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CORK Bibliography: Adolescents and Nicotine

132 citations. January 2007 to present

Prepared: January 2008

Abdalla AM; Al-Kaabba AF; Saeed AA; Abdulrahman BM; Raat H. Gender differences in smoking behavior among adolescents in Saudi Arabia. Saudi Medical Journal 28(7): 1102-1108, 2007. (18 refs.)

Objectives: To describe and assess gender differences in current cigarette smokers' according to certain variables including prevalence, access to tobacco, knowledge and attitude, environmental tobacco smoke, cessation of smoking, tobacco related advertisements, and education on tobacco in school among adolescents in grades 7-12 in Tabuk, Saudi Arabia. Methods: A random sample of schools in Tabuk city was obtained using a 2-stage cluster, in April 2005. A total of 16 governmental schools were selected. Within the schools, 48 classes were selected, targeting grades was 7 to 12. An anonymous, self-administered questionnaire was used to select 1,505 participants, with 96% response rate. Results: Out of 1,505 students, 22.3% (34% males, 11.1% females) were current cigarette smokers (students who had smoked on one or more days in the 30 days preceding the survey), and 5.8% (11.1% males, 0.7% females) were daily smokers. There were significant gender differences concerning source of cigarettes, usual place of smoke, intensity of smoking, knowledge on addiction of tobacco, exposure to education on tobacco, attitudes, and exposure to tobacco smoke in public places. While no significant gender differences were found with respect to age of initiation, knowledge of health hazards of tobacco, exposure to media, desire to quit, or exposure to tobacco smoke at home. Conclusion: For the suppression of the use of tobacco by adolescents in Saudi Arabia differential intervention strategies and policies in males and females are needed, such as reducing youth access to cigarettes - in addition to intensive school and community antitobacco programs

Abdullah ASM; Ho WWN. What Chinese adolescents think about quitting smoking: A qualitative study. Substance Use & Misuse 41(13): 1735-1743, 2006. (18 refs.)

The aim of this study was to investigate the attitudes of Chinese adolescents toward smoking, giving up smoking, and smoking cessation programs presently available. The study was a qualitative study carried out in 2002 by focus groups of 32 male secondary school students in Hong Kong who were either current smokers or had recently given up smoking. Subjects were students (grades 8-10) attending two full-day secondary schools in Hong Kong. Participants did not feel the need to make any serious psychological preparation for quitting. They underestimated the addictive nature of cigarette smoking and felt that they could choose to quit smoking at any time with little difficulty. Several barriers to quitting were reported, including boredom, peer influence, the urge to smoke, school work pressure, the wish to do something with their hands, difficulty in concentrating, and the ready availability of free cigarettes from peers. Those who had attempted to quit smoking (26/32) reported that peer influence and boredom were the main reasons why they started smoking and insisted that willpower and determination could have helped them in their quitting attempt. Participants were unanimous that pressure or encouragement from teachers, parents, or girlfriends did not help them to stay off cigarettes. Most (24/32) of the current smokers knew that smoking cessation services were available in Hong Kong, only 50% (12/24) of those who knew had made use of such services. None of the participants were able to identify any effective way of quitting smoking, though some suggested that the best practical measure was to avoid friends who smoked. The study suggests that attempts to persuade young people to quit smoking might benefit if they were framed to address issues such as the strong influence of their peers, the ease with which tobacco products can be obtained, the casual attitudes of young people toward smoking cessation, the perceived pros and cons of quitting, and (given that underage smoking is frowned upon by many parents and teachers) the need to respect confidentiality when offering support.

Al Mamun A; Alati R; O'Callaghan M; Hayatbakhsh MR; O'Callaghan FV; Najman JM et al. Does childhood sexual abuse have an effect on young adults' nicotine disorder (dependence or withdrawal)? Evidence from a birth cohort study. Addiction 102(4): 647-654, 2007. (40 refs.)

Aims To examine whether there is evidence of an independent association between childhood sexual abuse (CSA) and nicotine disorder in youth and to explore the mechanisms underlying this association in a prospective cohort study. Design Birth cohort study followed-up to 21 years. Setting One of two major obstetric hospitals in Brisbane, Australia. Participants The Mater-University of Queensland Study of Pregnancy involves a prospective birth cohort from a population-based sample involving 7223 singletons whose mothers were enrolled between 1981 and 1984 at the first antenatal visit. The present cohort consisted of a subgroup of 2571 youth who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up. Measurements Nicotine disorder was measured based on Diagnostic and Statistical Manual version IV (DSM-IV) diagnostic criteria and measures of CSA, including retrospective self-reports of rape, were obtained at 21 years. Results Of 2571 young adults, 16.6% met the criteria for either dependence (12.8%) or withdrawal (8.5%). Non-penetrative sexual abuse was reported by 15.5% of respondents and 8.0% reported penetrative sexual abuse. For any types of sexual abuse including non-penetrative, penetrative and self-reported rape before age 16 years, young adults had significantly higher rates of nicotine disorder than young adults who did not experience CSA. This relationship was independent and appeared direct after adjustment for a range of potential confounding and mediating factors. Conclusions This study shows that CSA is associated with young adult nicotine disorder. The results extend the public health significance of findings in this area and highlight the importance of not only intensifying public health efforts to address substance use problems among those who have experienced CSA, but of early intervention, so that emerging risky behaviours may be targeted in the earliest stages.

Albrecht SA; Caruthers D; Patrick T; Reynolds M; Salamie D; Higgins LW et al. A randomized controlled trial of a smoking cessation intervention for pregnant adolescents. Nursing Research 55(6): 402-410, 2006. (42 refs.)

Background: The smoking prevalence rate among pregnant adolescents has been estimated at 59-62%, and 60-80% of these adolescents continue to smoke throughout their pregnancies. Objectives: The aim of this study was to evaluate the short- and long-term effects. of smoking cessation strategies tailored to the pregnant adolescent to attain and maintain abstinence. The specific aim was to examine differences in short- and long-term smoking behaviors among three groups: Teen FreshStart (TFS), Teen FreshStart Plus Buddy TFS-B, and Usual Care (UC) control. Methods: In this randomized controlled intervention study, a 3-group (TFS, TFS-B, and UC) by 3-occasion (baseline, 8 weeks postrandomization, and 1-year following study entry) design was used. The study included 142 pregnant adolescents who were aged 14 to 19 years. Both self-reported smoking status collected on the Smoking History Questionnaire and saliva cotinine levels were used to identify smoking behaviors. Results: There were no significant differences among the three treatment groups at baseline in terms of the racial, distribution, age, gestational age, age of menses initiation, number in family household, number of family members who smoked, or tobacco use. A significant difference be tween the UC group and the TFS-B group (p = .010) was seen in smoking behaviors measured 8 weeks following treatment initiation. At 1 year following study entry, however, there were no differences between the groups in smoking behaviors. Discussion: The TFS-B intervention was more effective in attaining short-term smoking cessation in the pregnant adolescent than TFS or UC. Findings suggest that the peer-enhanced programming had a limited effect but could not sustain the participant beyond postpartum (1 year following study entry). Future studies should include relapse prevention to sustain smoking abstinence into the postpartum period.

Ames SC; Patten CA; Werch CE; Schroeder DR; Stevens SR; Fredrickson PA et al. Expressive writing as a smoking cessation treatment adjunct for young adult smokers. Nicotine & Tobacco Research 9(2): 185-194, 2007. (35 refs.)

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.

Apodaca TR; Abrantes AM; Strong DR; Ramsey SE; Brown RA. Readiness to change smoking behavior in adolescents with psychiatric disorders. Addictive Behaviors 32(6): 1119-1130, 2007. (45 refs.)

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers (N=191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

Ashare RL; Hawk LW; Cummings KM; O'Connor RJ; Fix BV; Schmidt WC. Smoking expectancies for flavored and non-flavored cigarettes among college students. Addictive Behaviors 32(6): 1252-1261, 2007. (20 refs.)

Several tobacco companies have introduced specially flavored cigarettes, yet little is known about their appeal among college student nonsmokers, regular smokers, and those susceptible to smoking. Undergraduates (N=424) rated 12 brands of cigarettes on multiple attributes based on manufacturer advertisements. This paper focused on two brands with flavored and non-flavored versions (Camel and Salem). Despite brand, regular smokers and those susceptible to smoking initiation had higher positive expectancies and lower negative expectancies about smoking than nonsmokers. Flavored cigarettes elicited higher positive expectancies than non-flavored counterparts across all groups, including nonsmokers. Indeed, the degree to which flavored Camels had higher positive expectancies than Camel Lights was at least as large in a group of susceptible nonsmokers and experimenters (susceptible/experimenters). Despite being present in nonsmokers and susceptible/experimenters, negative expectancies were significantly lower for flavored versus non-flavored brands. Logistic regressions revealed that positive expectancies predicted "intention to try" each brand for regular smokers and susceptible/ experimenters. These findings suggest that targeting the marketing of positive attributes may be useful in preventing smoking behavior.

Assanangkornchai S; Pattanasattayawong U; Samangsri N; Mukthong A. Substance use among high-school students in Southern Thailand: Trends over 3 years (2002-2004). Drug and Alcohol Dependence 86(2/3): 167-174, 2007. (28 refs.)

Purpose: To examine the trends of substance use and correlated variables in high-school students in Southern Thailand. Methods: Surveys of high-school years 7, 9 and I I and vocational school year 2 students in four provinces in Southern Thailand were conducted in 2002-2004 to examine lifetime substance use, use within 1 year and 30 days before the interview, using a self-completed questionnaire. Results: The prevalence of lifetime use of any illicit substance was 5-7% overall (about 7%, 9% and 13% in boys and 2%, 1 % and 3% in girls in 2002, 2003 and 2004, respectively). Krathom, a local addictive plant, and cannabis were the most commonly used illicit substances on a lifetime basis with prevalences of 2.3%, 2.8%, 4.9% (p < 0.01) and 2.6%, 2.3%, 3.4% (p > 0.05) in the surveyed years. The rates of alcohol consumption in the past 30 days were 19.3%, 17.3% and 15.2%(p > 0.05) while smoking rates were 14.6%, 8.8% and 10.8% (p < 0.05). The significant correlates of current illicit substance use were surveyed year, male, vocational school, school level, and school performance. Conclusion: The problem of substance abuse is increasing among Thai adolescents. School-based interventions seem desirable, especially in boys, vocational and public school students.

Bagot KS; Heishman SJ; Moolchan ET. Tobacco craving predicts lapse to smoking among adolescent smokers in cessation treatment. Nicotine & Tobacco Research 9(6): 647-652, 2007. (36 refs.)

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

Barnes GM; Hoffman JH; Welte JW; Farrell MP; Dintcheff BA. Adolescents' time use: Effects on substance use, delinquency and sexual activity. Journal of Youth and Adolescence 36(5): 697-710, 2007. (32 refs.)

Using an integration of social control theory and the routine activity perspective, adolescent time use was examined for effects on problem behaviors. We examined a wide variety of time use categories, including homework, extracurricular activities, sports time, alone time, paid work, housework, television watching, as well as indices of family time and peer time, for their effects on heavy alcohol use, cigarette smoking, illicit drug use, delinquency and sexual activity. The study employed a representative household sample of adolescents (n=606) and took into account important sociodemographic factors - gender, age, race (Black and White), and socioeconomic status. The most important predictors of adolescent problem behaviors were family time and peer time. Family time serves as a protective factor against all five problem behaviors while peer time is a highly significant risk factor for all five problem behaviors.

Bauermeister JA; Zimmerman MA; Barnett TE; Caldwell CH. Working in high school and adaptation in the transition to young adulthood among African American Youth. Journal of Youth and Adolescence 36(7): 877-890, 2007. (37 refs.)

