking among American Arab Yemeni adolescents, a descriptive correlational design was used, and regression models representing the proposed relationships in the study were tested from a convenience sample of 297 adolescents who attended a teen health clinic and two high schools. The participants completed five measures. Fourteen hypotheses were tested. Experimentation with tobacco was found to be significant in predicting narghile smoking. Tobacco use prevention and cessation interventions for this population can be focused on targeting the family and peer units, from which their identity is likely derived.

Bassiony MM. Stages of progression in drug abuse involvement across generations in Jeddah, Saudi Arabia. Neurosciences 13(1): 37-40, 2008. (32 refs.)

Objectives: To investigate the stages of progression in drug involvement among adolescents and adults in Saudi Arabia. Methods: One hundred and one consecutive male patients (91 adults and 10 adolescents), with substance abuse or dependence according to DSM-IV criteria, admitted to Al-Amal Hospital in Jeddah, Saudi Arabia, during July and August 2002 for treatment, were included in the study. All participants answered a questionnaire, which included questions pertaining to the ages and stages of progression in drug abuse. Results: Adolescents started using tobacco and drugs at a younger age than adults. The difference is statistically significant for drugs (14.6 +/- 2.6 versus 22.0 +/- 8.3, t = 2.8; p = 0.006), but not for tobacco (14.7 +/- 1.8 versus 16.4 +/- 6.5, t = -0.8;p = 0.4). Adolescents and adults were different in the first (Chi 2 (3) = 13, P = 0.00 1) and the second (Chi 2 (3) = 14.5; p = 0.002) stages of progression, but similar in the third stage (Chi 2 (3) = 0.1; P = 1.0). Conclusion: Adolescents were different from adults regarding the age of onset and sequence of progression in drug involvement. This sequence was different in Saudi Arabia from that in other cultures and this could have an implication in prevention programs.

Bean MK; Mitchell KS; Speizer IS; Wilson DB; Smith BN; Fries EA. Rural adolescent attitudes toward smoking and weight loss: Relationship to smoking status. Nicotine & Tobacco Research 10(2): 279-286, 2008. (30 refs.)

Perceptions that smoking contributes to weight loss are widespread among youth. We examined the association between weight loss and smoking to determine whether supportive attitudes were associated with smoking status and whether this is a particular problem in rural areas. High school students (N=730) completed a survey assessing smoking-related characteristics and behaviors. Attitudes assessed included perceptions of whether weight concerns were the reasons others smoke and personal beliefs about tobacco's effect on weight gain. Smoking status was categorized as never (44%), experimental (42%), and current (14%). Multinomial logistic regressions investigated relationships between attitudes and smoking, adjusting for weight goals, gender, ethnicity, parent/peer smoking, and body mass index. Both attitudinal measures were associated with smoking (p<.05). Nonsmokers and experimental smokers were more likely than current smokers to believe that people smoke to lose weight. Although current smokers were less likely to report that others smoke for weight control, they believed they would gain weight if they quit. Conversely, nonsmokers and experimental smokers were less likely to believe they would gain weight if they do not smoke compared with current smokers. Thus personal attitudes differ from attitudes toward others with respect to weight loss and smoking. Moreover, endorsement of these attitudes can reliably distinguish current versus experimental smokers and may help better clarify the transition to current smoker. Because weight concerns are a significant factor in youth smoking, these issues should be included in intervention efforts, particularly in rural communities where smoking rates are higher and age at initiation is earlier.

Beebe LA; Vesely SK; Oman RF; Tolma E; Aspy CB; Rodine S. Protective assets for non-use of alcohol, tobacco and other drugs among urban American Indian youth in Oklahoma. Maternal and Child Health Journal 12(Supplement 1): S82-S90, 2008. (34 refs.)

Objective This study explored associations between nine youth assets and tobacco, alcohol and other drug non-use among participating American Indian adolescents. Methods Data from 134 American Indians, ages 13-19 years, participating in an inner-city youth asset study, were analyzed. Individual logistic regression analyses were conducted, controlling for demographic variables, with nine youth assets as the independent variables and alcohol, tobacco and other drug non-use as the dependent variables. Results: Among American Indian youth, nearly 79% reported not using alcohol in the past 30 days. The prevalence of tobacco non-use was somewhat lower than that of alcohol, with 71% reporting not using tobacco in the past 30 days. For other drug non-use, 87% reported not using other drugs in the past 30 days. The non-parental adult role models asset was significantly associated with non-use of alcohol (OR = 4.4, 95% CI 1.5-13.3), tobacco (OR = 7.5, 95% CI 2.2-25.6), and other drugs (OR = 5.0, 95% CI 1.5-16.8). The use of time (religion) asset was also significantly associated with alcohol non-use (OR = 2.8, 95% CI 1.1-7.2). The family communication asset was associated only with other drug non-use (OR = 3.1, 95% CI 1.02-9.4). For tobacco non-use, an interaction was observed between family structure and the good health practices (exercise/nutrition) asset. Among youth in single-parent households, the odds of tobacco nonuse were 4.4 times greater among those who possessed the good health practices (exercise/nutrition) asset. Conclusions Despite the relatively small sample size of American Indian youth, these results suggest an important role for specific youth assets in the prevention of substance abuse among American Indian youth.

Bernat DH; Erickson DJ; Widorne R; Perry CL; Forster JL. Adolescent smoking trajectories: Results from a population-based cohort study. Journal of Adolescent Health 43(4): 334-340, 2008. (19 refs.)

Purpose: To identify distinct smoking trajectories during adolescence and assess how smoking-related factors relate to trajectory membership. Methods: The sample includes 3637 youth from across the state of Minnesota. Measures include tobacco use, smoking behaviors of parents and friends, Youth smoking-related attitudes and beliefs, and home smoking policies. A cohort-sequential design was used to identify smoking trajectories. including live cohorts of youth (ages 12-16) followed for 3 years. Results: Six distinct trajectories of tobacco use were found: nonsmokers (54%). triers (17%). occasional users (10%), early established (7%). late established (8%), and decliners (4%). Several factors were associated with increased likelihood of being in a smoking trajectory group (vs. the nonsmoking group): parental smoking, friend smoking, greater perceptions of the number of adults and teenagers who smoke, and higher functional meaning of tobacco use. In contrast, higher perceived difficulty smoking in public places, negative perceptions of the tobacco industry, and home smoking policies were associated with less likelihood of being in one of the smoking trajectories (vs. the nonsmoking trajectory). Conclusions: Adolescents exhibit diverse patterns of smoking during adolescence and tobacco-related influences were strong predictors of trajectory membership.

Boardman JD; Saint Onge JM; Haberstick BC; Timberlake DS; Hewitt JK. Do schools moderate the genetic determinants of smoking? Behavior Genetics 38(3): 234-246, 2008. (65 refs.)

This paper uses data from the National Longitudinal Study of Adolescent Health to examine the extent to which school-level social and institutional factors moderate genetic tendencies to smoke cigarettes. Our analysis relies on a sub-sample of 1,198 sibling and twin pairs nested within 84 schools. We develop a multilevel modeling extension of regression-based quantitative genetic techniques to calculate school-specific heritability estimates. We show that smoking onset (h(2) = .51) and daily smoking (h(2) = .58) are both genetically influenced. Whereas the genetic influence on smoking onset is consistent across schools, we show that schools moderate the heritability of daily smoking. The heritability of daily smoking is the highest within schools in which the most popular students are also smokers and reduced within schools in which the majority of the students are non-Hispanic and white. These findings make important contributions to the literature on gene-environment interactions.

Bombard J; Rock V; Pederson L; Asman K. Monitoring polytobacco use among adolescents: Do cigarette smokers use other forms of tobacco? Nicotine & Tobacco Research 10(11): 1581-1589, 2008. (35 refs.)

The extent of concurrent use of cigarettes and one or more other tobacco products (polytobacco use) is important to explore because users may be at an increased risk for adverse health effects and nicotine dependency. We determined national population estimates of current cigarette and current polytobacco use for at least 50,000 students from the 2002 and 2004 National Youth Tobacco Surveys. We identified which tobacco products were most often used in conjunction with cigarettes and used multivariate analyses to identify factors associated with polytobacco use. The overall prevalence was 16.0% for current cigarette smoking among all respondents and 15.0% for current cigarette smoking among respondents with complete information on concurrent cigarette and other tobacco product use: 8.1% used cigarettes only, and 6.9% were polytobacco users. Among current male cigarette smokers, 62.0% used other tobacco products; among current female cigarette smokers, 30.9% did. Among current cigarette smokers using one other tobacco product, cigars or smokeless tobacco were the most frequently used products. In multivariate analysis, polytobacco use was associated with being male; being in middle school; residing in the Midwest, South, or West; being able to obtain cigarettes from a retailer; being subject to peer influence; having favorable beliefs about tobacco; being willing to use tobacco promotional items; being exposed to tobacco advertisements; and having higher levels of lost autonomy (an indicator of nicotine dependency). Youth interventions need to broaden their focus to address the use of all tobacco products, paying particular attention to adolescent males and youth living outside of the Northeast.

Brook JS; Duan T; Zhang CS; Cohen PR; Brook DW. The association between attention deficit hyperactivity disorder in adolescence and smoking in adulthood. American Journal on Addictions 17(1): 54-59, 2008. (35 refs.)

This longitudinal study examined the interrelationships between early and/or middle adolescent attention deficit hyperactivity disorder (ADHD), middle adolescent conduct disorder (CD), and later adult smoking behavior. This is a prospective longitudinal study. Data were collected via structured interviews of representative families in the northeastern United States (N=641). The mean ages of the offspring were as follows: 14 years (T2, 1983), 17 years (T3, 1985 - 1986), and 32 years (T6, 2002). The dependent variable was the participants' daily cigarette smoking in their early thirties. Logistic regression analyses indicated that the relationship between ADHD and daily smoking behavior was mediated by CD with control on gender, age, SES, and adolescent smoking. CD had a direct effect on daily smoking in adulthood. Our findings suggest that ADHD is related to CD, which in turn is associated with daily smoking. Therefore, interventions with ADHD adolescents who have ADHD at an early age might lead to some reduction in later smoking provided that the intervention has a positive effect on CD. For those adolescents who never had ADHD, our findings suggest that prevention or treatment aimed at reducing CD may be most successful in reducing daily smoking later in adulthood.

Brooks A; Larkin EMG; Kishore S; Frank S. Cigars, cigarettes, and adolescents. American Journal of Health Behavior 32(6): 640-649, 2008. (22 refs.)

Objective: To examine public health implications of adolescent use of cigars only, cigarettes only, and both cigarettes and cigars. Methods: A cross-sectional health risk survey was administered to a random sample of 4486 high school students in a Midwestern county. Results: More adolescents reported using both cigarettes and cigars (10.6%) than cigar-only (7.4%) or cigarette-only (6.4%). Product of initiation was associated with current product use. Dual use was associated with more frequent use of both products, high stress, and susceptibility to future cigarette use. Conclusion: Assessing cigarette use without examining cigar use overlooks a critical dimension of adolescent tobacco use.

Chen PL; Chiou HY; Chen YH. Chinese version of the Global Youth Tobacco Survey: Cross-cultural instrument adaptation. BMC Public Health 8(e-article 144), 2008. (16 refs.)

Background: Tobacco smoking poses public health concerns because of its high risk for many chronic diseases. Most smokers begin using tobacco in their teens and recent reports indicate that smoking prevalence is climbing among youth. The Global Youth Tobacco Survey (GYTS) is a worldwide, school-based, tobacco-specific survey, but cross-cultural differences limit its effectiveness in international studies. Specifically, the GYTS assesses not only the prevalence of smoking, but also tobacco-related attitudes, school curricula, and advertisements, which are culturally influenced. Therefore, we conducted this study to develop a Chinese version of the GYTS for both national surveillance and international comparison. Methods: The original English GYTS was translated and back translated using a cross-cultural adaptation process. The comprehensiveness and feasibility of using the Chinese-version GYTS were reviewed by a panel of 6 tobacco-control experts. The understandability and cultural relevance of the Chinese-version GYTS were discussed in a focus group of 5 schoolteachers and 8 students. The expert and focus group feedback was incorporated into a final Chinese version of the GYTS, which was administered to 382 students throughout Taiwan by multi-stage sampling from 10 randomly selected schools. Results: The internal consistency (Cronbach's alpha) for the GYTS subscales (smoking susceptibility, attitude toward smoking, and media messages about smoking) ranged from 0.70 to 0.94. The internal logical agreement of responses ranged from 85.3 to 99.2%. Conclusion: The Chinese version of the GYTS has good reliability and validity and can serve as the foundation for international comparison and tobacco control in Chinese-speaking communities.

Cheng TO. Adolescent smoking in China. (editorial). International Journal of Cardiology 126(1): 1-2, 2008. (5 refs.)

Cigarette smoking is a serious health problem in China, not only in adults but also in adolescents. The Chinese government is walking a tightrope, trying to balance prevention of diseases from smoking prohibition against revenue collection from the tobacco industry.

Choi S; Rankin S; Stewart A; Oka R. Effects of acculturation on smoking behavior in Asian americans: A meta-analysis. Journal of Cardiovascular Nursing 23(1): 67-73, 2008. (29 refs.)

Background: Cigarette smoking is the most preventable risk factor for many negative health consequences, such as cancer, heart disease, and lung disease. in the United States, the prevalence rate in Asian immigrants is high (26%-70%), with Southeast Asian men having the highest rate. Acculturation has been associated with smoking behavior in this ethnic group. Objective: The purposes of this meta-analysis are to describe the extent to which acculturation affects smoking behavior in Asian immigrants and to compare the direction and magnitude of the effect between subgroups by gender and age. Methods: Databases within PubMed, CINAHL, The Cochrane Library, and PsycINFO were searched. Twenty-one studies published in English or Korean from 1994 through 2005 met criteria, and 9 of these studies contained sufficient data. Among the 9 studies, 3 presented gender-specific data; thus, these studies were entered separately for men and women, making a total of 12 entries for final analysis. The odds ratio was used as an effect size statistic. The values of odds ratios were calculated from the data in the studies. Results: The average effect size for men was 0.53 (95% confidence interval, 0.28-0.99), indicating that acculturated men are 53% less likely to smoke than nonacculturated or "traditional" men. The average effect size for women was 5.26 (2.75-10.05), suggesting that acculturated women are 5 times more likely to smoke than traditional women. In adolescents, the average effect size was 1.92 (1.22-3.01), indicating that acculturated adolescents are almost 2 times more likely to smoke than traditional adolescents. Conclusions: Acculturation may have a protective effect on smoking behavior in Asian men and a harmful effect in Asian women and adolescents. The magnitude of effect is larger in women and adolescents than in men. Smoking cessation programs should target acculturated women, adolescents, and traditional men.

Costello DM; Dierker LC; Jones BL; Rose JS. Trajectories of smoking from adolescence to early adulthood and their psychosocial risk factors. Health Psychology 27(6): 811-818, 2008. (35 refs.)

Objective: To explore patterns of persistence and change in smoking behavior as well as risk factors associated with the developmental course of smoking from age 13 to 25. Design: Data from the public use sample of the National Longitudinal Study of Adolescent Health (N = 5,789) were analyzed Using semiparametric group-based modeling. Main Outcome Measures: Smoking quantity-frequency in the past 30 days. Results: Six distinct smoking trajectories were identified: nonsmokers, experimenters, stable light smokers, quitters, late escalators, and stable high smokers. Baseline risk factors that were associated with greater likelihood of membership in all (if the smoking trajectory groups compared with nonsmokers included alcohol use, deviance. peer smoking. and (with the exception of the late escalators) drug use. Deviance. peer smoking, and alcohol and drug use also distinguished the likelihood of membership among several of the 5 smoking trajectory groups. Conclusion: The results add to basic etiologic research on developmental pathways of smoking in adolescence and voting adulthood by providing evidence of heterogenecity in smoking behavior and prospectively linking different patterns of risk factors with the probability of trajectory group membership.

Cropsey KL; Linker JA; Waite DE. An analysis of racial and sex differences for smoking among adolescents in a juvenile correctional center. Drug and Alcohol Dependence 92(1/3): 156-163, 2008. (43 refs.)

The purpose of this study was to investigate racial and sex differences on the risk factors for smoking initiation and daily smoking among juvenile justice adolescents, a population that is traditionally ignored in school-based epidemiological samples. This study used archival data collected by juvenile justice authorities for a large sample of juvenile justice adolescents (N = 4381), examining interaction terms to determine race and sex differences for risk factors. About 70% of juvenile justice adolescents reported ever having smoked cigarettes while almost half reported daily smoking. Overall predictors of ever and daily smoking included older age, being female, White, use of alcohol, cannabis, and cocaine in the past year, affiliation with smoking peers, not living with at least one parent, and a diagnosis of ADHD. While differences were seen between individual predictor models for both race and sex, the interaction terms did not add significantly to the overall model. These important racial and gender differences in this study suggest that tailored prevention messages and interventions may be needed to be most effective with adolescents in the juvenile justice system. While this study provides a basic foundation of risk factors for smoking among juvenile justice adolescents, future research is needed to assess the efficacy of treatment and prevention interventions with this high risk group of adolescent smokers.

Dalum P; Schaalma H; Nielsen GA; Kok G. "I did it my way" - An explorative study of the smoking cessation process among Danish youth. Patient Education and Counseling 73(2): 318-324, 2008. (25 refs.)

Objective: To explore the smoking cessation process of adolescents and their attitudes and beliefs towards smoking cessation and cessation interventions. Method: Focus group discussions and individual interviews during April-May 2004 with 26 persons aged 15-21 years who all initiated a quit attempt on 1 January 2004. Results: The approach towards all stages of the youth smoking cessation process varied greatly among both successful and unsuccessful quitters. Apart front 'commitment' or the amount of energy put into a cessation attempt, there were no differences in the way successful and unsuccessful quitters approached the quit attempt. 'Smoking friends' and 'Social support' were important for maintaining cessation. Further, participants had negative attitudes towards formalized smoking cessation interventions. Conclusion: There are many approaches to the smoking cessation process. Whether an attempt is successful depends more on individual conditions and the amount of commitment invested in the attempt than on the specific cessation strategy used. Practice Implications: Future adolescent smoking cessation interventions should be flexible regarding both structure and content and should focus on the individual learning process, rather than adhering to rigid cessation strategies.

de Leeuw RNH; Engels RCME; Vermulst AA; Scholte RHJ. Do smoking attitudes predict behaviour? A longitudinal study on the bi-directional relations between adolescents' smoking attitudes and behaviours. Addiction 103(10): 1713-1721, 2008. (44 refs.)

Aims: Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi-directional relations existed between smoking attitudes and behaviour. Design: Data were used from the three annual waves of the 'Family and Health' project. Setting Participants were asked to complete questionnaires individually at their homes. Participants Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement. Measurements: Self-reports were used to assess adolescents' smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling. Findings: Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking. Conclusions: The current findings imply that smoking behaviour predominantly shapes smoking-related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.

de Leeuw RNH; Scholte RHJ; Harakeh Z; van Leeuwe JFJ; Engels RCME. Parental smoking-specific communication, adolescents' smoking behavior and friendship selection. Journal of Youth and Adolescence 37(10): 1229-1241, 2008. (51 refs.)

In this study, we investigated whether parental smoking-specific communication is related to adolescents' friendship-selection processes. Furthermore, we investigated whether adolescents and their best friends influence each other over time, and what role parents play in this process. In the present study we used data from the Family and Health project in which at baseline 428 full families participated. In this 2-year, three-wave longitudinal study data were available from fathers, mothers, early adolescents (aged M = 13.4 years, SD = .50), and middle adolescents (aged M = 15.2 years, SD = .60). The majority of the participating adolescents were of Dutch origin (> 95%). There was an almost equal distribution of boys and girls, and adolescents with lower, middle, and higher educational levels were equally represented. Analyses were conducted by means of Structural Equation Modeling. Results demonstrate that a high quality of the smoking-specific communication is related to a lower likelihood of adolescent smoking, whereas the frequency is positively associated with adolescent smoking. Both the quality and frequency of parental smoking-specific communication were related to adolescents' selective affiliation with (non-)smoking friends. The findings suggest that parental smoking-specific communication is associated with adolescent smoking directly but also indirectly by influencing the friends the adolescents will associate with.

deBry SC; Tiffany ST. Tobacco-induced neurotoxicity of adolescent cognitive development (TINACD): A proposed model for the development of impulsivity in nicotine dependence. (review). Nicotine & Tobacco Research 10(1): 11-25, 2008. (140 refs.)

Early initiation of cigarette use is associated with higher levels of nicotine dependence. This paper provides a theory to explain this finding based on the neurotoxic effects of cigarettes on a developing system. The tobacco-induced neurotoxicity of adolescent cognitive development (TINACD) theory postulates that alterations in executive functioning, particularly evident under stressful or emotionally intense states, lead to higher levels of dependence. The model proposes that the neurotoxic effects of tobacco are most pronounced when smoking begins during early adolescence, a period of major neurodevelopment subserving inhibitory control.

DiFranza JR; Richmond JB. Let the children be heard: Lessons from studies of the early onset of tobacco addiction. (commentary). Pediatrics 121(3): 623-624, 2008. (21 refs.)

Because smokers die, on average, a decade younger than nonsmokers, and smoking kills between one third and one half of those who start,1 it is important that all physicians become cognizant of the hazards related to the early onset of smoking. When Dr Richmond assumed the post of Surgeon General in 1977, it was accepted that addiction to nicotine was caused by years of daily smoking. It was assumed that anyone who experienced nicotine withdrawal had to smoke at least 5 times per day to keep it in abeyance. It was assumed that prolonged regular daily smoking was a prerequisite for dependence. Through the end of the century, the onset of dependence was envisioned as a creeping, protracted, erosion-like process, the product of tens of thousands of doses of nicotine. It was intriguing, when a teenaged pediatric patient volunteered a history of failing at several attempts to quit smoking within a few weeks of trying her first cigarette. Another girl described unpleasant nicotine withdrawal symptoms despite having smoked only 1 or 2 cigarettes a few days a week for 2 months. She, too, had failed in her quit attempts. These initial cases turned out to be quite typical. Among youth who develop dependence, 10% report symptoms after their very first cigarette, and 25% have symptoms within 2 weeks. Through 20,000 individual interviews with adolescents and surveys from 100,000 youth, have documented how dependence develops. Contrary to the perceived wisdom, withdrawal symptoms typically appear before the onset of daily smoking and almost always before smoking progresses to 5 cigarettes per day. Animal experiments have confirmed that nicotine induces enduring neurophysiologic adaptations in the brain from the first dose. Of note is the resistance to acceptance this data as it contradicts the accepted beliefs. The authors maintain that nicotine dependence is a disease of pediatric onset.

Dino G; Horn K; Abdulkadri A; Kalsekar I; Branstetter S. Cost-effectiveness analysis of the Not On Tobacco program for adolescent smoking cessation. Prevention Science 9(1): 38-46, 2008. (26 refs.)

Public health researchers and practitioners emphasize the need for effective, adoptable, and available youth smoking cessation interventions. Scarce resources demand that such interventions also be cost effective. This study describes a cost-effectiveness analysis (CEA) of the American Lung Association's Not On Tobacco (N-O-T) national and international teen smoking cessation program. N-O-T has been rigorously evaluated as an effective and adoptable program, and was recently found to be the most frequently-used teen smoking cessation program in the nation. N-O-T studies show intent-to-treat quit rates between 15% and 19%, among the highest reported in the literature. The current CEA resulted from a 2-year state-wide demonstration study in Florida, comparing the effectiveness of N-O-T with a 20-min brief intervention (BI). The CEA utilized a Markov transition model of decision analysis to explain stage progression of smoking cessation among participants from the age of 17 to 25 years. The Markov simulation predicted that out of a cohort of 100 N-O-T students, 10 will quit smoking and remain smoke-free at the age of 25 years and 14 will reduce smoking, resulting in 102.22 life years saved and a total of 20.11 years discounted life years (DLY) saved. Among BI youth, six will quit smoking and nine will reduce, indicating 64.31 life years saved and a total 12.65 DLY saved. The incremental DLY saved is 7.46 years. Results indicate that N-O-T is a very cost-effective option school-based smoking cessation, as cost effective as school-based primary tobacco prevention, and potentially more cost effective than adult tobacco use cessation.

Dunn MS; Goodrow B; Givens C; Austin S. Substance use behavior and suicide indicators among rural middle school students. Journal of School Health 78(1): 26-31, 2008. (26 refs.)

BACKGROUND: This study provides a descriptive profile of substance use behavior and the prevalence of suicide indicators (thought about, considered, and planned) among rural middle school students and examines the association between substance use and suicidal indicators among middle school students participating in the Coordinated School Health Program in a rural state. METHODS: During April and May 2004, 10,273 middle school students completed the middle school Youth Risk Behavior Survey. RESULTS: This study found that a large percentage of students had initiated substance use behavior, with the greatest number of students having tried cigarettes (40.9% females and 42.7% males), followed by alcohol use (37.2% females and 41.3% males). Additionally, suicidal ideation and behavior were prevalent. Significant associations were found between substance use and suicidal ideation and behavior among middle school students. CONCLUSIONS: Prevention programs for adolescent suicide should be implemented during the middle school years and should focus on preventing substance use given its relationship to suicide.

Easton A; Jackson K; Mowery P; Comeau D; Sell R. Adolescent same-sex and both-sex romantic attractions and relationships: Implications for smoking. American Journal of Public Health 983(3): 462-467, 2008. (27 refs.)

Objectives. We examined cross-sectional and longitudinal associations between smoking and romantic attractions and relationships. Methods. We used data from the National Longitudinal Study of Adolescent Health to assess associations of smoking at Waves I and II with same-sex, both-sex, and opposite-sex romantic attractions or relationships as determined at Wave I. We used logistic regression to predict smoking at Wave II by sexual orientation. Results. Both adolescent boys and adolescent girls with both-sex attractions or relationships were significantly more likely than those with opposite-sex attractions or relationships to be current smokers. Adolescent boys and girls with both-sex attractions or relationships who were nonsmokers at Wave I were more likely to be current smokers at Wave II than those with opposite-sex attractions or relationships. Conclusions. Our findings support previous research on smoking among youths who report same-sex or both-sex romantic attractions or relationships and demonstrate the increased risk bisexual youths have for smoking initiation and smoking prevalence. Tobacco use prevention programs targeting gay and bisexual youths are warranted, particularly among adolescent girls and boys who have had both-sex romantic attractions or relationships.

Ellickson PL; Tucker JS; Klein DJ. Reducing early smokers' risk for future smoking and other problem behavior: Insights from a five-year longitudinal study. Journal of Adolescent Health 43(4): 394-400, 2008. (45 refs.)

Purpose: To identify risk and protective factors during early and later adolescence that predict future regular smoking and multiple problem behavior among at-risk youth, defined as those who tried smoking by grade 7. Methods: At grades 7, 10, and 12, data were collected from 2,000 early Smokers drawn from California and Oregon. Multivariate regression analyses tested predictors of the two grade 12 outcomes in separate models using data from grades, 7 and 10. Gender interactions and buffering of risk factors by protective factors were assessed. Results: For at-risk youth, consistent protective factors against future smoking and problem behavior included living in an intact nuclear family (all four models) plus getting good grades and parental disapproval of smoking/drug use (three of four models). Consistent risk factors included exposure to substance-using peers (four models) and problems in school (three of four models). Adult Substance use was a predictor during early, but not later, adolescence pro-smoking/drug use beliefs were significant predictors during later adolescence. There were few differences across gender and no significant buffers against risk. Conclusions: At-risk youth would likely benefit from peer resistance training, parental involvement in prevention efforts, and efforts to improve educational performance during both middle school and high school. Changing pro-drug beliefs may be more effective among older adolescents.

Else IRN; Hishinuma ES; Goebertc DA; Nishimura ST; Baker S. Predicting cigarette use among Hawai'i adolescents. School Psychology International 29(2): 230-247, 2008. (62 refs.)

The aim of the study was to determine rates and correlates and to predict cigarette use for Hawaiian and non-Hawaiian adolescents in Hawai'i. Data were collected on a multi-ethnic adolescent sample of 7,317 students in five high schools from three islands in the state of Hawai'i from 1992-1996. Psychopathology symptoms, school measures, environment and suicide/self injury accounted for the most variance in cigarette use. Non-Hawaiians (especially immigrant groups), females, speaking non-standard English, lower socioeconomic status and higher rates of suicide/self injury were related to cigarette use. Hawaiian culture was a small, but significant risk factor. For adolescents, psychopathology, school, environmental factors, the role of culture and the growing ethnic diversity of youth should be considered in smoking prevention and cessation interventions.

Ennett ST; Faris R; Hipp J; Foshee VA; Bauman KE; Hussong A et al. Peer smoking, other peer attributes, and adolescent cigarette smoking: A social network analysis. Prevention Science 9(2): 88-98, 2008. (47 refs.)

Peer attributes other than smoking have received little attention in the research on adolescent smoking, even though the developmental literature suggests the importance of multiple dimensions of adolescent friendships and peer relations. Social network analysis was used to measure the structure of peer relations (i.e., indicators of having friends, friendship quality, and status among peers) and peer smoking (i.e., friend and school smoking). We used three-level hierarchical growth models to examine the contribution of each time-varying peer variable to individual trajectories of smoking from age 11 to 17 while controlling for the other variables, and we tested interactions between the peer structure and peer smoking variables. Data were collected over five waves of assessment from a longitudinal sample of 6,579 students in three school districts. Findings suggest a greater complexity in the peer context of smoking than previously recognized.

Feldner MT; Leen-Feldner EW; Trainor C; Blanchard L; Monson CM. Smoking and posttraumatic stress symptoms among adolescents: Does anxiety sensitivity matter? Addictive Behaviors 33(11): 1470-1476, 2008. (36 refs.)

The present study examined the hypothesized moderating role of anxiety sensitivity (AS) in the relationship between lifetime smoking history and post-traumatic stress symptoms among 64 traumatic event-exposed adolescents. As predicted, the relationship between smoking status and post-traumatic stress symptom levels was moderated by anxiety sensitivity. Specific facets of anxiety sensitivity also were examined. Disease concerns, but not unsteady, mental illness, or social concerns, moderated the association between smoking and symptom level. These findings are generally consistent with findings from adult samples, but importantly extend this area of research to another phase of the lifespan.

Fidler JA; West R; van Jaarsveld CHM; Jarvis MJ; Wardle J. Smoking status of step-parents as a risk factor for smoking in adolescence. Addiction 103(3): 496-501, 2008. (18 refs.)

Aim: To examine the extent to which smoking by step-parents and biological parents predicts adolescent smoking. Dsign: Five-year cohort study. Setting: Thirty-six schools in South London, England. Participants A subset of 650 students participating in the Health and Behaviour In Teenagers Study (HABITS), who reported living in step-families, were assessed annually from age 11-12 to age 15-16 years. Measurements: Students reported their smoking status, which was cotinine-verified, as well as whether their parents smoked and, if they lived with a step-parent, whether that step-parent smoked. Analyses also controlled for gender, ethnicity and deprivation. Findings Students who reported that just their step-parent smoked at age 11-12 were significantly more likely to report current smoking at any time-point from age 11-16 than those who reported having neither biological parents nor a step-parent who smoked [odds ratio (OR) 2.72, 95% confidence interval (CI) = 1.36-5.47], as were those with both a parent and a step-parent who smoked (OR 2.23, 95% CI = 1.46-3.41). While the association between smoking in students and smoking in biological parents in this subsample did not reach statistical significance (OR 1.39, 95% CI = 0.88-2.19), these students were no more or less likely to smoke than those with just a step-parent who smoked. Conclusion: Smoking by a non-biological parent appears at least as influential as smoking by biological parents. This confirms the importance of social influence on smoking initiation and suggests that attempts to work with parents in smoking prevention should involve, and perhaps pay particular attention to, step-parents who smoke.

Greene K; Banerjee SC. Adolescents' responses to peer smoking offers: The role of sensation seeking and self-esteem. Journal of Health Communication 13(3): 267-286, 2008. (73 refs.)

This article deals with an important topic (youth smoking) and makes a contribution to the literature by validating existing research and extending our understanding of smoking resistance strategies. This study classified adolescent reports of their responses to cigarette smoking offers utilizing four drug refusal strategies of refuse, explain, avoid, and leave (REAL) and explored how personality factors explain adolescents' use of cigarette refusal strategies. Participants were predominantly Hispanic junior high students (6th-8th grades) from schools in the Northeast United States who participated in a survey design (N = 260). The strategy of explain was reported most frequently for initial and follow-up smoking offers. Adolescents with a greater number of friends who smoked were more likely to use the avoid strategy for initial smoking offers. Sensation seeking was positively related to the use of leave and avoid strategies for initial smoking offers and leave strategy for follow-up smoking offers. No association was found between self-esteem and use of smoking refusal strategies. Implications and directions for future research are discussed.

Griesler PC; Kandel DB; Schaffran C; Hu MC; Davies M. Adolescents' inconsistency in self-reported smoking - A comparison of reports in school and in household settings. Public Opinion Quarterly 72(2): 260-290, 2008. (68 refs.)

Extent and sources of inconsistency in self-reported cigarette smoking between self-administered school surveys and household interviews was examined in two longitudinal multiethnic adolescent samples, the urban Transition to Nicotine Dependence in Adolescence (TND) (N = 832) and the National Longitudinal Study of Adolescent Health (Add Health) (N = 4,414). Inconsistency was defined as a positive report of smoking in school followed by a negative report in the household. Smoking questions were ascertained with paper-and-pencil instruments (PAPI-SAQ) in school in both studies, and computer-assisted personal interviewing (CAPI) in TND but audio computer-assisted self-interviewing (ACASI) in Add Health in the household. In TND, 23.5 percent of youths who reported smoking lifetime and 20.4 percent of those who reported smoking the last 12 months in the school survey reported in the household never having smoked; in Add Health, the latter was 8.6 percent. Logistic regressions identified five common correlates of inconsistency across the two studies: younger age, ethnic minority status, lesser involvement in deviant activities, having nonsmoking parents and friends. In TND, interviewing of youth and parent by the same interviewer increased inconsistent reporting. Matching the definition of inconsistent reporting and the age, gender and race/ethnic distributions of TND on an urban Add Health subsample reduced the predicted rate of inconsistency in TND. The estimated bias attributable to CAPI compared with ACASI methodology did not reach significance in the aggregated matched samples suggesting that irrespective of administration mode, household interviews decrease reporting of smoking, especially among younger, minority and more conventional youths embedded in a social network of nonsmokers.

Grotvedt L; Stigum H; Hovengen R; Graff-Iversen S. Social differences in smoking and snuff use among Norwegian adolescents: A population based survey. BMC Public Health 8(e-article 322), 2008. (60 refs.)

Background: A change in pattern of tobacco use has been observed in the last decade in Norway. Snuff use and occasional smoking have to some degree replaced daily smoking among adolescents and young adults. Daily smoking is known to be negatively associated with social background factors, but little is known about these associations for other types of tobacco use. Our aim was to study different types of tobacco use among adolescents according to gender, educational ambitions, family background factors, and urbanization. Methods: Cross-sectional, school-based study with 15 931 participants and response-rate 87%, conducted among 15 and 16 year olds during 2000-2004. Results: More girls (33.8%) than boys (26.4%) were daily or occasional smokers, while more boys (21.4%) than girls (3.5%) were daily or occasional snuff users. Daily smoking was more common among adolescents planning vocational education, with single parents or poor family economy. Occasional smoking and snuff use (daily or occasionally) showed a similar, but less pronounced pattern regarding education and single parent families. Adolescents with parents from foreign countries were less likely to use tobacco. One exception was boys with parents from Muslim majority countries who had an increased risk of daily smoking. A typical combination user of both tobacco types was a Norwegian boy with divorced parents and ambitions to complete vocational studies or only one year of upper secondary school. Conclusion: Tobacco use in adolescents is mainly associated with low educational ambitions and less affluent self-reported family economy. Adolescents with divorced parents use more tobacco than those living with both parents. Public health initiatives to avoid or reduce tobacco use should mainly target adolescents in vocational studies and those leaving school early.

Hanewinkel R; Morgenstern M; Tanski SE; Sargent JD. Longitudinal study of parental movie restriction on teen smoking and drinking in Germany. Addiction 103(10): 1722-1730, 2008. (40 refs.)

Aims To determine if adolescents who report that their parents restrict viewing movies based on rating have a lower risk of trying smoking and drinking alcohol in the future. Design: Prospective observational study. A cohort of 2110 German adolescents younger than 15 years who had never smoked or drunk alcohol at baseline were surveyed 12-13 months later to determine smoking and binge drinking initiation. Risk of substance use was assessed as a function of parental restriction on viewing FSK-16 movies (movies that only those aged 16 years and over would be allowed to see in theaters). Findings The percentage of students who tried smoking was 16.3%, 10.9% initiated binge drinking and 5.0% used both substances during the follow-up period. There was a significant effect of parental movie restriction on each substance use outcome measure after controlling for covariates. Compared with adolescents whose parents never allowed them to view FSK-16 movies, the adjusted relative risk [(RR) (95% confidence interval (CI)] for use of both substances were 1.64 (1.05-2.58) for adolescents allowed to view them once in a while, 2.30 (1.53-3.45) for sometimes and 2.92 (1.83-4.67) for all the time. FSK-16 restrictions were associated with lower viewership of all classes of movies, but especially FSK-16/18 movies; in addition, FSK-16 restrictions were associated with substantially lower exposure to movie depiction of tobacco and alcohol use, suggesting a mediational mechanism for the association. Conclusions: Among young adolescents, parental restriction from viewing movies rated for older adolescents/adults decreases the risk of substance use in the future.