Researchers have found mixed support for documenting whether work is protective or harmful during adolescence. This study examined the association between work and problem behaviors among African American youth (N = 592; 53% female; M = 14.8 years, SD = .60) followed from mid-adolescence to young adulthood over eight Waves (90% response rate over the first four Waves and a 68% response rate across all eight Waves). We explored three competing operationalizations of work: work history (never worked, worked), work intensity (no work, 20 h or less, and 21 h or over), and work trajectories (never worked, episodic work, stopped working, late starter, and consistent worker). Non-working youth reported higher marijuana use during young adulthood than their working counterparts. Nonworkers reported lower self-acceptance during young adulthood than those working greater number of hours per week. Differences in work trajectories for cigarette use, depression, and anxiety during adolescence imply that when and for how long youth work are also important factors to explore. Our findings lend tentative support to the work benefits perspective and suggest that the association between work and problem behaviors may depend on the work measure used. We discuss the implications of employing different work measures in adolescent research.

Berlin I; Gasior MJ; Moolchan ET. Sex-based and hormonal contraception effects on the metabolism of nicotine among adolescent tobacco-dependent smokers. Nicotine & Tobacco Research 9(4): 493-498, 2007. (28 refs.)

Variations in nicotine metabolism influence smoking patterns. Differences between sexes or related to sex hormones may affect nicotine metabolism. Because smoking initiation starts during adolescence, observations gathered from adolescent smokers might broaden our understanding of such sex-based differences. We tested the hypothesis that nicotine metabolism-as indexed primarily by the ratio of trans-3'-hydroxycotinine (3HC) to cotinine-is more rapid among adolescent girl smokers compared with boys and that regular use of hormonal contraceptives influences nicotine and cotinine metabolism. We also hypothesized that more rapid nicotine metabolism is associated with higher nicotine dependence as indexed by smoking frequency and morning urgency. Plasma samples of nicotine, cotinine, and 3HC concentrations were obtained from 120 adolescents (36 boys). Plasma nicotine and cotinine concentrations were similar in boys and girls. Median plasma 3HC concentrations were 44.45 ng/ml for girls versus 35.74 ng/ml for boys (p=.025), and median plasma 3HC-cotinine ratios were significantly higher in girls than in boys (0.317 vs. 0.253, p=.025). After stratifying girls into two groups based on use versus nonuse of hormonal contraception, plasma 3HC-cotinine ratios in girls using hormonal contraception (0.47) were substantially higher ( p<.0001) than in boys (0.25) and were significantly higher than in girls not using hormonal contraception (0.28). Controlling for cigarettes smoked per day, ethnicity, and age did not modify these results. Although plasma nicotine, cotinine, or 3HC concentrations were significantly lower in less dependent adolescent smokers, nicotine and cotinine metabolite ratios were similar. This study showed that hormonal contraception in adolescent girls may accelerate cotinine metabolism, an effect likely related to induction of cytochrome P450 2A6 and independent of ethnicity and cigarette consumption. Prospective controlled studies are needed to further evaluate the role of hormonal contraception in patterns of adolescent smoking and nicotine metabolism.

Bird Y; Moraros J; Olsen LK; Forster-Cox S; Staines-Orozco H; Buckingham RW. Smoking practices, risk perception of smoking, and environmental tobacco smoke exposure among 6th-grade students in Ciudad Juarez, Mexico. Nicotine & Tobacco Research 9(2): 195-203, 2007. (45 refs.)

This study assessed the smoking practices, risk perception of smoking, and environmental tobacco smoke (ETS) exposure among adolescents in Ciudad Juarez, Mexico. We used a cross-sectional method to examine the smoking practices, risk perception of smoking, and ETS exposure of 6th-grade students (N=506), aged 11-13 years, attending six randomly selected middle schools. Schools were classified by school setting (i.e., public vs. private) and socioeconomic status (SES; i.e., low, middle, or high). The results indicated that 6th-grade students attending a public, low-SES school setting in Ciudad Juarez not only exhibited significantly higher rates of ETS exposure at home and in public places (p <.01) but also were more likely to have tried smoking (p <.01) and to be current smokers (p <.01), and were less likely to support a ban on smoking in public places (p <.01), compared with students who attended a private school or a public, middle- or high-SES school setting. These results provide further evidence that public health interventions to prevent initiation of smoking and to assist in smoking cessation among adolescents and to reduce their ETS exposure at home and in public need to target all school-aged students, especially those attending school in a low-SES settings.

Botvin GJ; Griffin KW; Nichols TD. Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science 7(4): 403-408, 2006. (24 refs.)

Violence is an important public health problem among adolescents in the United States. Substance use and violence tend to co-occur among adolescents and appear to have similar etiologies. The present study examined the extent to which a comprehensive prevention approach targeting an array of individual-level risk and protective factors and previously found effective in preventing tobacco, alcohol, and illicit drug use is capable of decreasing violence and delinquency. Schools (N=41) were randomly assigned to intervention and control conditions. Participants in the 20 intervention schools received the Life Skills Training prevention program including material focusing on violence and the media, anger management, and conflict resolution skills. Survey data were collected from 4,858 sixth grade students prior to the intervention and three months later after the intervention. Findings showed significant reductions in violence and delinquency for intervention participants relative to controls. Stronger prevention effects were found for students who received at least half of the preventive intervention. These effects include less verbal and physical aggression, fighting, and delinquency. The results of this study indicate that a school-based prevention approach previously found to prevent tobacco, alcohol, and illicit drug use can also prevent violence and delinquency.

Cain JJ; Dickinson P; Fernald D; Bublitz C; Dickinson LM; West D. Family physicians and youth tobacco-free education: Outcomes of the Colorado Tar Wars Program. Journal of the American Board of Family Medicine 19(6): 579-589, 2006. (25 refs.)

Background: Tar Wars is a national school-based tobacco-free education program operated by the American Academy of Family Physicians. The Tar Wars lesson uses an interactive 45-min session taught by volunteer family physicians in 4th- and 5th-grade classrooms and focuses on the short-term image-based consequences of tobacco use. In this study, we evaluated the effectiveness of the Tar Wars program in Colorado with both quantitative and qualitative measures. Methods: Students participating in the quantitative evaluation were tested before and after a Tar Wars teaching session using a 14-question test covering the short-term and image-based consequences of tobacco use, cost of smoking, tobacco advertising, and social norms of tobacco use. Qualitative evaluation of the program included guided telephone interviews and focus groups with participating students, teachers, and presenters. Results: Quantitative evaluation showed statistically significant improvement in correct responses for the 14 questions measured with an average increase in correct responses from 8.95 to 10.23. Three areas recommended by the Centers for Disease Control (CDC) for youth tobacco prevention showed greater change in correct responses, including cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. Qualitative evaluation found that the overall message of the session was well received, that previously known tobacco information was reinforced by its presentation in a novel format, and that new information learned included cost of smoking, truth of tobacco advertising, and peer norms of tobacco use. Conclusions: The Tar Wars lesson plan is effective in increasing students' understanding about the short-term consequences of tobacco use, cost of tobacco use, truth of tobacco advertising, and peer norms. Tar Wars meets the CDC guidelines as one component of effective comprehensive youth tobacco prevention.

Centers for Disease Control and Prevention; Flint KH; Ross JG; Iachan R; Robb WH; Pederson LL; Jackson K. Tobacco use, access, and exposure to tobacco in media among middle and high school students: United States, 2004. MMWR. Morbidity and Mortality Weekly Report 54(12): 297-301, 2005. (10 refs.)

Two of the national health objectives for 2010 are to reduce the prevalence of any tobacco use during the preceding month to <21% and the prevalence of current cigarette use to <16% among high school students. The National Youth Tobacco Survey (NYTS), conducted by CDC in 2004, provided estimates of current use of tobacco products and selected indicators related to tobacco use, including youth exposure to tobacco-related media and access to cigarettes. This report summarizes data from the that report and describes changes in tobacco use and indicators related to tobacco use since 2002. In 2004, a total of 11.7% of middle school students reported current use of any tobacco product. Cigarettes (8.1%) were the most commonly used product, followed by cigars (5.2%), smokeless tobacco (2.9%), pipes (2.6%), bidis (2.3%), and kreteks (1.5%). During 2002--2004, no significant changes were observed among middle school students in use of any tobacco or cigarettes (in 2002, a total of 13.3% of middle school students reported current use of any tobacco product, and 9.8% reported current use of cigarettes), cigars, smokeless tobacco, bidis, or kreteks. During 2002 - 2004, middle school students reported decreases in pipe use, seeing actors using tobacco on television or in movies, and seeing advertisements for tobacco products on the Internet. Among high school students, no changes were observed in the use of tobacco or in access to tobacco products. In 2004, a total of 28.0% of high school students reported current use of any tobacco product. Cigarettes (22.3%) were the most commonly used product, followed by cigars (12.8%), smokeless tobacco (6.0%), pipes (3.1%), bidis (2.6%), and kreteks (2.3%).The lack of substantial decreases in the use of almost all tobacco products among middle and high school students underscores the need to fully implement evidence-based strategies (e.g., increasing the retail price of tobacco products, implementing smoking-prevention media campaigns, and decreasing minors' access as part of comprehensive tobacco-control programs) that are effective in preventing youth tobacco use

Public Domain

Centers for Disease Control and Prevention; Gfroerer J; Caraballo R. Racial/ethnic differences among youths in cigarette smoking and susceptibility to start smoking -- United States, 2002-2004. MMWR. Morbidity and Mortality Weekly Report 55(47): 1275-1277, 2006. (10 refs.)

To assess the prevalence of cigarette smoking among youths aged 12-17 years in six major racial/ethnic populations and nine Asian or Hispanic subpopulations in the United States, the Substance Abuse and Mental Health Services Administration and CDC analyzed self-reported data collected during 2002--2004 from the National Survey on Drug Use and Health (NSDUH). This report summarizes the results of that analysis. It was found that the estimated prevalence of cigarette smoking in this age group ranged from 23.1% for American Indians/Alaska Natives (AI/ANs) to 2.2% for Vietnamese. In that survey current cigarette smoking was assessed by asking respondents aged 12--17 years, "During the past 30 days, have you smoked part or all of a cigarette?" Youths who answered "yes" were classified as current smokers. Susceptibility to start smoking among self-reported nonsmokers was determined by the following two questions: 1) "If one of your best friends offered you a cigarette, would you smoke it?" and 2) "At any time during the next 12 months, do you think that you will smoke a cigarette?" Possible answers were "definitely not," "probably not," "probably yes," and "definitely yes." Those who answered "definitely not" to both questions were classified as nonsusceptible; those who answered with any other combination of responses were considered susceptible to start smoking. As noted, AI/ANs youth had the greatest cigarette smoking prevalence (23.1%), followed by non-Hispanic whites (14.9%), Hispanics (9.3%), non-Hispanic blacks (6.5%), and Asians (4.3%). A wide range in susceptibility to start smoking was observed among youths who had never smoked. Overall, 22.2% were susceptible to start smoking. Youths in the Mexican subpopulation were significantly more susceptible (28.8%) to start smoking than non-Hispanic white (20.8%), non-Hispanic black (23.0%), Cuban (16.4%), Asian Indian (15.4%), Chinese (15.3%), and Vietnamese (13.8%) youths. For all questions, there were no significant differences among an ethnic sub-groups, or by gender. Children and teens constitute the majority of all new smokers. In 2003, cigarette companies spent approximately $15.2 billion to promote their products, nearly triple their spending in 1996. Conversely, spending by state tobacco-control programs declined from $749.7 million in 2002 to $551.0 million in 2006, an amount still less than 3% of the $21.3 billion that the states received in 2005 from tobacco excise taxes and the 1998 Tobacco Master Settlement Agreement. The decline in spending on tobacco-control programs might have been a factor in slowing the progress made in reducing smoking among adolescents. Sustained, culturally appropriate interventions to prevent youths from starting to smoke or help them to quit might be effective in racial/ethnic populations and subpopulations with high prevalences of cigarette smoking. To aid these populations in developing programs, systematic reviews of the effectiveness of interventions to reduce or prevent tobacco use are offered by the Guide to Community Preventive Services at .