Hanewinkel R; Sargent JD. Exposure to smoking in internationally distributed American movies and youth smoking in Germany: A cross-cultural cohort study. Pediatrics 121(1): E108-E117, 2008. (24 refs.)

OBJECTIVE. Studies of US adolescents have linked exposure to movie smoking with smoking behavior. It is unclear whether European adolescents are also responsive to movie tobacco imagery. METHODS. A longitudinal study was conducted to assess exposure to movie smoking in 2711 German never-smokers (aged 10 to 16 years). Movie smoking exposure was estimated by asking adolescents if they had seen movies from a list of 50 movie titles, randomly selected for each adolescent from 398 internationally distributed movies released between 1994 and 2004 that became box-office hits in Germany. These films were reviewed for smoking content. Adolescents were resurveyed 12 to 13 months later to determine smoking status, and results were compared with a similarly designed survey of 2603 white US adolescents. We hypothesized replication of the main effect of the exposure on trying smoking, and an interaction, with a significantly larger response among adolescents whose parents did not smoke. RESULTS. The 398 internationally distributed movies represented 80% of the German box-office hits within this time frame, with the majority (388) produced and/or distributed internationally by US companies. Smoking was present in 74% of the movies. Overall, 503 (19%) of the students tried smoking during the follow-up period. The incidence of trying smoking was associated with increased exposure to movie smoking. The form of the dose-response was similar to the US sample, with the strongest response to movies seen in the lower 2 quartiles of exposure. After controlling for baseline covariates, exposure to movie smoking remained a significant predictor of trying smoking in German adolescents, and the effect was significantly stronger in adolescents whose parents did not smoke. CONCLUSIONS. Smoking in internationally distributed US movies predicts trying smoking among German adolescents, closely replicating findings from a longitudinal study of white US adolescents. Smoking in these movies could have important worldwide public health implications.

Hanson K; Zylla E; Allen S; Li ZZ; Hatsukami DK. Cigarette reduction: An intervention for adolescent smokers. Drug and Alcohol Dependence 95(1/2): 164-168, 2008. (8 refs.)

This observational study examined whether adolescents who were not interested in quitting could reduce cigarette smoking and if cigarette reduction led to a corresponding and significant reduction in biomarkers of exposure. The study design was a randomized, open-label trial of nicotine patch and nicotine gum with an added placebo control. Participants (n = 103) attended 4 treatment visits over 4 weeks and follow-up visits at 3- and 6-months. Participants were told to reduce their smoking by 25% of baseline smoking during the 1 st week and by 50% of baseline smoking during the subsequent 3 weeks. Of consented participants, 91.3% (n = 94/103) completed the study until the end-of-treatment, 85.1 % (n = 80/94) completed the 3-month follow-up visit and 71.3% (n = 67/94) completed the 6-month follow-up visit. Participants had a very high prevalence of co-morbidity. With regard to the percentage of participants who achieved a 50% reduction of baseline smoking, there were no significant differences among treatment groups (p = .89). At the end-of-treatment, 49.4% of participants (n = 41) had reduced smoking by at least 50%. Additionally, there was no significant group, visit or interaction effect of a biomarker measure for carcinogen exposure (p > .05). The results suggest that reduction may be a potential aid to engage adolescents who are unable or unwilling to quit, but should not be an end goal. The effect of treatment methods on outcome measures did not differ significantly.

Harakeh Z; Neiderhiser JM; Spotts EL; Engels RCME; Scholte RHJ; Reiss D. Genetic factors contribute to the association between peers and young adults smoking: Univariate and multivariate behavioral genetic analyses. Addictive Behaviors 33(9): 1113-1122, 2008. (24 refs.)

This present study investigated the genetic and environmental influences on the associations between adolescents' peer characteristics (i.e., peer college orientation, and peer delinquency) and smoking in young adulthood. We used longitudinal data from the Nonshared Environment and Adolescent Development (NEAD) project. Parents' reports on adolescents' peer characteristics and adolescents' self-reports on smoking in young adulthood were examined. Genetic and environmental influences on each construct as well as on the association between the two were analyzed. Findings showed that genetic and nonshared environmental influences contributed to peer college orientation and smoking status. Genetic, shared and nonshared environmental influences contributed to peer delinquency. Further, genetic and nonshared environmental influences contributed to the association between adolescents' peer college orientation and smoking in young adulthood. Genetic and shared environmental influences contributed to the association between adolescents' peer delinquency and smoking in young adulthood. In conclusion, the present study showed that genetic influences contributed to adolescents' peer characteristics and, in addition, genetic factors mediated the association between peer characteristics and smoking.

Harris JB; Schwartz SM; Thompson B. Characteristics associated with self-identification as a regular smoker and desire to quit among college students who smoke cigarettes. Nicotine & Tobacco Research 10(1): 69-76, 2008. (23 refs.)

Tobacco use among college students increased substantially during the 1990s. Better understanding of college smokers is warranted to develop interventions specific to the needs of this population. We examined sociodemographic and tobacco-use characteristics associated with self-identification as a regular smoker and intentions to quit smoking among college students who smoke cigarettes. We conducted logistic regression analysis on baseline survey data from the Campus Health Action on Tobacco study, a 4-year group-randomized trial at 30 four-year colleges in Washington, Oregon, and Idaho. Students who self-identified as a regular smoker smoked more cigarettes before starting college, smoked a greater number of cigarettes the prior 30 days, smoked more cigarettes per day, and were more likely to smoke within 30min of waking up, compared with students who were current smokers but did not consider themselves regular smokers. Females, older students, and those who had decreased the amount they smoked since coming to college were more likely to want to quit "very much." Females and students in early college years were more likely to be planning to quit before graduation, as were students who had decreased the amount they smoked since coming to college. Interventions should target students who are in their early college years, given that habits prior to college, changes in smoking habits while in college, and year in college are associated with students' self-identification as a regular smoker, desire to quit smoking, or plan to quit smoking while in college.

Heckman JJ; Flyer F; Loughlin C. An assessment of causal inference in smoking initiation research and a framework for future research. Economic Inquiry 46(1): 37-44, 2008. (37 refs.)

Reliably identifying the causal factors underlying youth smoking initiation is an important part of developing effective smoking prevention programs and shaping other types of smoking-related policies. The establishment of reliable scientific evidence in support of a causal link between cigarette advertising and youth smoking initiation depends on both rich longitudinal data as well as careful empirical applications. We examine basic principles of empirical scientific investigation of potential causal relationships, discuss findings of recent research on causal factors of youth smoking, and evaluate evidence from the public health literature regarding the effects of cigarette advertising on youth smoking.

Heikkinen AM; Pajukanta R; Pitkaniemi J; Broms U; Sorsa T; Koskenvuo M et al. The effect of smoking on periodontal health of 15-to 16-year-old adolescents. Journal of Periodontology 79(11): 2042-2047, 2008. (27 refs.)

Background: Smoking is a severe risk factor for periodontal health in adults, but data on the effect of smoking on periodontal health in teenage populations are sparse. The aim of this study was to investigate the effect of duration and quantity of smoking on periodontal health in teenagers and possible differences between genders. Methods: The oral health of 501 adolescents (15- to 16-year-old boys [n = 258] and girls [n = 2431) was examined. A structured questionnaire about self-reported smoking and health habits was filled out, and bitewing x-rays were taken. Clinical examinations included measuring periodontal indexes, such as visible plaque index, bleeding on probing, root calculus (RC), probing depth, and attachment loss. Results were analyzed by generalized linear logistic regression. Results: Twenty-five percent of boys and 27% of girls were smokers. The boys and girls who smoked had higher RC values than non-smokers (P<0.001). The adjusted scores for smoking boys and girls were 17.3 (95% confidence interval [CI]: 8.6 to 31.7) and 13.6 (95% CI: 5.5 to 29.7), respectively. The adjusted scores for non-smokers were 10.4 (95% CI: 5.7 to 18.3) and 7.7 (95% CI: 3.3 to 17.3), respectively. Smoking boys and girls also had more periodontal pockets >= 4 mm than non-smokers: the score for boys was 4.6 (95% CI: 2.2 to 9.1), and the score for girls was 5.4 (95% Cl: 1.1 to 23.2; P<0.001). Conclusion: Smoking significantly impaired periodontal health in teenagers.

Hong T; Johnson CC; Myers L; Boris N; Brewer D; Webber LS. Process evaluation of an in-school anti-tobacco media campaign in Louisiana. Public Health Reports 123(6): 781-789, 2008. (23 refs.)

Objectives. In light of challenges imposed by the changing media landscape and decreasing classroom time available for health interventions, new approaches are needed to disseminate anti-tobacco messages to adolescents. This study reported process evaluation of an in-school three-year anti-tobacco media campaign conducted in 10 schools in Louisiana. Methods. Over three years, 10 schools received an in-school anti-tobacco media campaign. The media campaign was one intervention component of the Acadiana Coalition of Teens against Tobacco. Campaign measures were tracked over the campaign's three-year duration. The campaign and evaluation were designed to target the students as they progressed through high school. The number of students who completed the surveys were 1,823 in Year 1, 1,552 in Year 2, and 1,390 in Year 3. Schools eligible for participation were publicly funded schools with no magnet or special populations and within a two-hour driving distance of the New Orleans study office. Results. In a self-report survey (Year 1, n=1,823; Year 2, n=1,552; Year 3, n=1,390), more than 75% and 50% of students reported being exposed to posters and public service announcements, respectively. Recognition of campaign theme was more than 80%. Almost half of respondents reported that the posters were interesting, one-third reported that the posters prevented them from smoking, and 10% reported that the posters encouraged them to cease smoking. Stock media posters had a significantly higher affective reaction than the customized media posters. Conclusion. Findings suggest that in-school media programs are useful and should be considered as a viable approach to health education for adolescents.

Horn K; McCracken L; Dino G; Brayboy M. Applying community-based participatory research principles to the development of a smoking-cessation program for American Indian teens: "Telling our story". Health Education & Behavior 35(1): 44-69, 2008. (50 refs.)

Community-based participatory research provides communities and researchers with opportunities to develop interventions that are effective as well as acceptable and culturally competent. The present project responds to the voices of the North Carolina American Indian (AI) community and the desire for their youth to recognize tobacco addiction and commercial cigarette smoking as debilitating to their health and future. Seven community-based participatory principles led to the AI adaptation of the Not On Tobacco teen-smoking-cessation program and fostered sound research and meaningful result s among an historically exploited population. Success was attributed to values-driven, community-based principles that (a) assured recognition of a community-driven need, (b) built on strengths of the tribes, (c) nurtured partnerships in all project phases, (d) integrated the community's cultural knowledge, (e) produced mutually beneficial tools/products, (f) built capacity through co-learning and empowerment, (g) used an iterative process of development, and (h) shared findings /knowledge with all partners.

Hu M-C; Muthen B; Schaffran C; Griesler PC; Kandel DB. Developmental trajectories of criteria of nicotine dependence in adolescence. Drug and Alcohol Dependence 98(1/2): 94-104, 2008. (71 refs.)

We describe the nature and predictors of developmental trajectories of symptoms of DSM-IV nicotine dependence in adolescence following smoking initiation. Data are from a longitudinal cohort of 324 new smokers from grades 6-10 in the Chicago Public Schools, interviewed 5 times at 6-month intervals. Monthly data on DSM-IV symptoms of nicotine dependence were available for 36 months. Growth mixture modeling was applied to the monthly histories to identify trajectories of DSM-IV criteria of nicotine dependence. A four-class solution best fitted the data: no DSM criterion (47.7%); early onset/chronic course (19.8%); early onset/remission (17.3%); late onset (15.2%). Blunt use prior to cigarette use was associated with the three symptomatic trajectories. Conduct disorder and prior heavy smoking were associated with Class 2 (chronic). Conduct disorder differentiated Class 2 from Class 4 (late onset), while pleasant initial sensitivity to the first tobacco experience was associated with Classes 2 and 3 (remit) and differentiated Class 2 from Class 4. Novelty seeking characterized Class 3. Parental dependence differentiated chronicity (Class 2) from remission (Class 3) among those who developed symptoms early. Being Hispanic reduced membership in Classes 3 and 4, and being male for Class 3. The data highlight the importance of parental nicotine dependence as a risk factor for early and sustained nicotine dependence by the offspring, pleasant initial sensitivity and conduct disorder for early onset of dependence, and blunt use prior to smoking for all trajectories. The factors important for onset of dependence are not necessarily the same as those for sustained course.

Hutchens L; Senserrick TM; Jamieson PE; Romer D; Winston FK. Teen driver crash risk and associations with smoking and drowsy driving. Accident Analysis and Prevention 40(3): 869-876, 2008. (48 refs.)

Motor vehicle crashes are the leading cause of death for young people in the United States. The goal of this study was to identify risk factor profiles of teen and young adult drivers involved in crashes. General demographic and behavioral as well as driving-related factors were considered. Analysis of a nationally representative telephone survey of U.S. young drivers ages 14 to 22 (N=900) conducted in 2005 was restricted to 506 licensed drivers (learners excluded). Statistically significant univariate associations between factors of interest and the primary outcome, crash involvement (ever) as a driver, were identified and included within a multivariate logistic regression model, controlling for potential demographic confounders. Aside from length of licensure, only driving alone while drowsy and being a current smoker were associated with having been in a crash. Gaining a better understanding of these behaviors could enhance the development of more customized interventions for new drivers.

Ilomaki R; Riala K; Hakko H; Lappalainen J; Ollinen T; Rasanen P et al. Temporal association of onset of daily smoking with adolescent substance use and psychiatric morbidity. European Psychiatry 23(2): 85-91, 2008. (27 refs.)

Objective. - The association between cigarette smoking and psychiatric disorders is well established for adult populations. However, only limited number of studies has investigated whether the young onset age of daily smoking (DS) among adolescents is associated with psychiatric morbidity and vice versa. Methods. - Data from 508 adolescents admitted to psychiatric hospitalization were collected. Cox proportional hazard model were used to compare the initiation of DS between adolescents with and without substance use (SUD), and other psychiatric disorders. Results. - Rates of DS were high in each diagnostic category. Boys started smoking at younger age (mean 12.4 years) than girls (13.0 years). Both boys and girls diagnosed with conduct or oppositional defiant disorders (COD) and also girls with SUD started daily smoking earlier as compared to those of same gender without these disorders. COD were found to be primary to the initiation of DS among boys. SUD, psychotic, and depressive disorders (DEP) were found to be secondary to DS among both genders. Conclusions. - DS in adolescence is related with later SUD. COD are associated with subsequent initiation of DS among boys. The temporal gap between smoking initiation and COD is shorter among girls. Gender difference plays a role in association of DS and DER Initiation of DS at very early age should alert health care professionals of development of later psychopathology, especially SUD.

Jones SE; Lollar DJ. Relationship between physical disabilities or long-term health problems and health risk behaviors or conditions among US high school students. Journal of School Health 78(5): 252-257, 2008. (26 refs.)

BACKGROUND: This study explores the relationship between self-reported physical disabilities or long-term health problems and health risk behaviors or adverse health conditions (self-reported engagement in violent behaviors, attempted suicide, cigarette smoking, alcohol and other drug use, sexual activity, physical activity, dietary behaviors, self-reported overweight [based on height and weight], physical health, and mental health) among US high school students. METHODS: Data were from the Centers for Disease Control and Prevention's 2005 national Youth Risk Behavior Survey, a cross-sectional paper-and-pencil survey collected from a representative sample of public and private high school students (grades 9 through 12) in the United States. RESULTS: Significantly more students with physical disabilities or long-term health problems than without described their health as fair or poor and reported being in a physical fight, being forced to have sexual intercourse, feeling sad or hopeless, seriously considering and attempting suicide, cigarette smoking, using alcohol and marijuana, engaging in sexual activity, using computers 3 or more hours per day, and being overweight (for all, p <= .05). For none of the health risk behaviors analyzed were the rates significantly lower among students with physical disabilities or long-term health problems than among other students. CONCLUSIONS: Young people who live with physical disabilities or long-term health problems may be at greater risk for poor health outcomes. Public health and school health programs, with guidance from health care providers, need to work with these adolescents and their families to develop and implement appropriate interventions, with particular emphasis on promoting mental health.

Jun HJ; Rich-Edwards JW; Boynton-Jarrett R; Austin SB; Frazier AL; Wright RJ. Child abuse and smoking among young women: The importance of severity, accumulation, and timing. Journal of Adolescent Health 43(1): 55-63, 2008. (49 refs.)

Purpose: We examined the association between severity, accumulation, and timing of abuse in childhood and adolescence and smoking status among young women. Methods: Retrospective self-reported childhood abuse was ascertained with the modified Conflict Tactics Scale from 91,286 Nurses Health Study 11 participants in 2001 (68,505 returned; 75.0% response rate). Childhood abuse was categorized by severity (mile/moderate/severe), type (physical/sexual), and timing (childhood/adolescence). Smoking status during adolescence was reported at baseline (1989). Logistic regression was used to predict smoking initiation by age 14 and smoking status between the ages of 15 and 19. Results: A graded association between severity of abuse and early initiation of smoking (by age 14 years) was demonstrated (odds ratio [OR] = 1.9, 95% confidence interval [CI] = 1.7-2.1 for severe physical violence). Young women with both physical and sexual abuse were two times more likely to start smoking by age 14 than were those reporting no abuse (OR = 2.0, 95% CI = 1.8-2.3). Although abuse during childhood increased risk for adolescent smoking (OR = 1.7, 95% CI = 1.8-2.1) for those with childhood physical and sexual abuse, inclusion of adolescent physical and sexual abuse (OR = 2.2, 95% CI 2.1-2.4) diminished the impact of childhood abuse (OR = 1.1, 95% CI 1.1-1.2). The degree of familial emotional support was protective against smoking, and reduced the impact of abuse by 40% among those with high emotional support versus those without (p <.0001). Conclusions: A strong and graded association was observed between both severity and accumulation of abuse and the risk of early inifiation of smoking among girls. Smoking status during late adolescence was more strongly associated with adolescent abuse than childhood abuse. Early smoking onset is associated with both heightened risk for disease in adolescence but also increased morbidity and mortality in adulthood. Identifying and intervening in potentially modifiable risk factors for smoking onset in young women, such as early-life physical and sexual abuse, and building familial strengths, such as emotional support, may have significant public health implications.

Kleinjan M; Brug J; van den Eijnden RJJM; Vermulst AA; van Zundert RMP; Engels RCME. Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers' transition through the stages of change. Addiction 103(2): 331-338, 2008. (37 refs.)

Aims: To examine the significance of the transtheoretical processes of change in predicting transition through the stages of change in adolescent smokers, as well as the relative role of nicotine dependence in predicting stage transitions. Design In grades 9 and 10, adolescents' stage of change, the use of processes of change and nicotine dependence were assessed ( T1). Stage transitions were assessed 1 year later ( T2). Response rate was 73.2%. Setting: Twenty-five secondary schools throughout the Netherlands participated in the present study. Participants: Respondents were 721 adolescents who were classified as smokers at T1 and consequently completed the paper-and-pencil questionnaire at T2. Measurements Stages of change and processes of change were assessed according to the original transtheoretical measures. Nicotine dependence was measured using a newly developed multi-dimensional scale consisting of 11 items. Findings Few associations were found between the processes of change and stage transitions. Nicotine dependence contributed significantly to the explanation of adolescents' transition from preparation to action, after adjustment for processes of change. No evidence for a moderating effect of nicotine dependence in the relation between the processes of change and stage transitions was found. Conclusions: Processes of change do not seem significant in explaining adolescents' stage transitions. As an alternative for promoting the use of the processes of change for intervention purposes in adolescents, it might be more useful to focus on treating nicotine dependence.

Kleinjan M; Van den Eijnden RJJM; Van Leeuwe J; Brug J; De Ven MOMV; Engels RCME. Adolescents' movement towards cessation of smoking: Role and relative value of the processes of change and nicotine dependence. Psychology & Health 23(6): 729-743, 2008. (47 refs.)

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents' readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14-18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents' readiness to quit.

Kohler CL; Schoenberger YM; Tseng TS; Ross L. Correlates of transitions in stage of change for quitting among adolescent smokers. Addictive Behaviors 33(12): 1615-1618, 2008. (13 refs.)

Longitudinal studies have been conducted to evaluate correlates of stage of change movement among adult smokers but no studies were found to be conducted among adolescent smokers. This study used longitudinal data to examine adolescents' abstinence self-efficacy over 10-week and six-month periods and determined whether stage transitions were associated with concomitant changes or baseline values in perceived abstinence self-efficacy, nicotine dependence and motivation to quit. From baseline to 10-weeks results showed a change in motivation to quit and baseline stage were significantly associated with stage progression and regression. Additionally, intervention school status was significantly associated with stage progression. On the other hand, baseline score for nicotine dependence predicted stage regression not progression. Adolescents' becoming more or less 'ready' to quit smoking are influenced by their nicotine dependence and motivation to quit.

Kreslake JM; Wayne GF; Alpert HR; Koh HK; Connolly GN. Tobacco industry control of menthol in cigarettes and targeting of adolescents and young adults. Anerican Journal of Public Health 98(9): 1685-1692, 2008. (96 refs.)

Objectives. We examined whether tobacco manufacturers manipulate the menthol content of cigarettes in an effort to target adolescents and young adults. Methods. We analyzed data from tobacco industry documents describing menthol product development, results of laboratory testing of US menthol brands, market research reports, and the 2006 National Survey on Drug Use and Health. Results. The tobacco industry attracted new smokers by promoting cigarettes with lower menthol content, which were popular with adolescents and young adults, and provided cigarettes with higher menthol content to long-term smokers. Menthol cigarette sales remained stable from 2000 to 2005 in the United States, despite a 22% decline in overall packs sold. Conclusions. Tobacco companies manipulate the sensory characteristics of cigarettes, including menthol content, thereby facilitating smoking initiation and nicotine dependence. Menthol brands that have used this strategy have been the most successful in attracting youth and young adult smokers and have grown in popularity.

Kulbok PA; Rhee H; Botchwey N; Hinton I; Bovbjerg V; Anderson NLR. Factors Influencing adolescents' decision not to smoke. Public Health Nursing 25(6): 505-515, 2008. (41 refs.)

Objective: Although adolescents ultimately make their own decisions to smoke or not to smoke, social, economic, and environmental circumstances shape their choices. Most research on prevention of youth tobacco use focuses on predictors of smoking initiation. In this study, we explored nonsmoking attitudes, beliefs, and norms from the perspective of 16-17-year-old nonsmokers. Design: This qualitative study targeted nonsmoking youths because most social policy in the arena of tobacco prevention aims to support adolescents who are tobacco free. Sample: Participants were 39 nonsmokers recruited from youth organizations in an urban community and included 22 African Americans (12 females; 10 males) and 17 Caucasian Americans (10 females; 7 males). Methods: A health behavior framework guided the development of semistructured questions on attitudes, beliefs, and norms associated with nonsmoking, used in eight in-depth group interviews. Results: Concerns for health and addiction, a positive self-image, and perceived confidence, emerged as factors affecting participants' decisions not to smoke. The approval of parents and friends, and personal beliefs further reinforced adolescents' nonsmoking decisions. Conclusions: There were more commonalities than differences in nonsmoking attitudes across gender and race. Future studies of youth tobacco prevention should employ multifaceted approaches targeting adolescents' attitudes, families, and peer networks.

Lane SD; Webster NJ; Levandowski BA; Rubinstein RA; Keefe RH; Wojtowycz MA et al. Environmental injustice: Childhood lead poisoning, teen pregnancy, and tobacco. Journal of Adolescent Health 42(1): 43-49, 2008. (40 refs.)

Purpose: This study investigates the persistent relationships between childhood lead exposure, repeat teen pregnancy, and tobacco use in a sample of teenage females in Syracuse, NY. Methods: We analyzed the association of childhood lead poisoning with repeat pregnancy and tobacco use among 536 teens (aged 15-19 years) in Syracuse, NY, who received services at Syracuse Healthy Start between 1998 and 2002. Results: The mothers' childhood lead exposure, controlling for race, age, and Medicaid status, was associated with repeat teen pregnancy and tobacco use. Conclusion: Long-term negative health outcomes associated with childhood lead exposure should not be underestimated. This study helps to shore up prior research that found lead poisoning to have a long-lasting impact on children's functioning and healthy development. Policy efforts focused on neighborhood development and health education continue to be sorely needed.

Lawrance KAG; Lawler SA. Campus physicians' tobacco interventions with university students: A descriptive study of 16 Ontario university clinics. Patient Education and Counseling 70(2): 187-192, 2008. (36 refs.)

Objective: About one-quarter of Canadian post-secondary students smoke cigarettes. We examined how physicians from Ontario university health clinics intervene with these young adult smokers. Method: A convenience sample of 16 universities was identified and surveys were hand-delivered to all 228 physicians from these schools. A total of 125 doctors (54.82%) responded; 70 were from universities that were involved in a government-sponsored, coordinated, multi-campus, tobacco control initiative. Results: Twenty percent of doctors reported asking all or almost all patients about tobacco use; 25.22% asked fewer than half. Describing how they respond to patients identified as smokers, 96.00% of physicians advised cessation, 72.00% offered assistance, and 64.00% arranged for follow-up. Doctors discussed patients' tobacco use with 78.59% of smokers. Nicotine replacement therapies were rarely offered to patients wanting to quit. Doctors from universities involved in the tobacco control initiative were more likely to keep patient education materials in the examining room. Conclusion: Because most doctors ask only some patients about tobacco use, they may be missing opportunities to provide appropriate advice and assistance to all smokers. Practice implications: Physician education and support to the clinic are needed to improve the frequency and quality of physician-delivered smoking cessation services to post-secondary students.

Leatherdale ST; Smith P; AhMedicine R. Youth exposure to smoking in the home and in cars: How often does it happen and what do youth think about it? Tobacco Control 17(2): 86-92, 2008. (23 refs.)

Aim: Little is known about what youth think about restricting smoking in their homes or in cars. The present study characterises the frequency of youth being exposed to smoking in their homes and cars, and the beliefs that youth have about restricting people from smoking around youth in those locations. Methods: Data from the 2004 Youth Smoking Survey ( YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 29 243 Canadian youth in grades 5 - 9. Logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around children at home or smoking around children in cars. Results: In 2004, 23.1% of youth in grades 5 - 9 were exposed to smoking in their home on a daily or almost daily basis, 26.3% were exposed to smoking while travelling in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around children at home ( 90.6%) or in cars ( 90.2%). Males were more likely than females to report that smoking should not be allowed around children at home ( OR 1.38) or in cars ( OR 1.39). Youth living in a house where someone smokes inside daily were more likely to report that smoking should not be allowed around children at home ( OR 1.20) or in cars ( OR 1.21). Youth living in a house where the rules do not prevent people from smoking inside were also more likely to report that smoking should not be allowed around children at home ( OR 2.07) or in cars ( OR 1.76). Youth who have ridden in a car with someone who was smoking cigarettes in the past 7 days were more likely to report that smoking should not be allowed around children in cars ( OR 1.73). Conclusions: It is common for Canadian youth to be exposed to SHS in their homes or while in cars on a frequent basis even though the vast majority of youth do not think smoking should be allowed around children in those locations. This new evidence suggests that programs and policies designed to prevent individuals from smoking around youth in these locations should be a public health priority.

Leatherdale ST; Wong SL; Manske SR; Colditz GA. Susceptibility to smoking and its association with physical activity, BMI, and weight concerns among youth. Nicotine & Tobacco Research 10(3): 499-505, 2008. (32 refs.)

Research has yet to examine how physical activity, body mass index (BMI) and concerns about weight among youth populations are associated with susceptibility to smoking among never smokers. The Physical Activity Module of the School Health Action, Planning and Evaluation System (SHAPES) was completed by 25,060 students in grades 9 to 12 within 76 secondary schools in Ontario (Canada) to examine how being overweight, weight concerns, and physical activity are associated with susceptibility to smoking in a large sample of youth. Among the 14,795 students who were never smokers, 3,809 (25.8%) were classified as susceptible to future smoking and 10,986 (74.2%) were classified as non-susceptible to future smoking. Smoking susceptibility was negatively associated with being highly active or at risk of overweight and positively associated with perceptions of being slightly overweight or slightly underweight. Students who report 1 or more hours of screen or phone time per day were also more likely to be susceptible. This is the first study to identify that susceptibility to future smoking among never smokers is associated with physical activity, overweight and concerns about weight. This is valuable new insight for tailoring and targeting future school-based tobacco control and/or physical activity programming to youth populations.

Lenney W; Enderby B. "Blowing in the wind": a review of teenage smoking. (review). Archives of Disease in Childhood 93(1): 72-75, 2008. (32 refs.)

One quarter of all adults in the UK are regular smokers, the vast majority having started smoking in their teens. Teenage smoking, especially in females, continues to increase both as regards the numbers of cigarettes smoked and the numbers of teenagers who regularly smoke. The main factors influencing teenagers to smoke are peer pressure, family members who smoke and experimentation. Nicotine dependence can develop very quickly and in the UK little attention has been directed towards helping teenagers break the habit. In global terms the figures are frightening. Of the 1.25 billion smokers, 800 million live in developing countries. In the UK, government legislation, restrictions on advertising and educational programmes may improve the situation in the near future but there is still little recognition that smoking is responsible for 4 million deaths each year worldwide and insufficient attention has been paid to children and young families to try to prevent children and teenagers from smoking in the first place.

Lessov-Schlaggar CN; Hops H; Brigham J; Hudmon KS; Andrews JA; Tildesley E. Adolescent smoking trajectories and nicotine dependence. Nicotine & Tobacco Research 10(2): 341-351, 2008. (44 refs.)

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

Lipton R; Banerjee A; Levy D; Manzanilla N; Cochrane M. The spatial distribution of underage tobacco sales in Los Angeles. Substance Use & Misuse 43(11): 1597-1617, 2008. (60 refs.)

Objective: Underage tobacco sales is considered a serious public health problem in Los Angeles. Anecdotally, rates have been thought to be quite high. In this paper, using spatial statistical techniques, we describe underage tobacco sales, identifying areas with high levels of sales and hot spots controlling for sociodemographic measures. Methods: Six hundred eighty-nine tobacco outlets were investigated throughout the city of Los Angeles in 2001. We consider the factors that explain vendor location of illegal sales of tobacco to underage youth and focus on those areas with especially high rates of illegal sales when controlling for other independent measures. Using data from the census, the LA City Attorney's Office, and public records on school locations in Los Angeles, we employ general least-squares (GLS) estimators in order to avoid biased estimates. Main outcome measure: vendor location of underage tobacco compliance checks, violators, and nonviolators. Results: Underage tobacco sales in Los Angeles were very high (33.5%) for the entire city in 2001. In many zip codes this rate is considerably higher (60%-100%). When conducting spatial modeling, lower income and ethnicity were strongly associated with increases in underage tobacco sales. Hotspot areas of underage tobacco sales also had much lower mean family income and a much higher percentage of foreign born and greater population density. Conclusions: Spatial techniques were used to better identify areas where vendors sell tobacco to underage youth. Lower income areas were much more likely to both have higher rates of underage tobacco sales and to be a hot spot for such sales. Population density is also significantly associated with underage tobacco sales. The study's limitations are noted.

Lundborg P; Andersson H. Gender: Risk perceptions, and smoking behavior. Journal of Health Economics 27(5): 1299-1311, 2008. (45 refs.)

The underlying reasons for gender differences in smoking behavior, and thus for the recent trends, are not well understood. Using a sample of 8592 Swedish adolescents aged 15-18, this paper contributes to the literature by exploring gender differences in smoking risk perceptions and in the responses to the latter. The results show significant gender differences in the perception of smoking mortality risk and in the perception of the addictiveness of smoking. Girls perceive the mortality risk of smoking as significantly greater than boys do, but they also perceive the addictiveness of cigarettes as less. These results persist after controlling for a wide range of background characteristics, including smoking risk information sources. Moreover, the findings suggest that while smoking information from sources such as teachers, pals, and own search, affect smoking mortality perceptions in a significant and positive manner among boys, no such effects are obtained among girls. Finally, our results show that both boys and girls take both the addictiveness and mortality risk of smoking into account when making their smoking decision. Moreover, the magnitude of the response is similar among boys and girls. This is in contrast to the general belief that females dislike risks to a greater extent than males.

Ma HY; Unger JB; Chou CP; Sun P; Palmer PH; Zhou Y et al. Risk factors for adolescent smoking in urban and rural China: Findings from the China seven cities study. Addictive Behaviors 33(8): 1081-1085, 2008. (9 refs.)

Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. The majority of Chinese youth live in rural areas. but most research on the risk factors for smoking has been conducted in urban areas of China. This study examined the associations between parental smoking, peer smoking, and low refusal self-efficacy and smoking among urban and rural Chinese youth. This analysis used a cross-sectional sample of 3412 ninth grade students in urban and rural areas under the administrative jurisdiction of seven large cities in China. Multilevel logistic regression models were used to associate the risk factors with lifetime and current smoking, separately in boys and girls. Adolescent smoking was not strongly associated with parental smoking. However it was strongly associated with peer smoking and low refusal self-efficacy across both the urban and rural samples. Students with lower refusal self-efficacy were approximately 5-17 times more likely to be lifetime or current smokers than those with higher refusal self-efficacy. Smoking prevention interventions in China may need to focus on raising adolescents' refusal self-efficacy.

MacPherson L; Strong DR; Myers MG. Using an item response model to examine the nicotine dependence construct as characterized by the HONC and the mFTQ among adolescent smokers. Addictive Behaviors 33(7): 880-894, 2008. (44 refs.)

Despite efforts to operationalize the nicotine dependence syndrome among adolescents, little is known regarding the relative severity of dependence symptoms assessed by different measures. The current study utilized a nonparametric item response model to assess the unidimensionality of the nicotine dependence construct and relative severity of dependence symptoms characterized by the Hooked on Nicotine Checklist (HONC) and the modified Fagerstrom Questionnaire (mFTQ) in a sample of 109 adolescent smokers (58% female) participating in a prospective investigation of smoking self-change efforts. It was hypothesized that symptoms assessed by the HONC would be associated with lower levels of nicotine dependence severity than symptoms assessed with the mFTQ. Results indicated that HONC and mFTQ items could be linked to a single latent construct. Most HONC items captured variability at the lower range and mFTQ items made discriminations at the middle and higher end of the dependence severity continuum. Findings suggest the HONC and mFTQ may provide complementary information in assessing nicotine dependence levels in adolescent regular smokers and have implications for symptoms expression in youth.

Maggi S. Changes in smoking behaviours from late childhood to adolescence: 4 years later. Drug and Alcohol Dependence 94(1/3): 251-253, 2008. (4 refs.)

The purpose of this short report is to estimate trajectories documenting changes in the frequency of cigarette smoking between 10-11 and 20-21 years of age for 3959 participants to the Canadian National Longitudinal Survey of Children and Youth. This study is a follow up to Maggi, Hertzman, and Vaillancourt [Maggi, S., Hertzman, C., Vaillancourt, T., 2007. Changes in smoking behaviours from late childhood to adolescence: insights from the Canadian National Longitudinal Survey of Children and Youth. Health Psychology. 26, 232-240] who found that there are five distinct trajectories of acquisition of smoking from 10-11 to 16-17 years of age. While findings from this study replicate those reported in Maggi, Hertzman, and Vaillancourt [Maggi, S., Hertzman, C., Vaillancourt, T., 2007. Changes in smoking behaviours from late childhood to adolescence: insights from the Canadian National Longitudinal Survey of Children and Youth. Health Psychology. 26, 232-240], they provide a more accurate representation of the possible outcomes of the smoking acquisition process by indicating what specific trajectories of experimentation may lead to daily smoking, occasional smoking or non-smoking.

Malcon MC; Menezes AMB; Assuncao MCF; Neutzling MB; Hallal PC. Agreement between self-reported smoking and cotinine concentration in adolescents: A validation study in Brazil. Journal of Adolescent Health 43(3): 226-230, 2008. (25 refs.)