Public Domain

Centers for Disease Control; Marshall LT; Schooley M; Ryan H; Cox P; Easton A et al. Youth tobacco surveillance -- United States, 2001-2002. MMWR. Morbidity and Mortality Weekly Report 55(No. SS-3): 1-56, 2006. (26 refs.)

Problem/condition: Cigarette smoking is the leading preventable cause of death in the United States, accounting for approximately 440,000 deaths each year. The prevalence of cigarette smoking nationwide among high school students (grades 9-12) increased during the 1990s, peaking during 1996-1997, and then declined. Approximately 80% of tobacco users initiate use before age 18 years. An estimated 6.4 million children aged <18 years who are living today will die prematurely as adults because they began to smoke cigarettes during adolescence. the annual health-related economic cost associated with tobacco use exceeds $167 billion. Because of these health and economic consequences, CDC has recommended that sates establish and maintain comprehensive tobacco-control programs to reduce tobacco use among youth. Reporting period: This report covers data collected during January 2001-December 2002. Description of the System: The National Youth Tobacco Survey (NYTS) and state youth surveys (YTS) were developed to provide states with data to support the design, implementation, and evaluation of comprehensive tobacco-control programs. NYTS is representative of middle and high school students in the 50 states and the District of Columbia. During spring 2002, a total of 26,149 students in 246 schools completed NYTS questionnaires. Weighted data for the YTS were achieved by 13 states in 2001 and by 20 states in 2002. This report summarizes data from the 2002 and the 2001 YTS. Results and Interpretations: Findings from the 2002 NYTS indicate that current use of any tobacco product ranged from 13.3% among middle school students to 28.2% among high school students. Cigarette smoking was the most prevalent form of tobacco use, with 9.8% of middle school students and 22.5% of high school students reporting that they currently smoke cigarettes. Cigar smoking was the second most prevalent form of tobacco use, with 6.0% of middle school students and 11.6% of high school students reporting that they currently smoke cigars. Among current smokers, 41.8% of middle school students and 52% of high school students reported that they usually smoke Marlboro cigarettes. Black middle school and high school students who smoke were more likely to smoke Newport cigarettes than any other brand (58.3% and 66.8%, respectively.) Among middle school students aged <18 years, 75.9% were not asked to show proof of age when they bought or tried to buy cigarettes, and 63.4% were not refused purchase because of age. Among high school students aged <18 years, 58.5% were not asked to show proof of age when they bought or tried to buy cigarettes, and 60.6% were not refused purchase because of their age. Nearly half (49.6%) of middle school students and 62.1% of high school students who smoke reported a desire to stop smoking cigarettes, with 55.4% of middle school students and 53.1% of high school students reported having smoked cigarettes, 21.3% of middle school students and 22.9% of high school students were susceptible to initiating cigarette smoking in the next year. Exposure to second hand smoke was high. During the week before the survey 88.3% of middle school students and 91.4% of high school students who currently smoke cigarettes and 47.1% of middle schoolers and 53.3% of high schoolers who have never smoked cigarettes were in the same room with someone who was smoking cigarettes. Also, 81.7% of middle students and 83.7% of high schoolers who currently smoke and 31.5% of middle schoolers and 29.1% who have never smoked cigarettes rode in a car with someone who was smoking cigarettes. Also 71.5% of middle schoolers and 57.5% of high school students who currently smoke and 33.3% of middle school students and 29.9% of high school students who have never smoked live in a home in which someone else smokes cigarettes. Media and advertising influence was also noted, with 58.1% of middle students and 54.9% of high school students who currently use tobacco and 11.0% of middle school students and 13.7% of high school students who have never used tobacco report that they would wear or use an item with a tobacco company name or logo on it. Although 84.6% of middle school students and 91.2% of high school students had seen or heard antismoking commercials on television or radio, 89.9% of middle school students and 91.3% of high school students also had seen actors using tobacco on television or in the movies. Data is presented in 39 tables.

Public Domain

Chalela P; Velez LF; Ramirez AG. Social influences, and attitudes and beliefs associated with smoking among border Latino youth. Journal of School Health 77(4): 187-195, 2007. (45 refs.)

BACKGROUND: Adolescent smoking rates have declined among all ethnic groups since the late 1990s. However, despite the recent declines and intervention efforts, today smoking remains a serious problem among youth, with a quarter of adolescents being current smokers by the time they complete 12th grade. This problem is particularly prevalent among Latino youth, who have among the highest rates of lifetime and past-30-day use. The purpose of this study was to examine the association between psychosocial factors and the smoking behavior of Latino youth living along the Mexico-US border. METHODS: A convenient sample of 2471 middle and high school Latino students was surveyed in fall 2000. Logistic regression analysis was used to examine the association between study risk factors and youth smoking behavior. RESULTS: The strongest predictor of lifetime and past-30-day smoking was peer influence; however, the strength of the association was greater with recent use. There were also differences in the influence of family and attitudes and beliefs between the 2 groups. CONCLUSIONS: These differences need to be taken into consideration to guide development of tailored prevention and control interventions aimed at this specific group. These efforts should address social influences to smoke, particularly those from peers; promote changes in attitudes and beliefs toward smoking; increase understanding of the addictive nature of nicotine; and provide development of skills young people need to resist social and environmental pressures to smoke. Strict control and enforcement measures are needed to completely eliminate the sale of cigarettes to minors.

Curry SJ; Emery S; Sporer AK; Mermelstein R; Flay BR; Berbaum M et al. A national survey of tobacco cessation programs for youths. American Journal of Public Health 97(1): 171-177, 2007. (26 refs.)

Objectives. We collected data on a national sample of existing community-based tobacco cessation programs for youths to understand their prevalence and overall characteristics. Methods. We employed a 2-stage sampling design with US counties as the first-stage probability sampling units. We then used snowball sampling in selected counties to identify administrators of tobacco cessation programs for youths. We collected data on cessation programs when programs were identified. Results. We profiled 591 programs in 408 counties. Programs were more numerous in urban counties; fewer programs were found in low-income counties. State-level measures of smoking prevalence and tobacco control expenditures were not associated with program availability. Most programs were multisession, school-based group programs serving 50 or fewer youths per year. Program content included cognitive-behavioral components found in adult programs along with content specific to adolescence. The median annual budget was $2000. Few programs (9%) reported only mandatory enrollment, 35% reported mixed mandatory and voluntary enrollment, and 56% reported only voluntary enrollment. Conclusions. There is considerable homogeneity among community-based tobacco cessation programs for youths. Programs are least prevalent in the types of communities for which national data show increases in youths' smoking prevalence.

Dalton MA; Adachi-Mejia AM; Longacre MR; Titus-Ernstoff LT; Gibson JJ; Martin SK et al. Parental rules and monitoring of children's movie viewing associated with children's risk for smoking and drinking. Pediatrics 118(5): 1932-1942, 2006. (74 refs.)

OBJECTIVES. Evidence suggests that media portrayals of tobacco and alcohol use are important predictors of adolescent smoking and drinking. We examined the role of parents in monitoring and limiting children's movie exposure and whether or not this was associated with a lower risk of adolescent smoking and drinking. DESIGN. We surveyed 2606 child-parent dyads between 2002 and 2003. We asked children (9-12 years of age) how often their parents engaged in specific behaviors to monitor their movie viewing and if their parents allowed them to watch R-rated movies. We also surveyed children about parental monitoring of nonmedia-related behaviors. The primary outcomes were risk of smoking and drinking alcohol, defined by attitudinal susceptibility or early experimentation with either substance. RESULTS. Less than half (45.0%) the children were prohibited from watching R-rated movies. Of those who were allowed to watch R-rated movies, one third (34.7%) always viewed them with a parent and two thirds (65.3%) sometimes watched them without a parent. Less than 10% of the children reported that their parents consistently engaged in all 4 movie-monitoring behaviors. Even after controlling for parental monitoring of nonmedia-related behaviors and other covariates, children were at lower risk of smoking and drinking if their parents prohibited them from watching R-rated movies. Parental coviewing of R-rated movies was associated with a lower risk of child smoking but not drinking if parents consistently monitored what their children watched. CONCLUSIONS. Parental rules and monitoring of children's movie viewing may have a protective influence on children's risk for smoking and drinking, over and above parental monitoring of nonmedia related behaviors. This highlights a potential role for parents in preventing early initiation of tobacco and alcohol use among adolescents.

De Ven MOM; Van den Eijnden RJJM; Engels RCME. Smoking-specific cognitions and smoking behaviour among adolescents with asthma. Psychology & Health 21(6): 699-716, 2006. (45 refs.)

Several studies have shown that the prevalence of smoking among adolescents with asthma is similar or even higher than among non-asthmatic adolescents. To design effective interventions, the predictors of smoking among adolescents with asthma need to be identified. This is the first study investigating the theory of planned behaviour (TPB) among adolescents with asthma. An extended TPB model, also including risk perceptions and perceived prevalence of smoking, was tested in a national, cross-sectional sample of 713 adolescents with (self-reported) current asthma and 7140 non-asthmatic controls. No differences in the level of smoking-specific cognitions were found (except for perceived risk of lung affections). However, the effect of having pro-smoking cognitions (e.g. a positive attitude) on smoking was stronger for adolescents with asthma than for non-asthmatic adolescents. Therefore, smoking prevention programs based on the TPB, designed for changing cognitions, could be of extra importance for adolescents with asthma.

Dierker LC; Sledjeski EM; Botello-Harbaum M; Ramirez RR; Chavez LM; Canino G. Association between psychiatric disorders and smoking stages within a representative clinic sample of Puerto Rican adolescents. Comprehensive Psychiatry 48(3): 237-244, 2007. (61 refs.)

Objective: We examined the prevalence of smoking behaviors and their association with specific psychiatric disorders in a representative sample of youth from behavioral health clinics in Puerto Rico. Method: A complex sampling design was used to select the sample, and analyses were conducted to account for the unequal selection probability, stratification, and clustering. All analyses were weighted back to the clinical population from which they were drawn. Psychiatric and substance use disorders were assessed using the parent and youth versions of the Diagnostic Interview Schedule for Children, Version 4.0. Results: More than one third of the sample reported experience with cigarette smoking, and approximately one quarter reported smoking at least once per week (23.4%). As expected, the alcohol and drug use disorders demonstrated some of the strongest associations with individual smoking stages. These were the only disorders that remained significantly associated with nicotine dependence after controlling for comorbidity. Conclusions: Our findings confirm the need for screening of smoking behavior and nicotine dependence in treatment settings and the integration of psychiatric/substance use treatments with smoking cessation.

DiFranza JR; Savageau JA; Fletcher K; Pbert L; O'Loughlin J; McNeill AD et al. Susceptibility to nicotine dependence: The development and assessment of nicotine dependence in youth 2 study. Pediatrics 120(4): E974-e983, 2007. (93 refs.)

OBJECTIVES. The purpose of this work was to identify characteristics that predict progression from the first inhalation of a cigarette to dependence. We studied a cohort of 1246 public school 6th-graders in 6 Massachusetts communities (mean age at baseline: 12.2 years). METHODS. We conducted a 4-year prospective study using 11 interviews. We assessed 45 risk factors and measured diminished autonomy over tobacco with the Hooked on Nicotine Checklist and evaluated tobacco dependence according to the International Classification of Diseases, 10th Revision. Cox proportional-hazards models were used. RESULTS. Among 217 youths who had inhaled from a cigarette, the loss of autonomy over tobacco was predicted by feeling relaxed the first time inhaling from a cigarette and depressed mood. Tobacco dependence was predicted by feeling relaxed, familiarity with Joe Camel, novelty seeking, and depressed mood. CONCLUSIONS. Once exposure to nicotine had occurred, remarkably few risk factors for smoking consistently contributed to individual differences in susceptibility to the development of dependence or loss of autonomy. An experience of relaxation in response to the first dose of nicotine was the strongest predictor of both dependence and lost autonomy. This association was not explained by trait anxiety or any of the other measured psychosocial factors. These results are discussed in relation to the theory that the process of dependence is initiated by the first dose of nicotine.