Purpose: To validate self-reported data on smoking in adolescents in comparison with cotinine concentration. Methods: Two thousand two hundred nine seventh- and eighth-grade students from 32 public schools in Pelotas, Brazil. Adolescents were contacted twice-before and after an educational intervention-and samples Of urine for cotinine analyses were taken. In this paper, only data from the baseline phase are presented. High-performance liquid chromatography was used for cotinine analysis. Two cutoff points for cotinine were used: 10 ng/mL and 30 ng/mL. Two self-reported smoking variables were used: at least one cigarette smoked in the previous 30 days; and daily smoking. Results: The self-reported prevalence of smoking in the previous 30 days was 7.4%, and 0.9% of the adolescents reported to be daily smokers. Those who reported smoking in the previous 30 days presented mean cotinine values 10 times greater than those who reported to be nonsmokers. Using a cutoff of 10 ng/mL for cotinine, sensitivity of self-reported smoking was 16.3% (95% confidence interval [CI] 11.7: 20.9) and specificity was 93.6% (95% CI 92.8; 95.0). Using a cutoff of 30 ng/mL, sensitivity was 22.6% (95% CI 15.6; 29.6) and specificity was 93.7% (95% CI 92.6; 94.8). Conclusions: Self-reported smoking presents low agreement with cotinine concentration, suggesting that adolescents underestimate tobacco consumption.

Marcynyszyn LA; Evans GW; Eckenrode J. Family instability during early and middle adolescence. Journal of Applied Developmental Psychology 29(5): 380-392, 2008. (44 refs.)

Two studies investigated associations between family instability (changes in parents' intimate partners, work hours, residence, children's schools) and adolescent adjustment. In Study 1 (N = 141, M age = 15.23 years), instability was associated with increased caregiver-reported externalizing and internalizing behaviors (including youth-reported cigarette use), reduced teacher-reported frustration tolerance, social skills, task orientation, and lower academic grades. Logistic regression results for instability exposure showed an increased risk for school suspensions, Person in Need of Supervision status, binge drinking, and marijuana use. In Study 2 (N = 225, M age = 13.37 years), instability was linked to adolescent-reported externalizing and internalizing behaviors, teacher-reported disruptions. and lower English and math grades. Key sociodemographic factors and negative life events were statistically controlled in regression analyses. Results indicate that a more theoretically coherent measure of family instability, which is distinct from negative life events, may prove valuable in understanding the potentially adverse influence of instability on youth.

Martinez-Mantilla JA; Amaya-Naranjo W; Campillo HA; Diaz-Martinez LA; Campo-Arias A. Daily cigarette smoking among Colombian high school stuents: Gender related psychosocial factors. Revista Latino-Americana de Enfermagem 16(5): 903-907, 2008. (15 refs.)

This study aimed to establish the prevalence of daily cigarette smoking (DCS) and its gender correlated factors in high-school attending adolescents from Bucaramanga, Colombia. A random cluster sample was surveyed (N = 2291). The previous month DCS prevalence was 11.6% (95% CI 9.7-13.5) in boys and 4.4% (95% CI 3.3-5.5) in girls. In girls, DCS was associated with previous month illegal substance use (OR 8.13, 95%CI 3.52-18.87), abusive alcohol consumption (OR 5.88, 95% CI 2.54-13.70), being the best friend of a smoker (OR 3.25, 95% CI 1.38-7.63), and poor or mediocre academic achievement (OR 2.46, 95% CI 1.25-4.85). In boys, DCS was related to previous month substance use (OR 6.23, 95% CI 3.62-10.71), being the best friend of a smoker (OR 5.87, 95% CI 2.93-11.76), poor or mediocre academic achievement (OR 2.09, 95% CI 1.34-3.24), and being older than non-smokers (OR 1.48, 95% CI 1.21-1.81). DCS presents associated factors very similar for girls and boys. Thus, more research is needed.

Mazanov J; Byrne DG. Modelling change in adolescent smoking behaviour: Stability of predictors across analytic models. British Journal of Health Psychology 13(Part 3): 361-379, 2008. (53 refs.)

Objectives. The current paper examined the variability of predictors of changes in adolescent smoking across linear and nonlinear analytic models. Design. Three analytic models typically used to model adolescent smoking behaviour were tested: one linear model of change (standard linear), one static linear model (pre-post linear) and one nonlinear model of change (cusp catastrophe). Variability in model composition was assessed by examining the pattern of variables achieving statistical significance and proportion of variance explained. Methods. Model testing was conducted on data from Australian adolescents successfully tracked through a 12-month longitudinal study of smoking (N = 779). The survey measured demographics, self-reported smoking, smoking among friends and family, self-esteem, neuroticism, coping, stress and risk taking. Results. The results indicated that while predictors of change were invariant across analytic models explanatory power varied markedly. Models of change in smoking that included simple, interacted or polynomial forms of initial conditions (past behaviour) explained more than four times the variance of models without. Conclusions. These results justified confidence in the predictors of change in adolescent smoking across analytic models. A secondary implication was that more research into past behaviour's role in the context of dynamical models of adolescent smoking and other health behaviour is needed.

McLeod K; White V; Mullins R; Davey C; Wakefield M; Hill D. How do friends influence smoking uptake? Findings from qualitative interviews with identical twins. Journal of Genetic Psychology 169(2): 117-131, 2008. (42 refs.)

The smoking behavior of friends is a major risk factor for adolescent smoking uptake. To explore the social context of smoking experimentation and consolidation with a particular focus on friends, the authors interviewed both members of 14 young adult identical twin pairs who were discordant for smoking. The different smoking status of twins was connected to their different friendship groups and development of different identities. Smoking respondents gravitated to the behaviors and images of the peer group who smoked. Many nonsmokers felt strong pressure from their peers not to smoke and spoke about how the images conveyed by smoking were inconsistent with their peer group's image. Adolescents and young adults are aware of the messages that smoking can convey to others and exploit these images to construct a social identity.

Melchior M; Chastang JF; Goldberg P; Fombonne E. High prevalence rates of tobacco, alcohol and drug use in adolescents and young adults in France: Results from the GAZEL Youth study. Addictive Behaviors 33(1): 122-133, 2008. (34 refs.)

Background: Rates of substance use among adolescents have increased in the 1990s, however little is known about current patterns of substance use among youths entering adulthood. Methods: We studied sex and age-specific rates of substance use (tobacco, alcohol, cannabis, other illicit drugs, inhalants and psychotropic medications) in a large sample of French youths aged 12-26 years (the GAZEL Youth study, n = 1333). Results: Prevalence rates of substance use were high and varied with age and sex. Tobacco, cannabis and polysubstance use were most frequent among 19-21 year-olds (regular tobacco use: 41.5% in males, 39.9% in females; regular cannabis use: respectively 23.9% and 10.9%; tobacco + alcohol + cannabis: respectively 9.9% and 4.6%). Regular alcohol use was most frequent among 22-26 year-olds (29.8% in males, 15.6% in females). Across successive birth cohorts, the age of initiation of tobacco and cannabis use decreased. Males were consistently more likely to use psychoactive substances than females (except for tobacco and psychotropic medications). Conclusions: Rates of substance abuse peak in late adolescence but remain high among a subgroup of young adults. Moreover, substance use initiation appears to be occurring at increasingly younger ages.

Michaelidou N; Dibb S; Ali H. The effect of health, cosmetic and social antismoking information themes on adolescents' beliefs about smoking. International Journal of Advertising 27(2): 235-250, 2008. (57 refs.)

The paper examines the effect of long-term health-related and short-term social and physical antismoking information on adolescents' beliefs about smoking. Findings from a UK school-based study Indicate that antismoking information about the short-term effects of smoking, such as cosmetic (e.g. yellow teeth and fingernails and smelly clothes) and fitness, have a greater impact on beliefs than long-term health-related information. The implications for the design of antismoking campaigns are explored.

Mikkonen P; Leino-Arjas P; Remes J; Zitting P; Taimela S; Karppinen J. Is smoking a risk factor for low back pain in adolescents? A prospective cohort study. Spine 33(5): 527-532, 2008. (35 refs.)

Study Design. A prospective cohort study in adolescents. Objective. To evaluate whether smoking in adolescence is a risk factor of low back pain (LBP) among young adults. Summary of Background Data. Smoking has been found to associate with LBP among adults. Longitudinal studies performed in adolescents are few. Methods. The children belonging to the northern Finland Birth Cohort 1986 were examined at birth and at 16 years of age and followed up by a postal questionnaire at the age of approximately 18 years. The primary outcome was LBP during the past 6-month period. Incident cases reported LBP at 18 but not at 16 years. Persistent cases reported pain at both time points. Logistic regression analysis was used to evaluate the effect of smoking exposure on any LBP in both genders separately and multinomial regression analysis was used to evaluate the effect on the severity of LBP (No LBP, "Reporting LBP," "Consultation for LBP") in the total population. Parents' socioeconomic status, physical activity, body mass index, and depressive mood were used as confounders in the analyses. Results. Regular smoking at 16 years was associated with persistent LBP in girls (OR: 2.52; 95% CI: 1.40-4.53). Daily smoking of over 9 cigarettes at 16 was associated with persistent LBP (2.57; 1.03-6.46) and predicted incident pain in girls (2.80; 1.11-7.09). Pack-years of smoking were associated with incident and persistent LBP in the girls with an exposure-response relationship, whereas these associations were inconsistent in the boys. Pack-years of smoking at 18 years showed an exposure-response relationship with persistent Consultation for LBP, which was strongest in those with over 1.5 pack-years of exposure (5.82; 1.39-24.42). Conclusion. Regular smoking in adolescence was associated with LBP in young adults. Pack-years of smoking showed an exposure-response relationship among girls.

Mitchell J; Rosenberg M; Wood L. Adolescents with attitude ... changes in views about smoking over time. Health Promotion Journal of Australia 19(2): 109-112, 2008. (14 refs.)

Issue Addressed: Adolescents who experiment with smoking often develop into long-term, dependent smokers. Appropriate youth smoking prevention strategies require an understanding of the predictors of smoking (e.g. attitudes and beliefs) and the amenability of these to change over time. Method: A secondary analysis of 'Smarter than Smoking' evaluation data from a series of cross-sectional surveys conducted over six years (1999-2005). The study sample comprised 683, 14-15 year-old Western Australians residing across Perth. Basic descriptive statistics were calculated, accompanied by main effects logistic regression. Results: Significant changes were observed between 1999 and 2005 in key attitudes and beliefs relating to smoking, with a strengthening in agreement with statements relating to the smell, cost and effects on fitness. For several attitudes and beliefs however, no change or a weakening of agreement was observed over time. Conclusions: Overall, this study found support for a strengthening in smoking-related attitudes and beliefs over the six year period (1999 to 2005). A number of the attitudinal and belief changes corresponded to messages targeted by Smarter than Smoking's communication objectives and media strategies. Attitudes and beliefs that did not change significantly over time were more likely to relate to consequences of smoking not directly targeted by the project.

Morrison MA; Krugman DM; Park P. Under the radar: Smokeless tobacco advertising in magazines with substantial youth readership. American Journal of Public Health 983(3): 543-548, 2008. (26 refs.)

Objectives. In light of the Smokeless Tobacco Master Settlement Agreement (STMSA) and the fact that smokeless tobacco advertising has received little attention, we examined industry data to assess smokeless tobacco advertising in popular magazines. Of particular interest was the level of advertising in magazines with high youth readership and the amount of reach and frequency that was generated among readers aged 12 to 17 years. Methods. We used readership data from Mediamark Research Inc, advertising expenditure data from TNS Media Intelligence, and Adplus, a media planning program from Telmar to document the composition of adult and youth readership of magazines in which smokeless tobacco products were advertised, industry expenditures on advertising, and adolescents' exposure to smokeless tobacco advertising. Results. The STMSA appears to have had a limited effect on the advertising of smokeless tobacco products to youth; both before and after the agreement, smokeless tobacco companies advertised in magazines with high adolescent readership. Conclusions. Popular magazines with smokeless tobacco advertising reach a large number of adolescents through a combination of both youth-oriented and adult magazines. These exposure levels have generally increased since the STMSA.

Munafo MR; Hitsman B; Rende R; Metcalfe C; Niaura R. Effects of progression to cigarette smoking on depressed mood in adolescents: evidence from the National Longitudinal Study of Adolescent Health. Addiction 103(1): 162-171, 2008. (36 refs.)

Aims To investigate the relationship between smoking status and continuously distributed depressed mood among a cohort of adolescents. Design Quasi-experimental design, selecting the subset of adolescents who reported never having smoked a cigarette at baseline, some of whom progressed subsequently to smoking at follow-up approximately 1 year later. Setting Data were drawn from the National Longitudinal Study of Adolescent Health, an ongoing study designed to assess the health status of adolescents, and explore the causes of adolescent health-related behaviours. Participants Nationally representative sample of adolescents from the USA (n = 12 149), including a subsample who reported never having smoked a cigarette at baseline (n = 5475), aged on average 15 years at baseline and of predominantly European ancestry. Measurements Logistic and linear regression models controlling for potential confounders to explore the relationship between smoking status and depressed mood measured using the Centers for Epidemiological Studies Depression Scale (CES-D). Findings Various relationships between smoking status and depressed mood were observed, with a general trend for these effects to be greater among females. Smoking status at baseline did not significantly predict CES-D score at follow-up, although this effect approached significance in females (P = 0.077). Among never smokers at baseline, level of depressed mood at baseline predicted subsequent progression to smoking initiation (P = 0.022) but not progression to regular smoking (P = 0.229). Among never smokers at baseline, progression to smoking initiation during the follow-up period was associated with higher CES-D scores at follow-up, even after adjusting for baseline depressed mood (P < 0.001), with this effect greater for females than for males. Among those who initiated smoking, progression to regular smoking was associated with higher CES-D score at follow-up among females (P = 0.001), but not males (P = 0.966). Conclusions These data appear to support a complex model of the relationship between depressed mood and smoking status which includes elements of both confounding and causal models. The relationship between cigarette smoking and depression may be a factor in the development of subsequent dependence.

Murnaghan DA; Leatherdale ST; Sihvonen M; Kekki P. A multilevel analysis examining the association between school-based smoking policies, prevention programs and youth smoking behavior: Evaluating a provincial tobacco control strategy. Health Education Research 23(6): 1016-1028, 2008. (57 refs.)

This paper examined how smoking policies and programs are associated with smoking behavior among Grade 10 students (n = 4709) between 1999 and 2001. Data from the Tobacco Module from the School Health Action Planning and Evaluation System were examined using multilevel logistic regression analyses. We identified that (i) attending a school with smoking prevention programs only was associated with a substantial risk of occasional smoking among students with two or more close smoking friends and (ii) attending a school with both smoking prevention programs and policies was associated with substantial risk of occasional smoking among students who did not believe there were clear smoking rules present. Students attending schools where year of enrolment in high school starts in Grade 9 were more likely to be regular and occasional smokers. Each 1% increase in Grade 12 smoking rates increased the odds that a Grade 10 student was an occasional smoker. It appears that grade of enrolment, senior student smoking behavior, close friend's smoking behavior and clear rules about smoking at school can impact school-based tobacco control programming. These preliminary study findings suggest the need for further research targeting occasional smoking behavior and the transition stage into high school.

Niclasen B; Schnohr C. Has the curve been broken? Trends between 1994 and 2006 in smoking and alcohol use among Greenlandic School Children. International Journal of Circumpolar Health 67(4): 299-307, 2008. (15 refs.)

Objectives. To examine the development of smoking and alcohol use among Greenlandic schoolchildren and propose future preventive strategies. Study design. National survey in schoolchildren grade 6-11. Methods. Analysis of data from the 1994, 1998, 2002 and 2006 Health Behaviour in School Aged Children (HBSC) surveys in Greenland. Trends in the prevalence of the categories never having smoked. non-smoking, daily smoking, never tried alcohol, never been drunk and been drunk 4 times or more were calculated for children and youth aged 11, 13 and 15. In the data from 2006, the age trends for daily smoking and getting drunk 4 or more times, the assessment of risks attributed to Substance use and the perception of how easy it was to access cigarettes and alcohol were analysed. Results. A decrease in daily smokers and in children having been drunk 4 or more times and all increase in non-smokers and in children that had never been drunk was found in both genders among children and Youth aged 13 and 15. Among youth aged 15 to 17 years, both cigarettes and zn zn alcohol were reported as easy to access. Risk assessment was different for alcohol and cigarettes, as well as between genders. Conclusions. A decline in the use of tobacco and alcohol among Greenlandic school children was ascertained. Due to the children's evaluation of easy access and risk regarding smoking and alcohol use, some general recommendations regarding future focus areas of prevention were proposed.

Noor NM; Ahmad Z; Sadiq LNMAH; Yaacob MJ; Jalil RA. Smoking and self-eeteem among Malay adolescents in Kota Bharu, Kelantan. International Medical Journal 15(2): 137-143, 2008. (33 refs.)

Objective: This study was to determine the association between self-esteem and smoking among Malay adolescents in Kota Bharu, Kelantan. Design: Cross-sectional study Materials and Methods: This study was conducted between January to June 2005 among 1364 students selected from ten co-educational government secondary schools in Kota Bharu using stratified multistage cluster sampling. Guided self-administered questionnaire and anthropometric measurement were taken. Data was entered using SPSS 12.0 and analysed using STATA 8.0 using General Linear Regression for survey data analysis. Results: The overall prevalence of smoking was 6.7%. The prevalence of smoking among boys was 13.8% and among girls was 1.1%. There was no association between self-esteem and smoking. Conclusion: There was no association between self-esteem and smoking among Malay Adolescents in Kota Bharu, Kelantan.

Okoli CTC; Richardson CG; Ratner PA; Johnson JL. Adolescents' self-defined tobacco use status, marijuana use, and tobacco dependence. Addictive Behaviors 33(11): 1491-1499, 2008. (37 refs.)

Aims: To examine differences in tobacco use and dependence between adolescents who are and are not marijuana users. Design: Cross-sectional analysis of existing survey data. Participants: Data were obtained from 7440 adolescents who completed the British Columbia Youth Survey of Smoking and Health II (BCYSOSH-II), a school based survey conducted in 2004. Measures: Responses to demographic, current smoking, alcohol use, self-defined tobacco and marijuana use status questions, perceived physical and mental addiction to tobacco, modified-Fagerstrom Tolerance Questionnaire (M-FTQ), and the Dimensions of Tobacco Dependence Scale (DTDS) were obtained. Findings: Marijuana users were 5.9 times more likely to be current tobacco smokers and reported higher levels of perceived addiction to tobacco as compared with marijuana nonusers. After controlling for demographics, life-time tobacco use, and alcohol use, marijuana use was associated with the nicotine dependent and sensory dimensions of tobacco dependence. Conclusions: Adolescents who concurrently use tobacco and marijuana may be more tobacco dependent than are marijuana non-users. Concurrent use of marijuana may be a factor associated with tobacco dependence among a sub-group of concomitant drug-using adolescents.

Okoli CTC; Richardson CG; Ratner PA; Johnson JL. An examination of the smoking identities and taxonomies of smoking behaviour of youth. Tobacco Control 17(3): 151-158, 2008. (44 refs.)

Objective: To address observations that the smoking identities of youth are valid descriptors of their smoking behaviour, we examined the relationships between self-reported smoking identities, perceived levels of addiction, and established taxonomies of smoking behaviour of youth. Method: Cross-sectional data were collected on demographics, perceived extent of addiction to tobacco, smoking history, and self-reported smoking identity from questionnaires administered to 8225 students in British Columbia, Canada. A total of 7246 participants were categorised according to four smoking taxonomies established in the literature. Differences in perceived physical and mental addiction between smoking identity groups were calculated. The strength of the associations between the taxonomies of smoking and the smoking identity groups was also assessed. Results: There were significant differences in perceived levels of physical ( Kruskal-Wallis chi(2) = 3985.02, p < 0.001) and mental ( Kruskal-Wallis chi(2) = 4046.09, p < 0.001) addiction to tobacco by the participants' self-reported smoking identity. Youth smoking identities were modestly associated with the established smoking taxonomies (Pearson C contingency coefficient = 0.64-0.72). Conclusion: Self-reported smoking identities appear to provide valid characterisations of the smoking behaviour of youths that complement and elaborate existing taxonomies of smoking behaviour. Questions about self-reported smoking identity should be used in conjunction with smoking behaviour taxonomies when investigating youth smoking behaviours.

O'Loughlin J; Lambert M; Karp I; McGrath J; Gray-Donald K; Barnett TA et al. Association between cigarette smoking and C-reactive protein in a representative, population-based sample of adolescents. Nicotine & Tobacco Research 10(3): 525-532, 2008. (46 refs.)

Although related to inflammatory markers in adults, little is known about the association between cigarette smoking and C-reactive protein (CRP) in adolescent smokers. We examined the association between high-sensitivity CRP (hs-CRP) concentrations and smoking in youth. We used data from a cross-sectional, province-wide survey of a representative sample of youth conducted in Quebec, Canada, in 1999. Data were collected in self-report questionnaires completed by participants and their parents. Participants provided a fasting blood sample, and anthropometric measures were undertaken by trained technicians. The present analysis pertains to 1,501 adolescents aged 13 and 16 years who completed questionnaires and for whom blood samples were available. The independent association between a six-category indicator of smoking status and elevated hs-CRP, defined as a value at least in the 90th percentile of the age- and sex-specific CRP distribution, was assessed in multiple logistic regression analyses controlling for potential confounders. Relative to never-smokers, the odds ratios (95% confidence intervals) for puffers (i.e., never smoked a whole cigarette), those who smoked but not in the past month, light past-month smokers, moderate past-month smokers, and heavy past-month smokers were 1.04 (0.55-1.98), 1.76 (1.06-2.94), 1.39 (0.70-2.76), 2.07 (0.96-4.42), and 2.40 (1.18-4.88), respectively. Our data suggest a positive association between smoking status and elevated CRP in adolescents, and in particular among heavier past-month smokers. Damage related to cigarette smoking may begin soon after tobacco use initiation, reinforcing the preventive message that no level of smoking is safe in youth.

Otten R; Wanner B; Vitaro F; Engels R. Own and friends' smoking attitudes and social preference as early predictors of adolescent smoking. Journal of Clinical Child and Adolescent Psychology 37(4): 808-819, 2008. (51 refs.)

This study examined the role of friends' attitudes in adolescent smoking (N=203). Growth mixture modeling was used to identify three trajectories of smoking behavior from ages 12 to 14 years: a low-rate group, an increasing-rate group, and a high-rate group. Adolescents' own and their friends' attitudes at age 11 years were not significantly related to smoking. However, in the increasing-rate group (compared with the low-rate group), friends' attitudes interacted with both adolescents' own and friends' social preference (i.e., likeability). The link between friends' attitudes and membership in the increasing-rate group was stronger for early adolescents with low social preference scores and for early adolescents with friends who had low social preference scores. Other than for the high-rate group, for which causal factors of smoking may be located early in childhood (e.g., family and personality or temperamental characteristics), the combination of low social preference and friends who hold a positive attitude toward smoking is associated with escalating cigarette use among young adolescents.

Parzynski CS; Jaszyna-Gasior M; Franken FH; Moolchan ET. Measuring nicotine intake among highly-dependent adolescent smokers: Comparability of saliva and plasma cotinine concentrations. Pharmacology, Biochemistry and Behavior 89(2): 145-149, 2008. (35 refs.)

Cotinine is the most common biomarker used to assess nicotine exposure and abstinence. It can be measured in various matrices including saliva, plasma, and urine. Previous research with adults has shown high correlations between saliva and plasma cotinine concentrations. However, the research has not examined this relationship in adolescents. Additionally, variability in saliva flow and metabolism across gender, ethnicity, and age may impact the relationship between saliva and plasma cotinine concentration. Our aim was to examine the relationship between saliva and plasma cotinine concentration in a group of nicotine-dependent adolescent smokers. Additionally, we examined these correlations across gender, ethnicity and age. The sample consisted of 66 adolescent smokers (age 15.1 +/- 1.3, 63.6% girls, 66.7% European American, CPD 18.3 +/- 8.5, FTND 7.1 +/- 13). Saliva and plasma specimens were collected before the treatment phase of a nicotine replacement therapy trial and analyzed. The relationship between saliva and plasma cotinine concentration was analyzed using Pearson's correlation coefficients. We performed a secondary analysis using multiple regressions to compare correlations across race, gender and age. Results indicated a positive correlation between saliva cotinine and plasma cotinine concentration (r=0.84, p<0.001). Differences in correlations across age were significant (t=3.03, p<0.01). Differences across ethnicity approached significance (t=-1.93, p=0.058). Future research should seek to further validate saliva-to-plasma cotinine concentration ratios in adolescents as well as characterize saliva-to-plasma concentration differences and their underlying mechanisms.

Pillai A; Patel V; Cardozo P; Goodman R; Weiss HA; Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. British Journal of Psychiatry 192(1): 45-51, 2008. (48 refs.)

Background: Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years. Aims: To estimate the prevalence and correlates of mental disorders in adolescents. Method: Population-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use. Results Out of 2684 eligible adolescents, 2048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27-2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing 'non-traditional' lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders. Conclusions The current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.

Pisetsky EM; Chao YM; Dierker LC; May AM; Striegel-Moore RH. Disordered eating and substance use in high-school students: Results from the youth risk behavior surveillance system. International Journal of Eating Disorders 41(5): 464-470, 2008. (31 refs.)

Objective: To examine the association between disordered eating (fasting, diet product use, and vomiting or laxative use) and use of 10 substances (cigarettes, alcohol, marijuana, cocaine, inhalants, heroin, methamphetamines, ecstasy, steroids, and hallucinogens) in a nationally representative adolescent sample. Method: Participants were 13,917 U.S. high-school students participating in the 2005 Youth Risk Behavior Surveillance System. Results: Disordered eating was significantly associated with the use of each substance. Using effect size estimates that take base rates into consideration, for female students, associations between substance use and disordered eating were weak for all but three forms of substance use: current smoking, binge drinking, and inhalants. Among male students, strong (marijuana, steroids, and inhalants) or moderate effects (all other substances) were observed. Conclusion: Future research needs to focus on inhalant use and methamphetamine use in males. Increased medical attention should be directed toward adolescents who practice disordered eating behaviors because they are also at elevated risk for using cigarettes, alcohol, inhalants, methamphetamines, and steroids.

Pollack HA. Evidence of things unseen: Causality and confounding in path models of youth substance use. Addiction 103(2): 320-321, 2008. (6 refs.)

This is a commentary on the article by Zang et al. which considers an important question as whether discretionary income encourage youth tobacco use? If so, does this occur through the indirect pathway of youth alcohol use? It stems from an old question: are alcohol and tobacco substitutes or complements for youth? The data presented by Zang suggest that alcohol use provides a mediator between spending money and adolescent smoking. Youth with ready access to discretionary funds are more likely to drink. Drinking then provides opportunities and settings for tobacco experimentation and (perhaps) chronic use.

Primack BA; Land SR; Fine MJ. Adolescent smoking and volume of exposure to various forms of media. Public Health 122(4): 379-389, 2008. (37 refs.)

Objective: To assess the association between adolescent smoking and exposure to various forms of media after controlling for multiple relevant covariates. Methods: A survey of all adolescents at a large suburban high school assessed: (1) current smoking and susceptibility to future smoking; (2) volume of exposure to various media; and (3) covariates related to smoking. Multivariate logistic regression models assessed relationships between each of the independent variables (media exposures) and the two smoking outcomes after controlling for covariates. Results: Of the 1111 respondents, 11% (n = 211) reported current smoking. Forty percent (n = 342) of the non-smokers (n = 922) were susceptible to future smoking. Students reported exposure to an average of 8.6 (standard deviation 5.1) h of media daily, including 2.6 h of music. Those with high exposure to films and music were more likely to be smokers (P-trend = 0.036 and P-trend<0.001, respectively), and those with high exposure to books were less likely to be smokers (P-trend<0.001). After controlling for all relevant covariates, those with high exposure to music had greater odds of being smokers than those with low exposure [odds ratio (OR) 1.90, 95% confidence intervals (CI) 1.10-3.30], and those with high exposure to books had lower odds of being current smokers (OR 0.55, 95% CI 0.33-0.94). Conclusion: Exposure to films and music are associated with smoking, but only the relationship between music exposure and smoking persists after rigorous covariate control. Exposure to books is associated with lower odds of smoking.

Prokhorov AV; Kelder SH; Shegog R; Murray N; Peters R; Agurcia-Parker C et al. Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students. Nicotine & Tobacco Research 10(9): 10, 2008. (44 refs.)

Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institute's Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p <.05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIRE's effects on cessation.

Rachiotis G; Muula AS; Rudatsikira E; Siziya S; Kyrlesi A; Gourgoulianis K et al. Factors associated with adolescent cigarette smoking in Greece: Results from a cross sectional study (GYTS Study). BMC Public Health 8(e-article 313), 2008. (21 refs.)

Background: Data about the predictors of smoking among adolescents in Greece are sparse. We tried to identify factors associated with current cigarette smoking among in-school adolescents in Greece in the context of GYTS study. Methods: A secondary analysis of data from a questionnaire study using the Global Youth Tobacco Survey methodology was conducted to identify factors associated with smoking among adolescents in Greece. Data were collected in 2004-2005. The outcome variable was cigarette smoking within the past 30 days preceding the survey while independent variables included age, gender, parental educational status, parental smoking, perception of harmfulness of smoking, and the amount of pocket money at the adolescent's disposal. Results: 6141 adolescents (51.5% males and 48.5% females) participated in the study. In multivariate analysis, cigarette smoking was associated with male gender (OR: 1.62; 95% CI:1, 08-3.08), parental smoking (OR: 2.59; 95% CI: 1.45-5.89), and having pocket money >= 16 Euros (OR: 2.64; 95% CI: 1.19-5.98). Conclusion: Male gender, parental smoking, and having pocket-money >= 16 Euros were independently associated with current smoking among Greek students. These findings could be taken into account in order to formulate a comprehensive anti-smoking strategy in Greece.

Ribeiro SN; Jennen-Steinmetz C; MH; Becker K. Nicotine and alcohol use in adolescent psychiatric inpatients: Associations with diagnoses, psychosocial factors, gender and age. Nordic Journal of Psychiatry 62(4): 315-321, 2008. (49 refs.)

The aim of the survey was to describe the proportion of smokers and alcohol users in a group of children and adolescents admitted to a German department of child and adolescent psychiatry and psychotherapy. In addition, the proportion of smokers in this group of patients was compared with the proportion in the general population of the same age. The sample was composed of all children and adolescent inpatients (n = 432, 8-17 years old meeting inclusion criteria) admitted to a German department of child and adolescent psychiatry between May 2001 and June 2003. A shortened adaptation of the questionnaire on legal and illegal drug use, developed by the Swiss Professional Service for Alcohol Problems, Lausanne, was used. Initiation, frequency and quantity of drug use, and parental substance use were assessed. The results showed an association between conduct disorder (CD) and attention-deficit/hyperactivity disorder (ADHD) and an early initiation of nicotine and alcohol use. Girls and boys with CD and ADHD were significantly more likely to be involved in higher levels of nicotine use compared with the general population. Parental nicotine use was associated with smoking in girls, while maternal nicotine use was associated with smoking in boys. Furthermore, regular alcohol use in both girls and boys was associated with nicotine use. To conclude, early initiation and elevated rates of nicotine and alcohol use are a particular risk for adolescents with CD and ADHD.

Ribeiro-Carvalho A; Lima CS; Filgueiras CC; Manhaes AC; Abreu-Villaca Y. Nicotine and ethanol interact during adolescence: Effects on the central cholinergic systems. (review). Brain Research 1232: 48-60, 2008. (137 refs.)

Co-occurrence of tobacco smoking and alcohol consumption during adolescence is frequent and well documented. However, little is known about the basic neurobiology of the combined exposure in the adolescent brain. Since nicotine is a cholinergic agonist and it has been shown that ethanol interferes with nicotinic acetylcholine receptors (nAChRs), the current work focused on cholinergic systems. From the 30th to the 45th postnatal day (PN), C57BL/6 male and female mice were exposed to nicotine free base (NIC) and/or ethanol (ETOH). Four groups were analyzed: 1) concomitant NIC (50 mu g/ml in 2% saccharin to drink) and ETOH (25%, 2 g/kg i.p. injected every other day) exposure; 2) NIC exposure; 3) ETOH exposure; 4) vehicle. We assessed nAChR binding, choline acetyltransferase (ChAT) activity and [H-3]hemicholinium-3 (HC-3) binding in the cerebral cortex and midbrain of mice on PN45. In the cortex, ETOH had no effect on nAChRs. In contrast, NIC produced nAChR upregulation while NIC+ETOH elicited a more pronounced effect. In the midbrain, neither ETOH nor NIC had effects on nAChRs. NIC+ETOH, however, elicited a robust nAChR upregulation. Regarding ChAT activity, treatment effects differed between males and females in the cortex. Male NIC mice presented an increase in ChAT. However, ETOH reversed this effect. in contrast, female NIC mice presented decreased ChAT activity. In the midbrain, ETOH increased ChAT. HC-3 binding was not affected. These results indicate that the central cholinergic system is a site at which nicotine and ethanol interact. This interaction might underlie the association between tobacco and alcohol consumption during adolescence.

Robinson LA; Emmons KM; Moolchan ET; Ostroff JS. Developing smoking cessation programs for chronically ill teens: Lessons learned from research with healthy adolescent smokers. Journal of Pediatric Psychology 33(2): 133-144, 2008. (68 refs.)

Objective: Medically fragile teens who smoke need access to smoking cessation programs, because they are at even higher risk than their healthy peers for smoking-related complications. Methods To date, no studies on the outcome of smoking cessation programs for medically ill teens have been conducted. To suggest directions for future research, we turn to the literature on smoking cessation in the general population of teens and occasionally to the literature on adult smokers. Results Four areas are explored: (a) the prevalence of unaided cessation in healthy teens; (b) the outcomes of various treatments for smoking cessation in healthy adolescents; (c) special issues that should be considered when designing programs for medically ill teens; and (d) lessons learned from previous research. Conclusions: Medically ill teens face a number of medical, emotional, social, and developmental challenges that can affect the quitting process. Research is sorely needed to address the unique needs of this population.

Rosen IM; Maurer DM. Reducing tobacco use in adolescents. American Family Physician 77(4): 483-490, 2008. (37 refs.)

After steadily decreasing since the late 1990s, adolescent smoking rates have stabilized at levels well above national goals. Experts recommend screening for tobacco use and exposure at every patient visit, although evidence of improved outcomes in adolescents is lacking. Counseling should be provided using the 5-A method (ask, advise, assess, assist, and arrange). All smokers should be offered smoking cessation assistance, including counseling, nicotine replacement therapy, bupropion therapy, or combination therapy. Pharmacotherapy of any kind doubles the likelihood of successful smoking cessation in adults; however, nicotine replacement therapy is the only pharmacologic intervention that has been extensively studied in children. Community interventions such as smoking bans and educational programs have been effective at reducing smoking rates in children and adolescents. Antismoking advertising and tobacco sales taxes also help deter new smokers and motivate current smokers to attempt to quit.

Rosendahl KI; Galanti MR; Gilljam H. Trajectories of smokeless tobacco use and of cigarette smoking in a cohort of Swedish adolescents: Differences and implications. Nicotine & Tobacco Research 10(6): 1021-1027, 2008. (21 refs.)

Developmental trajectories of cigarette smoking have often been described, but there are no such analyses dealing with smokeless tobacco use. A semi-parametric group-based mixture modeling procedure was used to determine the development of smokeless tobacco (snus) use, as well as of cigarette smoking, over time in a cohort of 2,175 Swedish adolescents who were never-users of tobacco at the time of recruitment. An indicator of snus and of cigarette consumption in the previous year was used to model the development of the behavior between 11 and 18 years of age. For snus use three trajectories best described the cohort's experience, while four trajectories provided the best description of cigarette smoking in the cohort. For both tobacco types there were two escalation patterns and one sustained trial trajectory, while an extinction pattern was apparent for cigarette smoking only. Marked sex differences were found, since rapid escalation for snus use was found only among males while high consumption of cigarettes was observed only among females. Dual users (54.9% of all users) showed a trajectory of steeper and more prolonged increase of tobacco consumption than exclusive users of either snus or cigarettes. Several risk factors for tobacco use measured at baseline influenced individual probabilities of belonging to a particular trajectory. The developmental patterns of snus use and cigarette smoking showed high similarity, but they evolved differently in the two sexes. Dual users emerged as a high-risk group for tobacco dependence and tobacco-related harms.

Rubinstein ML; Benowitz NL; Auerback GM; Moscicki AB. A randomized trial of nicotine nasal spray in adolescent smokers. Pediatrics 122(3): E595-E600, 2008. (26 refs.)