DiFranza JR; Savageau JA; Fletcher K; O'Loughlin J; Pbert L; Ockene JK et al. Symptoms of tobacco dependence after brief intermittent use: The development and assessment of nicotine dependence in youth-2 study. Archives of Pediatrics & Adolescent Medicine 161(7): 704-710, 2007. (45 refs.)

Objective: To extend the findings of the first Development and Assessment of Nicotine Dependence in Youth study by using diagnostic criteria for tobacco dependence and a biochemical measure of nicotine intake. The first study found that symptoms of dependence commonly appeared soon after the onset of intermittent smoking. Design: A 4-year prospective study. Setting: Public schools in 6 Massachusetts communities. Participants: A cohort of 1246 sixth-grade students. Interventions: Eleven interviews. Main Outcome Measures: Loss of autonomy over tobacco as measured by the Hooked on Nicotine Checklist, and tobacco dependence as defined in International Classification of Diseases, 10th Revision (ICD-10). Results: Among the 217 inhalers, 127 lost autonomy over their tobacco use, 10% having done so within 2 days and 25% having done so within 30 days of first inhaling from a cigarette; half had lost autonomy by the time they were smoking 7 cigarettes per month. Among the 83 inhalers who developed ICD-10-defined dependence, half had done so by the time they were smoking 46 cigarettes per month. At the interview following the onset of ICD-10-defined dependence, the median salivary cotinine concentration of current smokers was 5.35 ng/mL, a level that falls well below the cutoff used to distinguish active from passive smokers. Conclusions: The most susceptible youths lose autonomy over tobacco within a day or 2 of first inhaling from a cigarette. The appearance of tobacco withdrawal symptoms and failed attempts at cessation can precede daily smoking; ICD-10-defined dependence can precede daily smoking and typically appears before consumption reaches 2 cigarettes per day.

Difranza JR; Wellman RJ. Early dating and smoking initiation: Some thoughts about a common cause. (editorial). Addiction 101(12): 1682-1683, 2006. (22 refs.)

DiRocco DN; Shadel WG. Gender differences in adolescents' responses to themes of relaxation in cigarette advertising: Relationship to intentions to smoke. Addictive Behaviors 32(2): 205-213, 2007. (32 refs.)

Studies have shown that increased exposure to cigarette advertising increases adolescents' risk of smoking and moreover, that gender may play an important role in moderating how cigarette advertisements are viewed and processed. However, information about the particular features of cigarette advertising that interact with gender to promote smoking among adolescents is scarce. The purpose of this study was to examine if gender moderates the degree to which the relaxation valence (i.e., degree to which relaxing themes are emphasized) of cigarette advertisements is related to smoking intentions in a sample of never smoking adolescents. Regardless of brand type (of the seven brands studied), cigarette advertisements that displayed highly relaxing images were associated with increased intentions to smoke among female adolescents only. These results have implications for understanding what features of cigarette advertisements have the most influence among different groups of adolescents.

Edwards C; Oakes W; Bull D. Out of the smokescreen II: will an advertisement targeting the tobacco industry affect young people's perception of smoking in movies and their intention to smoke? Tobacco Control 16(3): 177-181, 2007. (41 refs.)

Objective: To evaluate the effect of an antismoking advertisement on young people's perceptions of smoking in movies and their intention to smoke. Subjects/setting: 3091 cinema patrons aged 12-24 years in three Australian states; 18.6% of the sample (n = 575) were current smokers. Design/intervention: Quasi-experimental study of patrons, surveyed after having viewed a movie. The control group was surveyed in week 1, and the intervention group in weeks 2 and 3. Before seeing the movie in weeks 2 and 3, a 30 s antismoking advertisement was shown, shot in the style of a movie trailer that warned patrons not to be sucked in by the smoking in the movie they were about to see. Outcomes: Attitude of current smokers and non-smokers to smoking in the movies; intention of current smokers and non-smokers to smoke in 12 months. Results: Among non-smokers, 47.8% of the intervention subjects thought that the smoking in the viewed movie was not OK compared with 43.8% of the control subjects (p = 0.04). However, there was no significant difference among smokers in the intervention (16.5%) and control (14.5%) groups (p = 0.4). A higher percentage of smokers in the intervention group indicated that they were likely to be smoking in 12 months time (38.6%) than smokers in the control group (25.6%; p < 0.001). For non- smokers, there was no significant difference in smoking intentions between groups, with 1.2% of intervention subjects and 1.6% of controls saying that they would probably be smoking in 12 months time (p = 0.54). Conclusions: This real-world study suggests that placing an antismoking advertisement before movies containing smoking scenes can help to immunise non- smokers against the influences of film stars' smoking. Caution must be exercised in the type of advertisement screened as some types of advertising may reinforce smokers' intentions to smoke.

Epstein JA; Bang H; Botvin GJ. Which psychosocial factors moderate or directly affect substance use among inner-city adolescents? Addictive Behaviors 32(4): 700-713, 2007. (64 refs.)

Past etiology of adolescent substance use research concentrated on the main effects of various risk factors. The purpose of this study was to also longitudinally predict interactions on poly-drug use intensity and future smoking among inner-city adolescents. A panel sample of baseline, 1-year and 2-year follow-ups (N= 1459) from the control group of a longitudinal smoking prevention trial participated. We focused on the main effects, as well as, interaction effects between psychosocial protective factors and various risk factors, including perceived norms of friends, peers and adults to use drugs. Significant effects were identified for intensity of poly-drug use and future smoking. The analysis of the poly-drug use outcome indicated that refusal assertiveness undermined perceived friends' drug use and siblings' smoking, and that low risk-taking undermined perceived friends' drug use. There was a main effect for low psychological wellness. The significant interactions between perceived friends' drug use with refusal assertiveness and decision-making skills were observed for future smoking. Moreover, perceived peer smoking norms, siblings' smoking, and high risk-taking also showed significant main effects for increasing future smoking.

Ertas N. Factors associated with stages of cigarette smoking among Turkish youth. European Journal of Public Health 17(2): 155-161, 2007. (44 refs.)

Background: This study examines prevalence and determinants of cigarette smoking among Turkish youth and transition among smoking stages. Methods: Cross-sectional data from the Global Youth Tobacco Survey (GYTS) obtained from 15 197 youth were used to study factors associated with various stages of cigarette smoking among Turkish youth. Results: Males and high-school students have higher odds of being susceptible to smoking compared with other non-smokers and higher odds of becoming established smokers. Exposure to parent, teacher, and peer smoking, anti-tobacco curricula, cigarette promotions, and perceived ease of access to cigarettes are all significant predictors of being susceptible to smoking and established smoking. Turkish youth who attribute positive traits to smokers are more likely to be susceptible to smoking and to become established smokers. Parental advice and media exposure to anti-tobacco messages were not significantly associated with becoming an established smoker. Conclusion: The results reveal the importance of early prevention programmes, which should begin before high school, and targeting efforts towards male students and all students who are not yet smokers but susceptible to smoking. Findings also suggest that prevention policies that challenge the cultural perceptions of smokers among Turkish youth are needed.

Everson ES; Daley AJ; Ussher M. Brief report: The theory of planned behaviour applied to physical activity in young people who smoke. Journal of Adolescence 30(2): 347-351, 2007. (10 refs.)

It has been hypothesised that physical activity may be useful as a smoking cessation intervention for young adults. In order to inform such interventions, this study evaluated the theory of planned behaviour (TPB) for understanding physical activity behaviour in young smokers. Regular smokers aged 16-19 years (N = 124), self-reported physical activity and all TPB components. Physical activity behaviour was significantly explained by both intention and perceived behavioural control (PBC), with both intention and PBC making significant contributions to the model. Intention was significantly explained by attitude, subjective norm (SN) and PBC, with attitude, SN and PBC all making significant contributions to the model. The TPB may be a useful framework for guiding physical activity interventions among young smokers.

Falkin GP; Fryer CS; Mahadeo M. Smoking cessation and stress among teenagers. Qualitative Health Research 17(6): 812-823, 2007. (26 refs.)

The authors describe the experience of quitting smoking, focusing on the obstacles youth struggle with, based on individual interviews and focus groups with 54 teenagers in New York City. A major obstacle was the belief that people should stop smoking forever. The youth had to cope with temptation, frequent and often intense urges or cravings for cigarettes, and lack of social support from their family and friends. The young participants not only had to cope with general life stresses without being able to use cigarettes to reduce tensions but also had to contend with new stressful situations, such as friends who put them down for not smoking. In addition, the teens had to give up things that were important to them, such as friendships, during their quit attempts. The study describes how quitting can be a much more stressful experience for youth than research typically acknowledges. The authors discuss public health implications.

Fidler JA; West R; Van Jaarsveld CHM; Jarvis MJ; Wardle J. Does smoking in adolescence affect body mass index, waist or height? Findings from a longitudinal study. Addiction 102(9): 1493-1501, 2007. (30 refs.)

Aim: To assess the effect of smoking uptake on body mass index (BMI), waist circumference and height during adolescence. Design:a Five-year longitudinal study. Setting Thirty-six schools in South London, England, selected by a stratified random sampling procedure designed to ensure ethnic and socio-economic diversity. Participants A total of 5863 students took part in the HABITS (Health and Behaviour in Teenagers) Study between 1999 and 2003. Measurements Self-reported smoking behaviour, saliva cotinine concentrations and measured weight, waist circumference and height were obtained, along with information on gender, ethnicity, socio-economic deprivation, pubertal status, self-reported exercise and dieting. Students were examined annually from school year 7 (ages 11-12) to year 11 (ages 15-16), with response rates ranging from 74 to 84%. A total of 2665 never smokers at year 7 with complete data for years 7 and 11 were included in the analyses. Findings: Adjusting for year 7 BMI and other potential confounders, regular smokers (more than six cigarettes a week) at year 11 had significantly lower BMI (P = 0.002) than other students. Smokers defined by a cotinine above 15 ng/ml also had lower BMI (P < 0.0001). Waist circumferences were lower in regular smokers (P = 0.014) and cotinine-defined smokers (P < 0.011). No consistent association was found between smoking and height. The adjusted difference in weight between regular smokers and other students amounted to 1.8 kg (95% CI, 0.52-3.17) for an average-height student. Conclusion: Taking up regular smoking during adolescence may result in a lower BMI, but the effect is small and of uncertain significance.

Foshee VA; Ennett ST; Bauman KE; Granger DA; Benefield T; Suchindran C et al. A test of biosocial models of adolescent cigarette and alcohol involvement. Journal of Early Adolescence 27(1): 4-39, 2007. (95 refs.)

The authors test biosocial models that posit interactions between biological variables (testosterone, estradiol, pubertal status, and pubertal timing) and social context variables (family, peer, school, and neighborhood) in predicting adolescent involvement with cigarettes and alcohol in a sample of 409 adolescents in Grades 6 and 8. Models including the biological and contextual variables and their interactions explain significantly more variance in adolescent cigarette and alcohol involvement than do models including only the main effects of the biological and contextual variables. Post hoc analyses of significant interactions suggest that, in most cases, moderation occurred in the hypothesized direction. Consistent with dual hazards models of adolescent antisocial behaviors, the relationships between the biological and substance use variables become positive and stronger as the context becomes more harmful. Considerations of adolescent substance use should recognize the possible role of biological variables and how their influence may vary by social context.