OBJECTIVES. Nicotine nasal spray has been 1 of the most successful forms of nicotine-replacement therapy in adult populations. The nasal sprayer has not been studied in adolescent smokers. The objective of this pilot study was to determine the feasibility and utility of using nicotine nasal spray for adolescent smokers who wanted to quit smoking. METHODS. Forty adolescent smokers who were between 15 and 18 years of age and smoked >= 5 cigarettes daily for at least 6 months were recruited from several San Francisco Bay area schools from 2005 to 2007. Using a randomized, open-label, 12-week trial, adolescent smokers were assigned to receive either weekly counseling alone (control) for 8 weeks or 8 weeks of counseling along with 6 weeks of nicotine nasal spray. Self-reported smoking abstinence was verified by both expired-air carbon monoxide and salivary cotinine. RESULTS. There was no difference in cessation rates, the numbers of cigarettes smoked per day, or cotinine levels at 12 weeks. Fifty-seven percent of participants stopped using their spray after only 1 week. The most commonly reported adverse effect was nasal irritation and burning (34.8%) followed by complaints about the taste and smell (13%). CONCLUSIONS. The unpleasant adverse effects, poor adherence, and consequent lack of efficacy observed in our pilot study do not support the use of nicotine nasal spray as an adjunct to counseling for adolescent smokers who wish to quit.

Rubinstein ML; Benowitz NL; Auerback GM; Moscicki AB. Rate of nicotine metabolism and withdrawal symptoms in adolescent light smokers. Pediatrics 122(3): e643-e647, 2008. (28 refs.)

OBJECTIVES. The rate of nicotine metabolism may contribute to vulnerability in adolescents' transition from smoking initiation to addiction. The objectives of this study were to examine the associations between the rate of nicotine metabolism and cigarette consumption, addiction, and withdrawal symptoms in a sample of adolescent light smokers. PARTICIPANTS. Twenty adolescent smokers between 13 and 17 years old, who smoked between 1 and 6 cigarettes daily for >= 6 months, were recruited from several San Francisco Bay area schools and pediatric clinics from 2006 to 2007. METHODS. Participants underwent 24 hours of supervised tobacco abstinence. Serum was collected at baseline and at 24 hours for measurement of the nicotine metabolites cotinine and 3'-hydroxycotinine. Participants also completed self-report measures, which included smoking behavior, nicotine dependence, and withdrawal scales at baseline and 24 hours after baseline. The ratio of serum 3'-hydroxycotinine/cotinine (the nicotine metabolite ratio), a measure of the rate of nicotine metabolism, was computed by using measurements from the 24-hour serum samples. RESULTS. Participants were divided into 2 groups: faster metabolizers (3'-hydroxycotinine/cotinine ratio < 0.5; n = 5) and slower metabolizers (3'-hydroxycotinine/cotinine ratio < 0.5; n = 15). Faster metabolizers reported greater withdrawal symptoms after 24 hours of abstinence compared with slower metabolizers even after adjusting for the number of cigarettes smoked per day. The metabolite ratio was significantly correlated with self-described level of addiction. CONCLUSIONS. This is the first study to report a significant relationship between the rate of nicotine metabolism and withdrawal symptoms and self- reported addiction in adolescent light smokers. Given the association between withdrawal symptoms and nicotine addiction, adolescent smokers who are faster metabolizers of nicotine may be at greater risk for becoming addicted to nicotine compared with slower metabolizers.

Salomonsen-Sautel S; Van Leeuwen JM; Gilroy C; Boyle S; Malberg D; Hopfer C. Correlates of substance use among homeless youths in eight cities. American Journal on Addictions 17(3): 224-234, 2008. (40 refs.)

Homeless youths (N = 684) in eight cities participated in this study to understand the rates and correlates of substance use. Rates of lifetime and recent substance use ranged from 66% to 90%. Variability in lifetime and recent substance use was partially explained by being white (ages 14-17); ever attempting suicide (ages 14-17); not being African American (lifetime substance use) or Hispanic (ages 18-24); being male (ages 18-24); identifying as lesbian, gay, or bisexual (ages 18-24); using substances with a parent; beginning substance use at a young age; and having a family history of a substance problem.

Schnohr CW; Kreiner S; Rasmussen M; Due P; Currie C; Diderichsen F. The role of national policies intended to regulate adolescent smoking in explaining the prevalence of daily smoking: a study of adolescents from 27 European countries. Addiction 103(5): 824-831, 2008. (36 refs.)

Aims This study seeks to examine whether contextual factors influence adolescents' daily smoking. A focus was placed on three modifiable policies operating at a national level, non-smoking policy at educational facilities, price and minimum age for buying tobacco. Design: This study is based on a merged data set consisting of the 2001/02 Health Behavior in School-aged Children (HBSC) study and national-level data collected from the 2003 WHO European Tobacco Control Database and the World Development Indicators Database. HBSC is an international study including adolescents from 32 countries in Europe, Israel and North America. Data were analysed with multi-level hierarchical regression models. Findings The study found large differences in the prevalence of daily smoking among adolescents, and also large differences between boys and girls within some countries. The study found that smoking bans in schools were associated with lower odds ratios of daily smoking, which was the one positive association in the study. The study found no association between cigarette prices and adolescent daily smoking prevalence, and also the somewhat unexpected finding that having an age limit for allowing adolescents to purchase tobacco was associated with an increased risk of daily smoking. Conclusions: There was an association between mandatory national bans on smoking and lower smoking prevalence. This should be confirmed by studies that examine whether mandatory bans are more rigorously implemented than voluntary bans. If this association is causal, introducing mandatory bans may reduce adolescent smoking prevalence. The findings that price was unrelated to smoking prevalence undermine findings elsewhere that adolescent smokers are more price-sensitive than adult smokers, but longitudinal studies are needed.

Sitrin D; Bishai D. The association between cigarette smoking and work status among Egyptian adolescent males. International Journal of Tuberculosis and Lung Disease 12(6): 670-676, 2008. (20 refs.)

SETTING: Cigarette consumption has rapidly increased in Egypt and large numbers of young people are now smoking, but little is known about factors influencing smoking behavior in Egyptian adolescents. OBJECTIVE: To determine whether working is associated with cigarette smoking among Egyptian adolescent males. DESIGN: Data were from the nationally representative Adolescence and Social Change in Egypt survey. A total of 4354 boys and 4773 girls aged 10-19 years and one adult in each household were interviewed between March and August 1997. Given the low prevalence of smoking among girls, they were excluded from this analysis. RESULTS: Workers tended robe older, have more smoking peers, be of lower socio-economic status and live in rural regions; these confounders were included in multi-variate models. Comparing former and never workers, the OR of ever smoking was 1.57 (95%CI 1.17-2.12), and that of current smoking was 1.46 (95%CI 0.99-2.25); comparing unpaid workers and never workers, the OR for ever smoking was 0.86 (95%CI 0.63-1.19), and for current smoking it was 1.08 (95%CI 0.69-1.67); and comparing paid workers with never workers, the OR for ever smoking was 1.36 (95%CI 1.00-1.85) while for current smoking it was 1.68 (95%CI 1.07-2.65). CONCLUSION: Egyptian boys who do paid work have a higher likelihood of smoking. Policy makers can target youths at high risk for smoking in industries that hire adolescents.

Slotkin TA; Ryde IT; MacKillop EA; Bodwell BE; Seidler FJ. Adolescent nicotine administration changes the responses to nicotine given subsequently in adulthood: Adenylyl cyclase cell signaling in brain regions during nicotine administration and withdrawal, and lasting effects. Brain Research Bulletin 76(5): 522-530, 2008. (41 refs.)

Neurodevelopmental vulnerability to nicotine extends into adolescence, the stage at which most smokers begin using tobacco. The "sensitization-homeostasis" model postulates that nicotine treatment permanently reprogrammes neural communication, so that underlying functional changes remain present despite the apparent restoration of behavioral normality. We administered nicotine to adolescent rats (postnatal days PN30-47) or adults (postnatal days PN90-107), using regimens that reproduce plasma levels in smokers, and assessed effects on the adenylyl cyclase (AC) signaling cascade, which is involved in nicotine dependence and withdrawal but also mediates numerous other neurotransmitter responses. Evaluations were made in the cerebral cortex, brainstem and cerebellum on PN105, PN110, PN120, PN130 and PN180. Adolescent nicotine exposure elicited persistent suppression of basal AC activity and eventual compromise of responses to P-adrenergic receptor stimulation, with effects emerging in late adulthood; maximal AC activity as monitored with forskolin was elevated and in general, all the effects were more notable in males. Nicotine treatment in adulthood produced an immediate increase in AC activity in males that disappeared upon withdrawal; there were late-emerging deficits similar to, but smaller in magnitude than those seen with adolescent nicotine exposure. Adolescent treatment greatly exacerbated the response to subsequent nicotine administration in adulthood, producing profound AC deficits during withdrawal that persisted through at least 6 months of age. our results reinforce the concept that adolescence is a critical developmental period in which nicotine disrupts neural cell signaling in a lasting manner, and provide a mechanistic framework for understanding the biological substrates that determine the relationship between adolescent nicotine exposure and life-long susceptibility to nicotine addiction.

Smith AE; Cavallo DA; McFetridge A; Liss T; Krishnan-Sarin S. Preliminary examination of tobacco withdrawal in adolescent smokers during smoking cessation treatment. Nicotine & Tobacco Research 10(7): 1253-1259, 2008. (46 refs.)

Tobacco withdrawal symptoms have been shown to play a significant role in mediating relapse to smoking in adult smokers; however, few prospective studies have examined the course of tobacco withdrawal symptoms over time and their connection to lapse in adolescent smokers. Withdrawal symptoms were assessed weekly for 4 weeks in a sample of adolescent smokers participating in a pilot cessation intervention. Adolescent smokers experienced an exacerbation in overall withdrawal symptoms, particularly of cravings and restlessness, although symptoms were generally mild. The course of symptoms was different for boys and girls: Girls generally experienced a peak and subsequent decline in symptoms early in the establishment of abstinence, whereas boys experienced a constant level of symptoms that did not decline over the 4 weeks. Finally, withdrawal symptoms experienced on quit day were not related to lapse to smoking during the course of treatment for either boys or girls. These results suggest that although withdrawal symptoms may be uncomfortable, they may not be the most salient to a lapse to smoking for adolescent smokers attempting to quit. These findings have direct implications for the design and implementation of treatment of nicotine dependence in adolescent smokers.

Smith DW; Lee JT; Colwell B; Stevens-Manser S. Confirming the structure of the Why Do You Smoke? questionnaire: A community resource for adolescent tobacco cessation. Journal of Drug Education 38(1): 85-95, 2008. (21 refs.)

In response to the problem of adolescent smoking and limited appropriate cessation resources, this study examined the pattern and structure of the American Lung Association, Why Do You Smoke? (WDS) to determine its appropriateness for use in youth smoking cessation programs. The WDS is used to help smokers identify primary motivations for using tobacco and is comprised of eight subscales, each with three items representing primary smoking motivations ("Stimulation," "Handling," "Pleasure," "Crutch," "Psychological," "Habit," "Peer," and "Independence"). Study participants were all rainors enrolled in a tobacco cessation program (n = 251). The pattern and structure of this self-assessment was examined using a correlated multiple group component factor analysis as a confirmatory approach. Findings show that the level of endorsement (as evidenced by subscale means and standard deviations) was relatively large across the eight subscales. Alpha coefficients ranged from .54 to.85. Results also underlined that the pattern coefficient matrix provided support for the hypothesized subscales through an examination of simultaneously extracted confidence intervals. These subscales should be further examined as to their usefulness in cessation interventions, such as the validity of using this instrument by gender, ethnicity, and age. However, from a measurement perspective, the confirmatory analysis provides excellent credence for the continued use of the WDS in cognitive/behavioral intervention programs targeting adolescents.

Smith KC; Wakefield MA; Terry-McElrath Y; Chaloupka FJ; Flay B; Johnston L et al. Relation between newspaper coverage of tobacco issues and smoking attitudes and behaviour among American teens. Tobacco Control 17(1): 17-24, 2008. (56 refs.)

Objective: Geographic variation in youth smoking prevalence suggests that community-level factors influence risk of tobacco use. We examine the extent to which newspaper coverage of tobacco issues is related to youth smoking attitudes and behaviours. Design: We conducted a content analysis of 8390 newspaper articles on tobacco issues from 386 daily newspapers circulating at 5% or more in 2001-3 Monitoring the Future (MTF) survey communities. This resulted in the creation of community level measures of news volume, content and valence. Associations between news and youth outcomes were assessed using logistic regression analyses adjusting for individual, geographic and tobacco policy factors linked to youth smoking and attitudes. Subjects: 98 747 youth participating in the nationally representative school-based MTF annual surveys between 2001 and 2003. Main outcome measures: Perceived harm of smoking, perceived peer smoking, disapproval of smoking, smoking within the past 30 days, daily cigarette consumption. Results: In the five months preceding survey administration, newspapers in MTF communities published an average of 11.9 tobacco related articles (range 0-55.7). Each 10-article increase in newspaper volume over the five-month period was associated with increased odds of perceiving great harm from smoking (OR=1.04, p < 0.01) and disapproving of smoking (OR= 1.04, p < 0.05) and decreased odds of perceiving most or all friends smoke (0.94, p < 0.01) and smoking in the past 30 days (OR=0.93, p < 0.001). No consistent association was found between the content or valence of coverage and youth smoking outcomes. Conclusions: Gaining and keeping tobacco on the media agenda is an important tool for tackling youth smoking. As volume appears to be the driving factor, media advocacy may be best targeted towards generating events and highlighting issues likely to increase and sustain news attention.

Speizer IS; Bean MK; Obando CP; Fries E. Middle school students' perceived access to cigarettes in Virginia. American Journal of Health Behavior 32(4): 399-410, 2008. (31 refs.)

Objective: To examine correlates of perceived access to cigarettes at home, school, and the store among youth. Methods: Virginia middle school youth were surveyed before beginning tobacco prevention programs. Multivariate analyses examined household smoking, peer smoking, and perceived community tobacco use for their relationship to perceived access at home, school, and the store. Results: Perceived access at home was associated with parent, sibling, and friend smoking. Perceived access at school and stores was associated with perceived peer and community smoking. Conclusions: Youth tobacco prevention programs should target the commercial and social sources of tobacco access to reduce experimentation, adoption, and addiction among youth.

Storr CL. Characteristics associated with rapid transition to tobacco dependence in youth. Nicotine & Tobacco Research 10(6): 1099-1104, 2008. (25 refs.)

Epidemiologic data suggests the smoking trajectory for some adolescents escalates rapidly and that tobacco dependence can develop quickly after initiation. In this study, we examine variation in cigarette consumption and individual characteristics associated with the rapid development of tobacco dependence, focusing particularly on the 24-month interval after tobacco initiation. The analysis is based on public use data files of the National Household Survey on Drug Abuse conducted in 1994-1996. Representative samples of adolescents aged 12-17 years old, totaling 13,831, completed a standardized interview assessing demographic characteristics, tobacco involvement and past year dependence, and psychological functioning over the preceding 6-month period as assessed by the Youth Self-Report. Analyses were restricted to the 1,734 youth who had started smoking within 0-24 months prior to being assessed, of which the onset for 70% of them was between 11-24 months. Logistic regression models took into account sample weights and used a variance estimation procedure appropriate for the complex multistage sampling design. Overall, 210 recent initiators met dependence criteria (13.5%, 95% CI=12.0-15.2). Dependent smokers had greater cigarette involvement than youth who had not transitioned to being tobacco dependent by the time of assessment. Variation in mental health and sociodemographic characteristics were also detected. Disruptive behavior (p=.05) and being female (p=.02) were associated with being tobacco dependent. The rapid transition to dependence in youth depends not only on cigarette consumption features, but may also be associated with individual characteristics.

Tager IB. The effects of second-hand and direct exposure to tobacco smoke on asthma and lung function in adolescence. Paediatric Respiratory Reviews 9(1): 29-38, 2008. (50 refs.)

Cigarette smoking still is quite common in many parts of the world. In parallel, exposure to second-hand smoke continues to be common despite declines in smoking in developed countries and despite evidence of serious health effects in infants and children. This paper focuses on the effects of second-hand and direct exposure (personal smoking) on the respiratory health of adolescents, in particular effects on the occurrence of asthma and on lung function. Published data indicate that, in addition to whatever effects direct and postnatal second-hand tobacco smoke exposure have on the occurrence of asthma and impaired levels and growth of lung function in adolescents, there is an underlying alteration in the prenatal and early postnatal development of the structural and mechanical characteristics of the lung that contribute substantially to these deficits. These developmental effects may be important contributors to the future risks for impaired pulmonary function.

Tercyak KP; Britto MT; Hanna KM; Hollen PJ; Hudson MM. Prevention of tobacco use among medically at-risk children and adolescents: Clinical and research opportunities in the interest of public health. Journal of Pediatric Psychology 33(2): 119-132, 2008. (106 refs.)

Objective: Cigarette smoking and other forms of tobacco use are addictive and harmful. Though no level of smoking is safe, children and adolescents who are medically at-risk due to the presence of a chronic or life-threatening disease may be especially vulnerable to these dangers. This article provides an overview of considerations in the prevention of tobacco use in this special population. Methods: This article summarizes medical aspects of childhood chronic disease and the impact of cigarette smoking, the prevalence of tobacco screening in pediatric healthcare, and levels of prevention for individuals, families, schools, and healthcare. Recommendations for clinical services and research are also included. Results: There are a number of reasons to prevent and interrupt the onset of smoking in medically at-risk youth. Subspecialty clinics appear to be the most likely point of entry for prevention-based work in this area. However, no one single setting will be effective in preventing and deterring use without due consideration of other settings, perspectives, and influences on smoking uptake. Conclusions: The promise of smoking prevention to improve the health and outlook of children and adolescents with chronic or life-threatening disease is high, and additional efforts are needed for this population.

Thatcher DL; Clark DB. Adolescents at risk for substance use disorders. Alcohol Research & Health 31(2): 168-176, 2008. (51 refs.)

Adolescents with alcohol-related problems often also use cigarettes and marijuana. Furthermore, early childhood characteristics that increase the risk for adolescent alcohol use disorders also increase the risk for problematic drug use. Identifying these characteristics early in childhood can be important for the prevention of alcohol and other drug (AOD) use disorders. As a result, researchers are seeking to) identify liability factors and observable characteristics (i.e., phenotypes) that can predict substance use disorders (SUDs) across drug categories. Other studies are focusing on endophenotypes-characteristics that cannot be openly observed but which link a person's genetic makeup, or genotype, and disease. Both predictive behavioral phenotypes and endophenotypes may reveal pathways connecting heritable predispositions and early environmental influences to later SUDs. One suggested predictive phenotype is psychological dysregulation, which is characterized by cognitive, behavioral, and emotional difficulties in childhood. An endophenotype that has been studied extensively is a particular brain wave called the P300 event-related potential. For people who are at high risk of AOD use based on these characteristics, adverse environmental conditions frequently lead to SUDs. Given the strong evidence that childhood psychological dysregulation predicts problematic AOD use, effective interventions for preventing adolescent SUDs may need to target the environmental features that put adolescents with this behavioral constellation at increased risk.

Public Domain

Thomson WM; Poulton R; Broadbent JM; Moffitt TE; Caspi A; Beck JD et al. Cannabis smoking and periodontal disease among young adults. Journal of the American Medical Association 299(5): 525-531, 2008. (22 refs.)

Context: Tobacco smoking is a recognized behavioral risk factor for periodontal disease ( through its systemic effects), and cannabis smoking may contribute in a similar way. Objective To determine whether cannabis smoking is a risk factor for periodontal disease. Design and Setting Prospective cohort study of the general population, with cannabis use determined at ages 18, 21, 26, and 32 years and dental examinations conducted at ages 26 and 32 years. The most recent data collection ( at age 32 years) was completed in June 2005. Participants: A complete birth cohort born in 1972 and 1973 in Dunedin, New Zealand, and assessed periodically ( with a 96% follow- up rate of the 1015 participants who survived to age 32 years). Complete data for this analysis were available from 903 participants ( comprising 89.0% of the surviving birth cohort). Main Outcome Measure Periodontal disease status at age 32 years ( and changes from ages 26 to 32 years) determined from periodontal combined attachment loss ( CAL) measured at 3 sites per tooth. Results Three cannabis exposure groups were determined: no exposure ( 293 individuals, or 32.3%), some exposure ( 428; 47.4%), and high exposure ( 182; 20.2%). At age 32 years, 265 participants ( 29.3%) had 1 or more sites with 4 mm or greater CAL, and 111 participants ( 12.3%) had 1 or more sites with 5 mm or greater CAL. Incident attachment loss between the ages of 26 and 32 years in the none, some, and high cannabis exposure groups was 6.5%, 11.2%, and 23.6%, respectively. After controlling for tobacco smoking ( measured in pack- years), sex, irregular use of dental services, and dental plaque, the relative risk estimates for the highest cannabis exposure group were as follows: 1.6 ( 95% confidence interval [ CI], 1.2- 2.2) for having 1 or more sites with 4 mm or greater CAL; 3.1 ( 95% CI, 1.5- 6.4) for having 1 or more sites with 5 mm or greater CAL; and 2.2 ( 95% CI, 1.2- 3.9) for having incident attachment loss ( in comparison with those who had never smoked cannabis). Tobacco smoking was strongly associated with periodontal disease experience, but there was no interaction between cannabis use and tobacco smoking in predicting the condition's occurrence. Conclusion Cannabis smoking may be a risk factor for periodontal disease that is independent of the use of tobacco.

Tyc VL. Introduction to the special issue: Tobacco control strategies for medically at-risk youth. (editorial). Journal of Pediatric Psychology 33(2): 113-118, 2008. (41 refs.)

Tyc VL; Hovell MF; Winickoff J. Reducing secondhand smoke exposure among children and adolescents: Emerging issues for intervening with medically at-risk youth. Journal of Pediatric Psychology 33(2): 145-155, 2008. (70 refs.)

Objective: To summarize information on rates of secondhand smoke (SHS) exposure among healthy and medically at-risk pediatric populations, discusses the clinical manifestations of pediatric disease that are exacerbated by exposure, and provide an overview of promising strategies for reducing SHS in vulnerable pediatric populations. Methods The success of exposure reduction and smoking cessation interventions implemented with parents of healthy children and those with respiratory disease, in the context of their childs health care, is reviewed. Results: Concurrent implementation of multiple levels of intervention, including clinical interventions within the medical setting, will help to maximize the reduction in childhood SHS exposure. Conclusion: Ongoing intervention research and identification of strategies to capitalize on opportunities for providing effective SHS counseling in primary care and specialty clinics will be critical for effective tobacco control among medically at-risk children.

van Zundert RMP; Engels RCME; Kleinjan M; van den Eijnden RJJM. An integration of parents and best friends smoking, smoking-specific cognitions, and nicotine dependence in relation to readiness to quit smoking: A comparison between adolescents with and without asthma. Journal of Pediatric Psychology 33(8): 821-832, 2008. (52 refs.)

Objective: To study the impact of parents and best friends smoking, nicotine dependence, and craving on smoking-specific cognitions, and readiness to quit in adolescents with and without asthma. Methods: Structural equation analyses were applied to data from a sample of 1,120 daily smoking adolescents, 83 of whom had asthma. Results Adolescents with asthma felt more ready to quit, and cognitions were more strongly related to readiness to quit among adolescents with asthma than among adolescents without asthma. Moreover, best friends smoking seemed more relevant to the cognitions of adolescents with asthma. Nicotine dependence and craving were strongly related to cognitions, and to readiness to quit in both groups. The relation between craving and readiness to quit, however, was stronger among participants with asthma. Conclusions: Reduction of nicotine dependence and craving is essential for both groups. Youth with asthma may benefit even more from cognitive-based cessation services than healthy youth. The finding that adolescents with asthma are relatively more ready to quit, and that their cognitions are more easily affected can be turned into advantages in asthma-specific cessation services.

Vassallo S; Smart D; Sanson A; Cockfield S; Harris A; McIntyre A et al. Risky driving among young Australian drivers. II: Co-occurrence with other problem behaviours. Accident Analysis and Prevention 40(1): 376-386, 2008. (40 refs.)

This study examined the co-occurrence of risky driving with a range of externalising and internalising problems among 1055 young Australian drivers participating in an ongoing, 23-year longitudinal study. This issue was examined by: (1) investigating the co-occurrence of risky driving and other problem outcomes at 19-20 years; (2) exploring the rate of single and multiple problems among high, moderate and low young risky drivers and (3) investigating connections between risky driving in early adulthood and adolescent problem behaviours. Concurrent and longitudinal associations between risky driving and both substance use (alcohol, cigarette and marijuana use, binge drinking) and antisocial behaviour were found. However, risky driving generally appeared unrelated to internalising problems (depression, anxiety) and early sexual activity. Overall, young risky drivers varied considerably in the number and types of problem behaviours exhibited, although the great majority (70%) had displayed at least one other type of problem behaviour.

Waldie KE; Mcgee R; Reeder AI; Poulton R. Associations between frequent headaches, persistent smoking, and attempts to quit. Headache 48(4): 545-552, 2008. (30 refs.)

Background. Recent studies have found a strong relationship between tobacco smoking and headache pain. It remains unclear whether smoking behavior leads to headache or visa versa, mainly due to the cross-sectional nature of the majority of this research. Objective. To help clarify the direction of the relation between smoking and frequent headaches in a representative cohort study. Design and Methods. Members of the Dunedin Multidisciplinary Health and Development Study (N = 980) were asked about their cigarette smoking and headache history at ages 11 and 13 (childhood), age 15 (mid-adolescence), and age 26 (adulthood). Both cross-sectional and longitudinal associations between smoking and headache status were examined using logistic regression. Results. During mid-adolescence, the likelihood of frequent headaches doubled for smokers relative to nonsmokers (OR: 2.16, 95% CI: 1.39-3.35). Smoking did not increase the risk of developing headaches in adulthood, however. In contrast, individuals who suffered from frequent headaches during mid-adolescence were 2 times more likely to smoke in adulthood than those without headache (OR: 2.20, 95% CI: 1.3-3.7), after controlling for sex and family socioeconomic status. Attempts to quit smoking were significantly more difficult for migraine sufferers with a history of headache than for those with tension-type headache. Conclusions. Frequent headaches during mid-adolescence appear to increase the risk of daily smoking in adolescence and adulthood. These individuals also have a more difficult time quitting than their headache-free peers.

Werch CE; Moore MJ; Bian H; DiClemente CC; Ames SC; Weiler RM et al. Efficacy of a brief image-based multiple-behavior intervention for college students. Annals of Behavioral Medicine 36(2): 149-157, 2008. (66 refs.)

Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261)=2.73, p=0.01, marijuana-use behaviors, F(4, 278)=3.18, p=0.01, and health-related quality of life, F(5, 277)=2.80, p=0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281)=9.49, p=0.00, than those in the standard care control. A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

White V; Webster B; Wakefield M. Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours? Addiction 103(9): 1562-1571, 2008. (25 refs.)

Aims To assess the impact of the introduction of graphic health warning labels on cigarette packets on adolescents at different smoking uptake stages. Design School-based surveys conducted in the year prior to (2005) and approximately 6 months after (2006) the introduction of the graphic health warnings. The 2006 survey was conducted after a TV advertising campaign promoting two new health warnings. Setting Secondary schools in greater metropolitan Melbourne, Australia. Participants Students in year levels 8-12: 2432 students in 2005, and 2050 in 2006, participated. Measures Smoking uptake stage, intention to smoke, reported exposure to cigarette packs, knowledge of health effects of smoking, cognitive processing of warning labels and perceptions of cigarette pack image. Findings At baseline, 72% of students had seen cigarette packs in the previous 6 months, while at follow-up 77% had seen packs and 88% of these had seen the new warning labels. Cognitive processing of warning labels increased, with students more frequently reading, attending to, thinking and talking about warning labels at follow-up. Experimental and established smokers thought about quitting and forgoing cigarettes more at follow-up. At follow-up intention to smoke was lower among those students who had talked about the warning labels and had forgone cigarettes. Conclusions: Graphic warning labels on cigarette packs are noticed by the majority of adolescents, increase adolescents' cognitive processing of these messages and have the potential to lower smoking intentions. Our findings suggest that the introduction of graphic warning labels may help to reduce smoking among adolescents.

Wilens TE; Biederman J; Adamson JJ; Henin A; Sgambati S; Gignac M et al. Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: A controlled study. Drug and Alcohol Dependence 95(3): 188-198, 2008. (89 refs.)

Although previous work suggests that juvenile onset bipolar disorder increases risk for substance use disorders and cigarette smoking, the literature on the subject is limited. We evaluated the association of risk for substance use disorders and cigarette smoking with bipolar disorder in adolescents in a case-control study of adolescents with bipolar disorder (n = 105, age 13.6 +/- 2.5 years [mean]; 70% male) and without bipolar disorder ("controls"; it = 98, age 13.7 +/- 2.1 years; 60% male). Rates of substance use and other disorders were assessed with structured interviews (KSADS-E for subjects younger than 18, SCID for 18-year-old subjects). Bipolar disorder was associated with a significant age-adjusted risk for any substance use disorder (hazard ratio[95% confidence interval] = 8.68[3.02 25.0], chi(2) = 16.06, p < 0.001, df = 1), alcohol abuse (7.66 [2.20 26.7], chi(2) = 10.2, p = 0.001, df = 1), drug abuse (18.5 [2.46 139.10], chi(2) = 8.03, p = 0.005, df = 1) and dependence (12.1 [1.54 95.50], chi(2) = 5.61, p = 0.02, df = 1), and cigarette smoking (12.3 [2.83 53.69], chi(2) = 11.2, p < 0.001, df = 1), independently of attention deficit/hyperactivity disorder, multiple anxiety, and conduct disorder (CD). The primary predictor of substance use disorders in bipolar youth was older age (BPD - SUD versus BPD + SUD, logistic regression: chi(2) = 89.37, p < 0.001). Adolescent bipolar disorder is a significant risk factor for substance use disorders and cigarette smoking, independent of psychiatric comorbidity. Clinicians should carefully screen adolescents with bipolar disorder for substance and cigarette use.

Wilens TE; Vitulano M; Upadhyaya H; Adamson J; Sawtelle R; Utzinger L et al. Cigarette smoking associated with attention deficit hyperactivity disorder. Journal of Pediatrics 153(3): 414-419, 2008. (31 refs.)

Objective: To evaluate the association between attention deficit hyperactivity (ADHD) and severity of physical dependence on nicotine in a controlled study of adolescents and young adults with ADHD. Study design In controlled longitudinal family studies of ADHD, we examined self-reports on the modified Fagerstrom Tolerance Questionnaire (mFTQ) for degrees of physical dependence on nicotine. Results: We obtained mFTQ data from 80 ADHD probands and 86 control probands (mean age, 19.2 years). The smokers with ADHD had significantly higher scores on the mFTQ, indicative of more severe physical dependence on nicotine. Similarly, in current smokers, a positive linear relationship was found between mFTQ score and both inattentive and hyperactive ADHD symptoms. Environmental factors, such as current parental smoking, peer smoking, and living with a smoker, all increased the risk for smoking in those with ADHD compared with controls. Conclusion: Male and female smokers with ADHD manifest more severe physical dependence on smoking compared with controls. Important environmental factors appear to add to the risk of smoking associated with ADHD.

Wilkinson AV; Waters AJ; Vasudevan V; Bondy ML; Prokhorov AV; Spitz MR. Correlates of susceptibility to smoking among Mexican origin youth residing in Houston, Texas: A cross-sectional analysis:. BMC Public Health 8(e-article 337), 2008. (60 refs.)

Background: Survey data suggest that in Texas Latino youth exhibit higher rates of susceptibility to smoking than youth from other ethnic groups. In this analysis we examined the relationship between susceptibility to smoking and well-known risk factors associated with smoking initiation among a cohort of 11 to 13 year old Mexican origin youth residing in Houston, Texas. Methods: We analyzed cross-sectional survey data from 1,187 participants who reported they had never smoked, even a puff of a cigarette. The survey assessed peer and family social influence, school and neighborhood characteristics, level of family acculturation and socioeconomic status, and attitudes toward smoking. Bivariate associations, Student's t-tests, and logistic regression analysis were used to examine predictors of susceptibility. Results: Overall, 22.1% of the never-smokers were susceptible to smoking. Boys were more likely to be susceptible than girls (25.6% vs. 18.9%), and susceptible children were slightly older than non-susceptible children (12.1 vs. 11.8 years). In addition, multivariate analyses revealed that positive expectations about smoking exerted the strongest influence on susceptibility status (odds ratio = 4.85). Multivariate analyses further revealed that compared to non-susceptible participants, susceptibles were more likely to report peer influences supportive of smoking, lower subjective social status and more detentions at school, more temptations to try smoking and to have a mother and a brother who smokes. Conclusion: Our findings suggest that interventions that target positive expectations about smoking may be useful in this population. Furthermore, because youth encounter smoking-initiation risk factors in different social environments, our results underscore the continued need for both family- and school-based primary prevention programs to adequately combat their influence. The results also can be used to inform the development of culturally sensitive programs for Mexican origin youth.

Xiao L; Bechara A; Cen S; Grenard JL; Stacy AW; Gallaher P et al. Affective decision-making deficits, linked to a dysfunctional ventromedial prefrontal cortex, revealed in 10th-grade Chinese adolescent smokers. Nicotine & Tobacco Research 10(6): 1085-1097, 2008. (80 refs.)

This study addressed the question of whether poor decision making would be associated with adolescent past 7-day smoking. We conducted a cross-sectional study of 208 10th-grade adolescents in Chengdu City, China. We used the Iowa Gambling Task (IGT) to assess decision-making, and the Self-ordered Pointing Task (SOPT) to assess working memory capacity. Paper and pencil questionnaires assessed the school academic performance (SAP) and smoking variables. The results showed that a significantly higher proportion of past 7-day smokers (91.7%) were susceptible to future smoking and cigarette offers from best friends compared to other levels of smokers (never, ever and past 30-day smokers). Consistent with these behavioral data, the neuropsychological assessments revealed that relative to never smokers, past 7-day adolescent smokers (but not ever smokers or past 30-day smokers) demonstrated significantly lower scores on the IGT. Moreover, a higher proportion of past 7-day smokers (91.7%) performed poorly (no more than an overall net score of 10) on the IGT than nonsmokers and irregular (ever or past 30-day) smokers (about 65.3%). There were no differences on working memory performance for smokers (at any level) compared to never smokers after adjusting for school-type. In addition, logistic regression showed that the IGT significantly predicted past 7-day smoking after controlling for the working memory, school academic performance and demographic variables. These results suggest that poor affective decision making might predispose some adolescents to smoking in the future or in the social situations where their peers are smoking. Intervention targeting affective decision making might hold promise for reducing adolescents' risks for substance use.

Yang SM; Lynch J; Schulenberg J; Roux AVD; Raghunathan T. Emergence of socioeconomic inequalities in smoking and overweight and obesity in early adulthood: The National Longitudinal Study of Adolescent Health. American Journal of Public Health 983(3): 468-477, 2008. (35 refs.)

Objectives. We examined whether socioeconomic inequalities in smoking and overweight and obesity emerged in early adulthood and the contribution of family background, adolescent smoking, and body mass index to socioeconomic inequalities. Methods. Using data from the National Longitudinal Study of Adolescent Health we employed multinomial regression analyses to estimate relative odds of heavy or light-to-moderate smoking to nonsmoking and of overweight or obesity to normal weight. Results. For smoking, we found inequalities by young adult socioeconomic position in both genders after controlling for family background and smoking during adolescence. However, family socioeconomic position was not strongly associated with smoking in early adulthood. For overweight and obesity, we found socioeconomic inequalities only among women both by young adult and family socioeconomic position after adjusting for birthweight, other family background, and body mass index during adolescence. Conclusions. Socioeconomic inequalities in smoking emerged in early adulthood according to socioeconomic position. Among women, inequalities in overweight or obesity were already evident by family socioeconomic position and strengthened by their own socioeconomic position. The relative importance of family background and current socioeconomic circumstances varied between smoking and overweight or obesity.

Zhang B; Cartmill C; Ferrence R. The role of spending money and drinking alcohol in adolescent smoking. Addiction 103(2): 310-319, 2008. (42 refs.)

Aims Previous studies have shown inconsistent findings with regard to the association between amount of spending money and adolescent smoking. Drinking alcohol may be a mediator of the association between spending money and adolescent smoking. However, no studies have examined this potential role. The objective of this study was to investigate the association between amount of spending money and adolescent smoking and the potential mediation role of alcohol use in this association. Design The 2003 Ontario Student Drug Use Survey of students in grades 7-12. Measurements Multivariable logistic, probit and linear regression models were used to investigate the association between amount of spending money and smoking, and the contribution of drinking alcoholic beverages to this relationship. Findings Spending money was associated positively with experimental smoking, current smoking and daily consumption of cigarettes (P < 0.01). The analysis adjusted for confounders showed that students with spending money >=$20/week were significantly more likely to be experimental smokers, students with >=$30/week were significantly more likely to be current smokers and students with >=$60/week smoked significantly more cigarettes/day (P <= 0.05), compared to students with <$10/week. Alcohol use was an important mediator, responsible for 81% of the association of spending money with experimental smoking, 38% with current smoking and 37% with daily consumption of cigarettes. Conclusions: Amount of spending money was associated significantly and positively with smoking among adolescents, and alcohol use mediated this association. Integrated tobacco prevention programs may be more effective, and increasing taxes on cigarettes and alcohol would increase price sensitivity among youth and protect against adolescent smoking.