Foster SE; Jones DJ; Olson AL; Forehand R; Gaffney CA; Zens MS et al. Family socialization of adolescent's self-reported cigarette use: The role of parents' history of regular smoking and parenting style. Journal of Pediatric Psychology 32(4): 481-493, 2007. (48 refs.)

Objective: To examine the main and interactive effects of parental history of regular cigarette smoking and parenting style on adolescent self-reported cigarette use. Methods Predictors of adolescent self-reported cigarette use, including parents' history of regular cigarette smoking and two dimensions of parenting behavior, were analyzed in a sample of 934 predominately Caucasian (96.3%) parent-adolescent dyads. Families were drawn from the control group of a randomized control trial aimed at preventing adolescent substance use. Results In addition to the main effects of parents' history of regular smoking and parental warmth, logistic regression analysis revealed that the interaction of these two variables was associated with adolescent self-reported cigarette use. Parental warmth was associated with a decreased likelihood of the adolescent ever having smoked a cigarette; however, this was true only if neither parent had a history of regular cigarette smoking. Conclusions: Findings suggest that adolescent smoking prevention programs may be more efficacious if they address both parental history of regular smoking and parenting behavior.

Francis K; Katsani G; Sotiropoulou X; Roussos A; Roussos C. Cigarette smoking among Greek adolescents: Behavior, attitudes, risk, and preventive factors. Substance Use & Misuse 42(8): 1323-1336, 2007. (48 refs.)

This study was produced in the context of the first author's thesis at Athens University and was a collaboration between the Department of Clinical Care Medicine, Athens University, and Attiki Child Psychiatric Hospital. It was supported by a project grant from the THORAX Foundation, Greece. Objective: To study the smoking behavior, attitudes, and beliefs of Greek adolescents, as well as the risk and preventive factors for the onset of smoking and to obtain data to serve in the planning of comprehensive antismoking campaigns tailored to the Greek adolescent's specific profile. Sample and Method: A stratified, nationwide, representative, school-based sample of 3827 Greek adolescents was surveyed during the academic year 2001-2002, using a questionnaire on smoking and Achenbach's Youth Self-Report. Results: Cigarette smoking is a serious problem among Greek youth. Family and peers play a primary role in shaping smoking attitudes and habits. Adolescents who smoke regularly have increased rates of psychopathology as indicated by higher scores on the Externalising and Attention Problem scales of Achenbach's Youth Self-Report, compared to adolescents who are non-smokers. The data obtained can indeed guide smoking prevention strategies in Greece.

Galduroz JCF; Fonseca AM; Noto AR; Carlini EA. Decrease in tobacco use among Brazilian students: A possible consequence of the ban on cigarette advertising? Addictive Behaviors 32(6): 1309-1313, 2007. (11 refs.)

In 2000, cigarette advertising was banned from the Brazilian media [LEI N degrees 10.167, de 27 de dezembro de dezembro. (2000). http: www.planalto.gov.br/ccivil_03/Leis/L10167.htm]. Nevertheless, not enough surveys have been carried out to measure the impact of the prohibition. The objective of the present survey was to compare the use of tobacco by primary and secondary school students in 1997 and 2004, that is, before and after the ban on tobacco advertising in Brazil. Two surveys were conducted (in 1997 and 2004) using the same methodology, with a target population of primary (from the fifth grade on) and secondary public schools in ten different Brazilian capitals. The sampling was done by conglomerates, stratified, and obtained in two stages. In total, 15,501 students were surveyed in 1997, and 21,712 in 2004. The questionnaire was adapted from an instrument developed by WHO, anonymous, self-administered, and applied collectively in the classroom. In a comparison of the two surveys (1997 and 2004) tobacco lifetime use (used any psychotropic drug at least once in their life) decreased significantly in seven out of ten capitals surveyed. The 11-12 year old age group experienced the largest decrease in tobacco lifetime use. There was a decrease in lifetime use for males in nine capitals, and in eight capitals for females. A decrease was also observed in heavy tobacco use also in eight capitals. In conclusion there was a significant decrease in tobacco consumption among the surveyed students, suggesting that the decrease is related to changes in public policy in Brazil over the surveyed period.

Gamlin J; Romo PD; Hesketh T. Exposure of young children working on Mexican tobacco plantations to organophosphorous and carbamic pesticides, indicated by cholinesterase depression. Child Care Health and Development 33(3): 246-248, 2007. (8 refs.)

Background: Organophosphorous (OP) and carbamic pesticides are used in large quantities on tobacco plantations in Nayarit State, Mexico, where up to 3000 children and their families work. OP and carbamic pesticides are easily inhaled or absorbed through the skin and children may be particularly vulnerable to pesticides because of their smaller body mass, their height leaves.and more regular hand- mouth contact. The aim of this study is to assess the effect of pesticide exposure on acetylcholinesterase levels of very young migrant Mexican tobacco workers and younger siblings. Methods: Blood samples were collected from 160 children aged 0-14 years during harvest (exposure) and from 62 children in their home communities 6-9 months after harvest (baseline). Samples were tested for cholinesterase corrected for haemoglobin and ambient temperature. Results: Fifteen per cent of children had depression scores ranging from 40% to 190% of their baseline levels. Thirty-three per cent of children had depression scores of at least 15% and 86% of children were anaemic. Conclusion: These results suggest that very young children are exposed to potentially harmful and toxic amounts of pesticides while working. Further research is needed to assess the actual acute and chronic health impacts of such exposures.

Gilliland FD; Islam T; Berhane K; Gauderman WJ; McConnell R; Avol E et al. Regular smoking and asthma incidence in adolescents. American Journal of Respiratory and Critical Care Medicine 174(10): 1092-1100, 2006. (47 refs.)

Rationale: Although involuntary exposure to maternal smoking during the in utero period and to secondhand smoke are associated with occurrence of childhood asthma, few studies have investigated the role of active cigarette smoking on asthma onset during adolescence. Objectives: To determine whether regular smoking is associated with the new onset of asthma during adolescence. Methods: We conducted a prospective cohort study among 2,609 children with no lifetime history of asthma or wheezing who were recruited from fourth- and seventh-grade classrooms and followed annually in schools in 12 southern California communities. Regular smoking was defined as smoking at least seven cigarettes per day on average over the week before and 300 cigarettes in the year before each annual interview. Incident asthma was defined using new cases of physician-diagnosed asthma. Measurements and Main Results: Regular smoking was associated with increased risk of new-onset asthma. Children who reported smoking 300 or more cigarettes per year had a relative risk (RR) of 3.9 (95% confidence interval [95% Cl], 1.7-8.5) for new-onset asthma compared with nonsmokers. The increased risk from regular smoking was greater in nonallergic than in allergic children. Regular smokers who were exposed to maternal smoking during gestation had the largest risk from active smoking (RR, 8.8; 95% Cl, 3.2-24.0). Conclusions: Regular smoking increased risk for asthma among adolescents, especially for nonallergic adolescents and those exposed to maternal smoking during the in utero period.

Grucza RA; Bierut LJ. Cigarette smoking and the risk for alcohol use disorders among adolescent drinkers. Alcoholism: Clinical and Experimental Research 30(12): 2046-2054, 2006. (44 refs.)

Background: Cigarette smoking and alcohol use disorders (AUDs) are closely linked, but it is not clear whether higher rates of AUD among smokers are solely attributable to heavier drinking or, alternatively, whether smokers are more vulnerable to alcohol abuse and dependence than nonsmokers who drink comparable quantities. We sought to address this issue using data from a nationally representative U.S. sample of adolescents and young adults. Specifically, we analyzed the relationship between cigarette smoking, drinking, and AUDs. Methods: Data were from the aggregated 2002 through 2004 U.S. National Survey on Drug Use and Health. Participants were randomly selected, household-dwelling adolescents and young adults (ages 12-20) from the noninstitutionalized, civilian population of the United States (N=74,836). Measurements included current DSM-IV alcohol abuse or dependence, number of drinks in the past 30 days, and past-year cigarette smoking, defined as having smoked more than 100 cigarettes across the lifetime and having smoked during the past year. Results: Past-year smokers (prevalence=16.0%) drank in higher quantities than never-smokers, but were also at elevated risk for AUD when compared with never-smokers who drank equivalent quantities. The effect was observed across age groups, but was more prominent among younger adolescents. After adjusting for drinking quantity and sociodemographic variables, smokers had 4.5-fold higher odds of AUD than never-smokers [95% confidence interval (95% CI), 3.1-6.6]. Youths who reported smoking but did not cross the 100-cigarette threshold were at intermediate risk [odds ratio (OR), 2.3; 95% CI, 1.7-3.3]. Differences in AUD between smokers and never-smokers were most pronounced at lower levels of drinking. Conclusions: The results are consistent with a higher vulnerability to AUDs among smokers, compared with nonsmokers who drink equivalent quantities.

Guo Q; Johnson CA; Unger JB; Lee L; Xie B; Chou CP et al. Utility of the theory of reasoned action and theory of planned behavior for predicting Chinese adolescent smoking. Addictive Behaviors 32(5): 1066-1081, 2007. (36 refs.)

One third of smokers worldwide live in China. Identifying predictors of smoking is important for prevention program development. This study explored whether the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) predict adolescent smoking in China. Data were obtained from 14,434 middle and high school students (48.6% boys, 51.4% girls) in seven geographically varied cities in China. Theory of Reasoned Action and Theory of Planned Behavior were tested by multilevel mediation modeling, and compared by multilevel analyses and likelihood ratio tests. Perceived behavioral control was tested as a main effect in Theory of Planned Behavior and a moderation effect in Theory of Reasoned Action. The mediation effects of smoking intention were supported in both models (p < 0.001). TPB accounted for significantly more variance than Theory of Reasoned Action (p < 0.001). Perceived behavioral control significantly interacted with attitudes and social norms in Theory of Reasoned Action (p < 0.001). Therefore, Theory of Reasoned Action and Theory of Planned Behavior are applicable to China to predict adolescent smoking. Theory of Planned Behavior is superior to Theory of Reasoned Action for the prediction and Theory of Reasoned Action can better predict smoking among students with lower than higher perceived behavioral control.

Haberstick BC; Timberlake D; Ehringer MA; Lessem JM; Hopfer CJ; Smolen A et al. Genes, time to first cigarette and nicotine dependence in a general population sample of young adults. Addiction 102(4): 655-665, 2007. (45 refs.)

Aim: To examine variation in nicotine dependence scores and covariation between different dependence symptoms. Design: A 12-year, nationally representative, probability-based survey of adolescent health-related behaviors and their outcomes during young adulthood in the United States. The genetic contribution to nicotine dependence was evaluated in the sibling-pairs sample of the US National Longitudinal Study of Adolescent Health. Measurements Nicotine dependence (ND) was assessed using the Fagerstrom Test for Nicotine Dependence (FTND) and Heaviness of Smoking Index (HSI) in 1154 young adults, between the ages of 18 and 25 years, who were from twin, full sibling and half-sibling pairs. Findings: Dependence in this sample was common and varied in degree. Total HSI scores evidenced moderate to large heritable contributions (61%, 95% confidence interval (CI): 0.46-0.72), as did the quantity of cigarettes smoked (52%, 95% CI: 0.39-0.63) and urgency to smoke (55%, 95% CI: 0.38-0.68). Multivariate modeling identified a highly heritable underlying factor (76%, 95% CI: 0.56-0.91) that influenced the covariation of dependence symptoms and loaded most heavily on how soon after waking a smoker uses his or her first cigarette. The quantity of cigarettes smoked per day also evidenced residual genetic influences that were not common to other dependence-related behaviors. Conclusions: In this sample of young adults from the general population, both genes and individual-specific environments are important etiological factors in ND. The urgency to smoke, as measured by the time to first cigarette, may be the most informative measure on the FTND for genetic studies of nicotine dependence.

Ham OK. Stages and processes of smoking cessation among adolescents. Western Journal of Nursing Research 29(3): 301-315, 2007. (30 refs.)

The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 mate students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.

Ham OK; Lee YJ. Use of the transtheoretical model to predict stages of smoking cessation in Korean adolescents. Journal of School Health 77(6): 319-326, 2007. (34 refs.)

Background: Smoking is popular among Korean male high school adolescents, with the prevalence of 20.7% differing markedly with the type of school, being 16.3% and 27.6% in academic and vocational technical high schools, respectively. The purpose of this study was to identify significant variables that predict stages of smoking cessation among Korean high school students using the transtheoretical model (TTM), in order to provide an empirical basis for developing smoking cessation programs. Methods: Cross-sectional data were collected in April and May 2004 from 300 male students at 3 vocational technical high schools in Korean metropolitan areas. The survey variables comprised decisional balance, self-efficacy, stages and processes of change, nicotine dependence, and use of smoking cessation aids. Results: Current and former smokers comprised 26.3% and 22.7% of the cohort, respectively, of which 71.4% had experienced smoking cessation at least once and 55.1% utilized smoking cessation aids to help stop smoking. Nicotine-free tobacco and nicotine gum were the most common smoking cessation aids. Decisional balance, use of behavioral processes, and higher self-efficacy were significant in explaining stages of smoking cessation after controlling for nicotine dependence. Conclusions: The study results suggest that smoking cessation programs developed based on the TTM may help adolescents to progress through stages, with it being important to include information regarding the use of smoking cessation aids.

Hanewinkel R; Sargent JD. Exposure to smoking in popular contemporary movies and youth smoking in Germany. American Journal of Preventive Medicine 32(6): 466-473, 2007. (34 refs.)

Background: Studies have linked exposure to movie smoking and smoking initiation among adolescents in the United States, but there has been only one published study of adolescents outside the U.S. Method: A cross-sectional survey of 5586 schoolchildren aged 10-17 with a mean of 12.8 (SD = 1.2) years from randomly selected secondary schools in Schleswig-Holstein, Germany, was taken in October/November 2005. In August 2006, using previously validated methods, exposure to movie smoking was estimated from 398 internationally distributed films (98% produced and distributed by U.S. studios) released in Germany and examined its relationship with ever and current (30-day) smoking. Results: Overall, 40.7% of the sample had tried smoking, and 12.3% were current smokers. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of smoking initiation: 0.17 of adolescents in Q1 had tried smoking; 0.35 in Q2; 0.47 in Q3; and 0.64 in Q4. Movie smoking exposure was significantly associated with the prevalence of current smoking: 0.03 for adolescents in Q1; 0.08 in Q2; 0.14 in Q3; and 0.25 in Q4. After controlling for sociodemographics, parent/friend/sibling smoking, school performance, personality characteristics, TV consumption, receptivity to tobacco marketing, and parenting style, the adjusted odds ratios for having tried smoking were 1.7 (95% confidence interval [CI] = 1.4-2.1) for Q2, 1.8 (95% CI = 1.5-2.3) for Q3, and 2.2 (95% CI = 1.8-2.8) for Q4 compared with adolescents in Q1. The adjusted odds ratios for current smoking were 1.4 (95% CI = 0.9-2.2) for Q2, 1.7 (95% CI = 1.1-2.6) for Q3, and 2.0 (95% CI = 1.3-3.1) for Q4 compared with adolescents in Q1. Conclusions: Smoking in internationally distributed movies is associated with ever and current smoking among German adolescents. This suggests the need for prospective studies of this association in countries other than the U.S. and research into the potential impact of countrywide policies that would limit exposure of young adolescents to movie smoking.

Harakeh Z; Engels RCME; Vermulst AA; De Vries H; Scholte RHJ. The influence of best friends and siblings on adolescent smoking: A longitudinal study. Psychology & Health 22(3): 269-289, 2007. (74 refs.)

The present study investigated whether best friend and/or siblings' smoking affected adolescent smoking. Data of the Dutch Family and Health study was used in which 428 families participated with two adolescent children between the age of 13 and 17 years. Our findings showed that adolescents with older siblings who smoked were more likely to smoke one year later. In contrast, older adolescents were not affected by smoking of their younger siblings. Smoking of the best friend influenced smoking of the younger sibling. With regard to the specific transition from never smoking to smoking initiation, older and younger siblings with a smoking best friend were more likely to start smoking one year later. Younger siblings with older siblings who smoked were more likely to initiate smoking one year later. The influence of friends and siblings on adolescent smoking appeared to be small to moderate.

Hayes ER; Plowfield LA. Smoking too young: Students' decisions about tobacco use. American Journal of Maternal-Child Nursing 32(2): 112-116, 2007. (24 refs.)

Purpose: To describe college students' decisions related to tobacco use. Study Design and Methods: A sample of 49 smokers and 51 nonsmokers were asked about the smoking continuum of starting smoking, continuing to smoke, and tobacco cessation. An investigator-developed questionnaire was used to determine tobacco use and whether prevention and cessation messages were perceived as effective. Data were analyzed using descriptive statistics and qualitative descriptive analysis. Results: Peer pressure was the greatest influencing factor for beginning to smoke, and health was the major reason for not beginning to smoke. Addiction and stress maintained smoking. Both smokers and nonsmokers identified cessation strategies. Clinical Implications: Every interaction with youth is another opportunity to assess smoking status. Recommendations from teens for cessation programs identified in this study may be more attractive to teens and young adults than the current standards related to strategies for adults.

Hedman L; Bjerg-Backlund A; Perzanowski M; Sundberg S; Ronmark E. Factors related to tobacco use among teenagers. Respiratory Medicine 101(3): 496-502, 2007. (36 refs.)

Aim: To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program. Methods: From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years. Results: Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0-9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2-3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2-0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation. Conclusion: The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.

Jackson C; Brown JD; L'Engle KL. R-rated movies, bedroom televisions, and initiation of smoking by white and black adolescents. Archives of Pediatrics & Adolescent Medicine 161(3): 260-268, 2007. (45 refs.)

Objective: To test movie exposure and television use as predictors of smoking initiation among white and black adolescents who had never smoked cigarettes. Design: Survey research using audio computerassisted self-interviews at baseline and at 2- year followup ( 2002- 2004). Setting: Participants' homes located in central North Carolina. Participants: A sample of 735 12- to 14- year- old adolescents drawn from 14 public middle schools. Main Exposure: Frequency of exposure to movies rated R, PG- 13, PG, or G; frequency, location, and parental oversight of television viewing. Main Outcome Measure: Initiation of smoking, indicated by the first occasion of puffing on a cigarette. Results: Among white adolescents, high relative exposure to R- rated movies predicted a significantly greater likelihood of smoking initiation at follow- up, and private access to television during early adolescence, indicated by having a bedroom television, was also a significant independent predictor of smoking initiation at follow- up. No significant associations were observed between any movie- exposure or television- use variables and likelihood of smoking among black adolescents. Conclusions: Indicators of risky media use were associated with a significantly greater likelihood of smoking for white but not for black adolescents. These results diverge strongly from past results, which have indicated that all adolescents, regardless of race or place of residence, have a higher risk of smoking initiation as their exposure to movie smoking increases. Research is needed to identify the antecedents of risky media use and to understand how audience attributes, including race and other factors, moderate the effects of risky media use on health related behaviors.

Jacobsen LK; Mencl WE; Constable RT; Westerveld M; Pugh KR. Impact of smoking abstinence on working memory neurocircuitry in adolescent daily tobacco smokers. Psychopharmacology 193(4): 557-566, 2007. (51 refs.)

Rationale: Efficient function of neurocircuitry that supports working memory occurs within a narrow range of dopamine neurotransmission. Work in rodents has shown that exposure to nicotine during adolescence leads to nicotine withdrawal emergent alterations in cortical and subcortical dopamine neurotransmission. Objectives: To test for evidence that the efficiency of neurocircuitry supporting working memory is altered during acute smoking abstinence in adolescent daily tobacco smokers. Materials and methods Fifty-five adolescent daily tobacco smokers were compared with 38 nonsmokers using functional magnetic resonance imaging while subjects performed a verbal working memory task. Smokers were studied during smoking and after 24 h of abstinence from tobacco use. Results: Performance of a task with high working memory load in the context of smoking abstinence was associated with greater activation of components of the verbal working memory neurocircuit, including left ventrolateral prefrontal cortex and left inferior parietal lobe, among smokers relative to nonsmokers. During smoking abstinence, smokers failed to exhibit increases in functional connectivity between components of the working memory neurocircuit with increasing working memory load observed in nonsmoking adolescents and in prior studies of adults. Conclusions: Smoking abstinence in adolescent smokers is associated with reductions in the efficiency of working memory neurocircuitry and alterations in the functional coordination between components of the working memory neurocircuit. These alterations may stem from effects of nicotine exposure on catecholaminergic systems during adolescent development.

Jacobsen LK; Pugh KR; Constable RT; Westerveld M; Mencl WE. Functional correlates of verbal memory deficits emerging during nicotine withdrawal in abstinent adolescent cannabis users. Biological Psychiatry 61(1): 31-40, 2007. (97 refs.)

Background: Cannabis remains the most widely used illicit substance by adolescents and is typically consumed by this population in the context of ongoing tobacco use. Human studies have shown that both cannabis and tobacco exert effects on cognitive function; however, little is known about possible interacting effects of these drugs on brain function and cognition during adolescent development. Methods: Verbal learning and memory were assessed in 20 adolescent users of tobacco and cannabis and 25 adolescent tobacco users with minimal history of cannabis use. Functional magnetic resonance imaging was used to examine brain function and functional connectivity while a subset of these subjects performed a verbal working memory task. Results: Delayed recall of verbal stimuli deteriorated during nicotine withdrawal among cannabis users but not among comparison subjects. During high verbal working memory load, nicotine withdrawal selectively increased task-related activation of posterior cortical regions and was associated with disruption of frontoparietal connectivity in adolescent cannabis users relative to comparison subjects. Conclusions: These observations suggest that cannabis use during adolescent development may disrupt neurocircuitry supporting verbal memory formation and that deficits associated with disruption of these neurocircuits are unmasked during nicotine withdrawal.

Jaszyna-Gasior M; Schroeder JR; Moolchan ET. Alcohol use and tobacco abstinence among adolescents in cessation treatment: Preliminary findings. Addictive Behaviors 32(3): 617-621, 2007. (11 refs.)

Although adult alcohol use is negatively associated with tobacco cessation, this relationship has not been reported for adolescents. We assessed the relationship between alcohol use and point prevalence abstinence from smoking in a sample of tobacco-dependent adolescents undergoing cessation treatment. Alcohol use both at baseline and) during tobacco cessation treatment was examined as predicting smoking abstinence in 101 adolescents (age = 15.1 years, S. D. = 1.31 years; age at first cigarette = 11.3 years, S.D. = 1.93 years; age at first drink = 12.01 years, S.D. = 2.87 years) attending a total of 642 treatment visits. Mixed regression analysis showed that participants who reported alcohol use during tobacco cessation treatment were significantly less likely to abstain from tobacco smoking (OR = 0.42, 95% CI=0.23-0.78, t=-2.78, df=540, p=0.0057). However, pre-enrollment alcohol use was not significantly associated with either short- or long-term tobacco abstinence. If confirmed in a larger group of adolescents, our findings suggest that youths attempting to quit smoking should abstain from alcohol.

Johnson CA; Cen S; Gallaher P; Palmer PH; Xiao L; Ritt-Olson A et al. Why smoking prevention programs sometimes fail. Does effectiveness depend on sociocultural context and individual characteristics? Cancer Epidemiology, Biomarkers & Prevention 16(6): 1043-1049, 2007. (58 refs.)

Background: School-based smoking prevention programs sometimes fail in unexpected ways. This study tests the hypotheses that both social/cultural contexts and individual dispositional characteristics may interact with program content to produce effects that are variable in potentially predictable ways. Methods: Students in 24 culturally heterogeneous or primarily Hispanic/Latino middle schools (N = 3,157 6th graders) received a multicultural collectivist-framed social influences (SI) program, an individualist-framed SI program, or a control condition. Three-way linear and nonlinear interactions, program frame x social context x dispositional phenotype, were tested. Results: Three-way interactions were found for the dispositional phenotypes of depression and hostility with social context and program content/frame. In predominantly Hispanic/Latino schools, larger program effects were observed for high depressed and high hostile youth in both the collectivist and individualist framed programs. In culturally mixed schools, prevention effects were greatest for low depressed and low hostile youth, especially in the individualist framed program. In culturally mixed schools, there may have been a negative treatment effect for both programs among adolescents scoring high on depression and hostility. Discussion: Prevention program effects can vary by combination of program content, social setting, and individual dispositional characteristics. The results suggest that prevention program design and implementation should be sensitive to population characteristics at both the individual and sociocultural levels.

Johnson CA; Palmer PH; Chou CP; Pang ZC; Zhou DJ; Dong LJ et al. Tobacco use among youth and adults in mainland China: The China Seven Cities Study. Public Health 120(12): 1156-1169, 2006. (32 refs.)

Objective: The China Seven Cities Study (CSCS) monitors geographic and temporal trends in tobacco use among adolescents and adults in seven cities throughout Mainland China: Harbin, Shenyang, Wuhan, Chengdu, Kunming, Hangzhou, and Qingdao. This article presents the methodology and prevalence data from the baseline survey of the CSCS, conducted in 2002. Methods: Stratified random samples of middle schools, high schools, and colleges were selected within each city. Students and their parents completed self-report surveys of their tobacco use. Data were obtained from 6138 middle school students, 5848 academic high school students, 2448 vocational high school students, 2556 college students, and 25 697 parents. Results: Smoking prevalence varied across age groups, school types, genders, and cities. Past-month smoking prevalence was 9% among middle school students, 8% among academic high school students, 26% among vocational high school students, 21% among college students, and 40% among parents. Smoking prevalence was higher among mates than among females, with larger gender disparities among adults than among youth. Smoking also varied across cities, with higher smoking prevalence in southwestern cities and lower prevalence in coastal cities. Intraclass correlations of students within schools are presented to inform statistical power estimates for further research in China. Conclusions: These results provide a baseline for future longitudinal studies of smoking in these cities and identify demographic groups at risk for tobacco-related disease. Effective smoking prevention programmes for youth and smoking cessation programmes for adults are needed in China, especially in the tower-income southwestern cities and in vocational high schools throughout the country.

Kandel DB; Hu MC; Griesler PC; Schaffran C. On the development of nicotine dependence in adolescence. (review). Drug and Alcohol Dependence 91(1): 26-39, 2007. (116 refs.)

Little is known about the natural history of drug dependence. This article describes the development and predictors of DSM-IV nicotine dependence in adolescence when tobacco use is initiated. In a two-stage design, a survey was administered to 6th-10th graders in the Chicago Public Schools to select a cohort of adolescents. Household interviews were conducted with adolescents five times and with one parent (predominantly mothers, three times over 1 years, The analytical sample includes 353 youths, who started using tobacco within 11 months preceding Wave I or between Waves 1-5. Survival analysis estimated latency to individual DSM-IV nicotine dependence criteria and the full dependence syndrome. Twenty-five percent of youths experienced the syndrome within 23 months of tobacco use onset. Tolerance, impaired control and withdrawal were experienced most frequently. Youths who developed full dependence experienced their first symptom faster after tobacco use onset than those who experienced only one criterion through the end of the observation period. Cox proportional hazards models estimated the importance of time-constant and time-varying sociodemographic, tobacco and other drug use, parental and peer smoking, social psychological and biological risk factors for experiencing the first criterion and the full syndrome. Pleasant initial sensitivity to tobacco and number of cigarettes smoked the prior month predicted both outcomes. Parental dependence predicted the full syndrome. Significant covariates were generally the same across gender and racial/ethnic subgroups. The predictive significance of the initial smoking experience and parental dependence highlight the potential importance of genetic factors in the etiology of nicotine dependence.

Kassel JD; Evatt DP; Greenstein JE; Wardle MC; Yates MC; Veilleux JC. The acute effects of nicotine on positive and negative affect in adolescent smokers. Journal of Abnormal Psychology 116(3): 543-553, 2007. (69 refs.)

Although adolescent cigarette smoking remains a critical public health concern, little is known about the reinforcing mechanisms governing smoking in this vulnerable population. To assess predictions derived from both positive and negative reinforcement models of drug use, the authors measured the acute effects of nicotine, as administered via tobacco cigarettes, on both positive and negative affect in a group of 15-to 18-year-old smokers. A matched group of nonsmokers served as a comparison group. Findings revealed that whereas adolescents who smoked a cigarette experienced reductions in both positive and negative affect, the observed reductions in negative affect were moderated by nicotine content of the cigarette (high yield vs. denicotinized), level of nicotine dependence, level of baseline craving, and smoking expectancies pertinent to negative affect regulation. Nonsmokers experienced no change in affect over the 10-min assessment period, and no interaction effects were observed for positive affect. Overall, the findings conform to a negative reinforcement model of nicotine effects and strongly suggest that, even among young light smokers, nicotine dependence and resultant withdrawal symptomatology may serve as motivating factors governing smoking behavior.

Kassel JD; Greenstein JE; Evatt DP; Wardle MC; Yates MC; Veilleux JC et al. Smoking topography in response to denicotinized and high-yield nicotine cigarettes in adolescent smokers. Journal of Adolescent Health 40(1): 54-60, 2007. (32 refs.)

Purpose: The objective of this study was to explore the smoking topography of adolescent smokers. It is well established that the majority of adult nicotine-dependent smokers began smoking as adolescents. Whereas recent advances have been made with respect to identification of factors that predispose to nicotine dependence, very little is known about the actual smoking behavior (e.g., topography) of adolescent smokers, or its relationship to nicotine dependence. Correspondingly, the extent to which adolescent smokers smoke to obtain nicotine is also unknown. Methods: In the present study, we assessed several topographical indices of smoking (e.g., puff volume, puff number) in a sample of 35 light, adolescent smokers. Moreover, we examined whether smoking behavior is different in response to smoking a denicotinized relative to a high-yield, nicotine cigarette. Results: All participants evidenced a significant increase in expired air carbon monoxide after the smoking of a cigarette. Results of independent-sample t-tests revealed that adolescents who smoked a low-yield nicotine cigarette took significantly more puffs per cigarette than did those who smoked a high-yield cigarette. Conclusions: These findings suggest that adolescent smokers do titrate their nicotine intake in response to smoking denicotinized cigarettes, but do so not by taking larger puffs or smoking more quickly, but by simply taking more puffs per cigarette. Implications of the findings and future directions for this type of research with adolescents are discussed.

Kealey KA; Ludman EJ; Mann SL; Marek PM; Phares MM; Riggs KR et al. Overcoming barriers to recruitment and retention in adolescent smoking cessation. Nicotine & Tobacco Research 9(2): 257-270, 2007. (51 refs.)

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

Kelishadi R; Mokhtari MR; Tavasoli AA; Khosravi A; Ahangar-Nazari I; Sabet B et al. Determinants of tobacco use among youths in Isfahan, Iran. International Journal of Public Health 52(3): 173-179, 2007. (35 refs.)

Objective: To determine potential factors that may result in motivating the youths to adopt smoking behaviour Methods: This cross-sectional study was conducted on 210 smoking and 217 non-smoking youths, aged 12-20 years. Results: The average age of starting cigarette and water pipe smoking was 14.5 +/- 2.4 and 11.2 +/- 1.5 years, respectively. The first experience with water pipe occurred mostly in the traditional teahouses for girls (54.8 %), and in family parties (48.2 %) for boys. In both genders, the first place of cigarette smoking was at friends' parties (56.8 % for boys, and 52.1 % for girls) and then followed by traditional teahouses (43.2 % for boys, and 47.9 % for girls). The most common reasons youths have picked up cigarette smoking were mainly to attract attention from friends, family inattention and poverty. Meanwhile, nearly all water pipe smokers reported using it for fun. The strongest predictors of smoking among boys were respectively father's occupation, having a smoking mother, and the number of smoking peers, whereas among girls, these factors were respectively having a smoking mother, frequenting traditional teahouses, and the number of smoking peers. Lower education of fathers and divorce among parents increased the probability of smoking in both genders, especially girls. School/work failure, as well as troubled relationship with parents and siblings were the other significant predictors of smoking in both genders, notably in girls. Conclusions: Public health control measures should be adopted not only to curtail cigarette use, but also to address water-pipe use. Preventive measures should be regarded as a high priority for socio-economically disadvantaged families.

Knishkowy B; Amitai Y; Hardoff D; Levy Y; Kiro A; Israel School of Physical Study Group. Assessment of health issues and concerns of Israeli seventh graders during school physician examinations: A pilot study. Journal of School Health 77(2): 87-91, 2007. (16 refs.)

BACKGROUND: The AMA Guidelines for Adolescent Preventive Services (GAPS) recommends annual medical evaluations during adolescence, emphasizing screening and counseling regarding psychosocial issues. In Israel, seventh graders undergo medical examinations within the school health services, focusing on the detection of physical conditions. We addressed the psychosocial issues of these students by introducing an expanded school physician evaluation. METHODS: Twelve school physicians performed structured expanded health evaluations for seventh graders in 11 schools. Each student completed a questionnaire (checklist) with 22 health topics "about which s/he may want to receive information." The physician then carried out a biomedical and psychosocial evaluation, physical examination, and offered counseling to the student. RESULTS: Two hundred and seventy-eight students were examined. The questionnaire required 1-2 minutes, and the physician's evaluation 20-25 minutes. Health behaviors revealed included: currently dieting (28%), no physical activity after school (35%), ever smoked cigarettes (3%), ever smoked a water pipe (9%), used alcoholic beverages (6%), and does not always use front (22%) or rear (55%) seat belt. Nine percent rated their mood as being less than 7 (on a scale from 1 to 10). The leading topics about which the students requested information were height (50%), acne (42%), weight (38%), nutrition/diet (37%), physical activity (35%), and menstrual period (29% of the girls). The physicians counseled the students on an average of 3.6 topics per visit. CONCLUSIONS: An expanded school physician examination identifies students with psychosocial problems otherwise undetected during standard physical examinations, and provides the opportunity to address their personal concerns.

Kotani K; Osaki Y; Kurozawa Y; Kishimoto T. Insufficient smoking restrictions in restaurants around junior high schools in Japan. Tohoku Journal of Experimental Medicine 210(4): 349-353, 2006. (20 refs.)

Controls for second hand smoke (SHS) and adolescent smoking have been still sociomedical concerns in Japan. Restaurant smoking restrictions are associated with community social norms affecting adolescent smoking behavior, and the status in areas around Junior high schools (JHSs) in the community could be a sign of community practices on regulating SHS for adolescents. To examine whether restaurant smoking restrictions are seen especially in areas around JHSs in Japan, a survey using the direct inspection of a total of 16.3 restaurants (64 restaurants within and 99 outside a 1-km radius from the nearest JHSs) was conducted in May 2003 in Yonago city, Japan. We assessed smoking restriction status in each restaurant and classified them into 2 groups according to the distance from the nearest JHSs. There were only 2 (3.1%) restaurants with 100% nonsmoking and 11 (17.2%) with some partial restrictions among the restaurants within a 1-km radius of JHSs. There were 1 (1.0%) restaurant with 100% non-smoking, 3 (3.0%) with complete non-smoking sections and 17 (17.2%) with some partial restrictions among the restaurants outside a 1-km radius of JHSs. Among restaurants with some partial restrictions, restriction methods were considered insufficient. The smoking restriction status was not significantly different between the restaurant groups within and outside a 1-km radius of JHSs. These results suggest that the public awareness of and attitude toward adolescent smoking problems remains low in Japan. Further SHS control actions for adolescents are needed in Japan.

Krishnan-Sarin S; Reynolds B; Duhig AM; Smith A; Liss T; McFetridge A et al. Behavioral impulsivity predicts treatment outcome in a smoking cessation program for adolescent smokers. Drug and Alcohol Dependence 88(1): 79-82, 2007. (16 refs.)

Objective: To examine the relationship between impulsivity and smoking cessation treatment response among adolescents. Methods: Thirty adolescent smokers participated in a high school based smoking cessation program combining contingency management and cognitive behavioral therapy. Self-report (Barratt impulsiveness scale (BIS-II); Kirby delay discounting measure (DDM)) and behavioral (experiential discounting task (EDT); continuous performance task (CPT)) measures of impulsivity were assessed at treatment onset. Results: Sixteen participants (53%) were abstinent from smoking at completion of the four-week study. Compared to abstinent adolescents, those not achieving abstinence discounted monetary rewards more on the EDT and committed more commission errors on the CPT. Group differences were not observed on the BIS-II or DDM. Conclusions: These preliminary results suggest that specific behavioral measures of impulsivity may be associated with the ability to initiate and/or maintain abstinence from smoking among adolescent smokers.

Lawrence D; Fagan P; Backinger CL; Gibson JT; Hartman A. Cigarette smoking patterns among young adults aged 18-24 years in the United States. Nicotine & Tobacco Research 9(6): 687-697, 2007. (42 refs.)

Most tobacco control programs focus on prevention for children or cessation for adults. Little is known about cigarette smoking among young adults. This study examined sociodemographic variables associated with current, daily, heavy, and light smoking among young adults in the United States. Data from the 1998-1999 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) were used to examine cigarette smoking patterns and correlates of smoking among 15,371 young adults aged 18-24 years. We found that 26% of young adults were current smokers, 20% were daily smokers, and 80/0 were former smokers. Current smoking rates were higher among American Indians/Alaska Natives (330/4) and Whites (31%) than among other racial/ethnic groups. Compared with white-collar workers, blue-collar and service workers were more likely to report current and daily smoking. Blue-collar workers also were more likely to report heavy smoking (OR=1.97). The unemployed (those in the labor force but not currently working) and those reporting an annual household income of less than US$20,000 were more likely to report current, daily, and heavy smoking, compared with those not in the labor force and those reporting an annual household income of $20,000 or more, respectively. Young adults not currently enrolled in school were more than twice as likely to report current (OR=2.36) and daily (OR=2.90) smoking, compared with those currently enrolled in school. Differential cigarette smoking patterns by race/ethnicity, occupation, employment status, household income, and school enrollment status should be considered when developing interventions to reduce smoking among young adults.

Leatherdale ST; Ahmed R; Lovato C; Manske S; Jolin MA. Heterogeneity among adolescent non-daily smokers: Implications for research and practice. Substance Use & Misuse 42(5): 837-851, 2007. (18 refs.)

Cluster analysis modeling was used to identify distinct smoking taxonomies among 4,473 smokers from 29 secondary schools (2000-2001) in Ontario, Canada. Analyses revealed a two-cluster solution (4,349 [97.2%] situational smokers and 124 [2.8%] ubiquitous smokers). Different psychosocial characteristics influenced the smoking behavior of these unique groups. Our findings are substantially different from the traditional definitions for non-daily and daily smoking used in the literature, which typically impose rules about smoking frequency or volume when defining smoking status. These findings suggest that more robust taxonomies of youth smoking are required in future tobacco control research.

Leatherdale ST; Hammond DG; Kaiserman M; Ahmed R. Marijuana and tobacco use among young adults in Canada: Are they smoking what we think they are smoking? Cancer Causes & Control 18(4): 391-397, 2007. (17 refs.)

The authors characterized marijuana smoking among young adult Canadians, examined the co-morbidity of tobacco and marijuana use, and identified correlates associated with different marijuana use consumption patterns. Data were collected from 20,275 individuals as part of the 2004 Canadian Tobacco Use Monitoring Survey. Logistic regression models were conducted to examine characteristics associated with marijuana use behaviors among young adults (aged 15-24). Rates of marijuana use were highest among current smokers and lowest among never smokers. Marijuana use was more prevalent among males, young adults living in rural areas, and increased with age. Young adults who were still in school were more likely to have tried marijuana, although among those who had tried, young adults outside of school were more like to be heavy users. Males and those who first tried marijuana at an earlier age also reported more frequent marijuana use. These findings illustrate remarkably high rates of marijuana use and high co-morbidity of tobacco use among young adult Canadians. These findings suggest that future research should consider whether the increasing popularity of marijuana use among young adults represents a threat to the continuing decline in tobacco use among this population.

Lindstrom M. Materialist and post-materialist values and cannabis smoking among young adults: A population-based study in southern Sweden. Preventive Medicine 44(4): 363-368, 2007. (38 refs.)

Objectives. The association between materialist, mixed and post-materialist values, and the experience of cannabis smoking among young adults was investigated. Methods. The 2004 public health survey in Skane, southern Sweden, is a cross-sectional study with a 59% response rate. The 6787 persons aged 18-34 years included in this study answered a postal questionnaire. A logistic regression model was used to investigate the association between materialist, mixed and post-materialist values and ever having experienced cannabis smoking. The multivariate analysis was performed to investigate the importance of possible confounders (age and education) on the differences in ever having experienced cannabis smoking according to materialist, mixed and post-materialist values. Results. 28% of the men and 17% of the women had ever experienced cannabis smoking. The experience of cannabis smoking was significantly and positively associated with post-materialist values among both men and women. The odds ratios were 2.4 (1.8-3.1) for men with post-materialist values compared to men with materialist values, and 3.1 (2.4-4.0) for women with post-materialist values compared to women with materialist values. Conclusions. This study suggests that post-materialist values are positively associated with the risk of ever smoking cannabis. Because this is a cross-sectional study, the direction of causality remains to be investigated.

Ling PM; Neilands TB; Nguyen TT; Kaplan CP. Psychographic segments based on attitudes about smoking and lifestyle among Vietnamese-American adolescents. Journal of Adolescent Health 41(1): 51-60, 2007. (40 refs.)

Purpose: Tobacco marketing campaigns target distinct psychographic segments of the population. We describe psychographic segments among Vietnamese-American youth and their relationship to smoking behavior. Methods: This was a cross-sectional survey of 411 Vietnamese-American young people (aged 14-24 years). Cluster analysis was performed to describe different population segments. Results: We identified four segments, categorized as follows: risk seekers, stressed pessimists, optimistic achievers, and sedentary well-behaved individuals. The risk seekers and stressed pessimists reported that they had tried smoking at some time (60% and 53%, respectively) in greater proportions than the other two segments (25% and 24%); and 20% of risk seekers and 22% of stressed pessimists were current smokers compared with 2% of the other clusters. In comparison to the other groups, the risk seekers more frequently went to bars and clubs, and their friends engaged in risky behavior. They agreed that secondhand smoke was dangerous, but accepted ventilation as an alternative to smoke-free policies more frequently than the other groups. The stressed pessimists had negative views of the future, did not value physical fitness, and doubted the dangers of secondhand smoke. Optimistic achievers were active in sports and student activities, were optimistic about future achievements, prioritized good nutrition, and supported smoke-free policies. The sedentary well-behaved group had well-behaved friends, did not value physical fitness, strongly opposed smoking, and supported smoke-free policies. Conclusion: Different segments of the Vietnamese-American population have different attitudes and smoking risk, which may facilitate targeted tobacco control message development. Future research should address whether similar psychographic segments exist in other ethnic populations.

Liu JM; Peterson AV; Kealey KA; Mann SL; Bricker JB; Marek PM. Addressing challenges in adolescent smoking cessation: Design and baseline characteristics of the HS Group-Randomized trial. Preventive Medicine 45(2/3): 215-225, 2007. (75 refs.)

Objective. Well-documented challenges have hampered both intervention development and research in teen smoking cessation. Addressing these challenges, the Hutchinson Study of High School Smoking (HS Study), the largest group-randomized trial in adolescent smoking cessation to date, incorporates several design innovations to investigate the effect of a counselor-initiated, individually tailored telephone counseling smoking cessation intervention for older adolescents. This paper presents and discusses these innovative design features, and baseline findings on the resulting study population. Method. The trial used a population-based survey to proactively identify and recruit all high school juniors who had smoked in the past month - potentially expanding intervention reach to all smokers, even those who smoked less than daily and those not motivated to quit. For ethical and intervention reasons, some nonsmokers were enrolled in the intervention, also. Other important design features included the random allocation of schools into experimental conditions (intervention vs. no-intervention control) and a multi-wave design. Results and conclusion. The design innovations address problems and challenges identified in adolescent smoking cessation literature. The heterogeneous baseline characteristics of the study population, well-balanced between the two arms, have three significant implications: They (1) demonstrate the effectiveness of the trial's design features, (2) highlight several intervention-related issues, and (3) provide assurance that the trial's evaluation of intervention effectiveness will be unbiased.

Lubman DI; Hides L; Jorm AF. Beliefs of young people and their parents about the harmfulness of alcohol, cannabis and tobacco for mental disorders. Medical Journal of Australia 187(5): 266-269, 2007. (18 refs.)

Objective: To ascertain the beliefs of young people and their parents about the role of alcohol, tobacco and marijuana in the prevention and treatment of mental disorders. Design, setting and participants: Between May and August 2006, a national computer-assisted telephone survey was conducted on a representative sample of Australian youths aged 12-25 years. 3746 young people and 2005 of their parents were presented with a case vignette portraying psychosis, depression, depression with alcohol misuse, or social phobia in a young person. Main outcome measures: Participants' beliefs regarding the role of substance use in preventing or dealing with mental disorders in young people. Results: Over 85% of participants agreed that alcohol, tobacco and marijuana were harmful for the young people in the vignettes, and over 80% of youths agreed that not using marijuana or drinking alcohol in excess would reduce the risk of developing a similar problem. Conclusion: Young people and their parents are fully aware of the negative impact of substance use on mental disorders. Translating this knowledge into behavioural change will be a major challenge for future public health campaigns.

Lundborg P. Smoking, information sources, and risk perceptions: New results on Swedish data. Journal of Risk and Uncertainty 34(3): 217-240, 2007. (35 refs.)

Using data on Swedish adolescents, this study examines (1) perceptions of the addictiveness and mortality risk of smoking, (2) the effects of these perceptions on smoking behaviour, and (3) the role of various smoking risk information sources. The average respondent believed that 46 out of 100 smokers would die from diseases caused by their smoking. As to addictiveness perceptions, the average respondent believed that 68 out of 100 smokers trying to quit would not succeed. Both a higher perceived addictiveness and a higher perceived mortality risk were negatively related to smoking participation. The results showed substantial variation in the weight that the teenagers attached to the various information sources.

MacDonald S; Rothwell H; Moore L. Getting it right: Designing adolescent-centred smoking cessation services. Addiction 102(7): 1147-1150, 2007. (25 refs.)

Aims: To demonstrate the importance of identifying adolescent preferences for smoking cessation in order to inform the design of effective adolescent cessation services. Design Structured qualitative interviews drawing on means-end theory. Setting Three youth-clubs and two secondary schools in south-east Wales. P