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CORK Bibliography: Adolescents and Nicotine

138 citations. March 2011 to present

Prepared: December 2011

Al Ghobain MO; Al Moamary MS; Al Shehri SN; AL-Hajjaj MS. Prevalence and characteristics of cigarette smoking among 16 to 18 years old boys and girls in Saudi Arabia. Annals of Thoracic Medicine 6(3): 137-140, 2011. (20 refs.)

OBJECTIVE: To study the prevalence and characteristics of cigarette smoking among secondary school students (16- to 18-year-old boys and girls) in Riyadh city, Saudi Arabia. METHODS: We applied a standard two-stage, cross-sectional study design. Secondary schools for both boys and girls in Riyadh city were randomly selected using a cluster sampling method. We used the global youth tobacco survey (GYTS) tool to achieve our objectives. RESULTS: Among 1272 students (606 boys and 666 girls), the prevalence of those ever smoked cigarettes was 42.8% (55.6% of boys and 31.4% of girls). The prevalence of current smoking was 19.5% (31.2% of boys and 8.9% of girls). Despite the fact that the majority of students think smoking is harmful, most do not wish to stop smoking, and they had not tried to stop in the past year. Cigarette smoking is significantly associated with the male gender, having friends who smoke, and having parents who smoke, but is not significantly associated with the type of school attended. CONCLUSION: Smoking prevalence among secondary schools students in Saudi Arabia is high and alarming. There is a need to implement an education program about the risks of smoking and to include parents and friends as healthy models to prevent students from beginning to smoke.

Alwan H; Viswanathan B; Rousson V; Paccaud F; Bovet P. Association between substance use and psychosocial characteristics among adolescents of the Seychelles. BMC Pediatrics 11: 85, 2011. (42 refs.)

Background: We examined the associations between substance use (cigarette smoking, alcohol drinking, and cannabis use) and psychosocial characteristics at the individual and family levels among adolescents of the Seychelles, a rapidly developing small island state in the African region. Methods: A school survey was conducted in a representative sample of 1432 students aged 11-17 years from all secondary schools. Data came from a self-administered anonymous questionnaire conducted along a standard methodology (Global School-based Health Survey, GSHS). Risk behaviors and psychosocial characteristics were dichotomized. Association analyses were adjusted for a possible classroom effect. Results: The prevalence of cigarette smoking, alcohol drinking and cannabis use was higher in boys than in girls and increased with age. Age-adjusted and multivariate analyses showed that several individual level characteristics (e. g. suicidal ideation and truancy) and family level characteristics (e. g. poor parental monitoring) were associated with substance use among students. Conclusions: Our results suggest that health promotion programs should simultaneously address multiple risk behaviors and take into account a wide range of psychosocial characteristics of the students at the individual and family levels.

Amin TT; Amr MAM; Zaza BO. Psychosocial predictors of smoking among secondary school students in Al-Hassa, Saudi Arabia. Journal of Behavioral Medicine 34(5): 339-350, 2011. (65 refs.)

The objective of this study was to determine the prevalence and determinants of the current smoking status among secondary school students in Al-Hassa, Saudi Arabia. A total of 1,652 secondary school adolescents were selected by multistage proportionate sampling method. Data collection was carried out through self-administered anonymous questionnaire including: Arabic version of the Global Youth Tobacco Survey, modified Fagerstrom Test for Nicotine Dependence and Patient Health Questionnaire to asses for anxiety and depressive disorders. This study revealed that the prevalence of current smokers was 21.7. Seventy-one percent of current cigarette smokers were minimally nicotine dependent. Major depressive and anxiety disorders were significantly higher among current smokers. Hierarchical regression analysis shows that, male, older age, smoking of close relatives and friends, anxiety disorders and socializing motives were statistically significant determinants of current smoking status among the included adolescents. Family members should be made aware of the detrimental influence their smoking behavior has on their youth. Counseling and preventive psychiatric services should be an integral part of the clinical facilities caring for secondary school students.

Arcan C; Kubik MY; Fulkerson JA; Hannan PJ; Story M. Substance use and dietary practices among students attending alternative high schools: Results from a pilot study. BMC Public Health 11(e-article 263), 2011. (57 refs.)

Background: Substance use and poor dietary practices are prevalent among adolescents. The purpose of this study was to examine frequency of substance use and associations between cigarette, alcohol and marijuana use and selected dietary practices, such as sugar-sweetened beverages, high-fat foods, fruits and vegetables, and frequency of fast food restaurant use among alternative high school students. Associations between multi-substance use and the same dietary practices were also examined. Methods: A convenience sample of adolescents (n = 145; 61% minority, 52% male) attending six alternative high schools in the St Paul/Minneapolis metropolitan area completed baseline surveys. Students were participants in the Team COOL (Controlling Overweight and Obesity for Life) pilot study, a group randomized obesity prevention pilot trial. Mixed model multivariate analyses procedures were used to assess associations of interest. Results: Daily cigarette smoking was reported by 36% of students. Cigarette smoking was positively associated with consumption of regular soda (p = 0.019), high-fat foods (p = 0.037), and fast food restaurant use (p = 0.002). Alcohol (p = 0.005) and marijuana use (p = 0.035) were positively associated with high-fat food intake. With increasing numbers of substances, a positive trend was observed in high-fat food intake (p = 0.0003). There were no significant associations between substance use and fruit and vegetable intake. Conclusions: Alternative high school students who use individual substances as well as multiple substances may be at high risk of unhealthful dietary practices. Comprehensive health interventions in alternative high schools have the potential of reducing health-compromising behaviors that are prevalent among this group of students. This study adds to the limited research examining substance use and diet among at-risk youth.

Aubin HJ; Karila L; Reynaud M. Pharmacotherapy for smoking cessation: Present and future. (review). Current Pharmaceutical Design 17(14): 1343-1350, 2011. (123 refs.)

Tobacco dependence is a chronic disease that often requires repeated interventions and multiple attempts to quit. To date, three medications are FDA-approved for smoking cessation: nicotine replacement therapy, sustained-release bupropion, and varenicline. These treatments are effective across a broad range of populations, and are recommended for all smokers, including those with psychiatric or addictive comorbidity. Less is known however concerning the benefit-risk profile of these medications in pregnant women and adolescents. With these limitations in mind, clinicians should encourage and offer counseling and a prescription of pharmacotherapy to every patient willing to make a quit attempt. Despite the relative efficacy of first-line medications, many smokers relapse after one given quit attempt, and alternative pharmacotherapies are needed. Clonidine and nortriptyline have been proposed as second-line medications. In addition, this review identifies a series of promising drugs that hopefully will be available to complete our current armory.

Auger N; Daniel M; Knauper B; Raynault MF; Pless B. Children and youth perceive smoking messages in an unbranded advertisement from a NIKE marketing campaign: A cluster randomised controlled trial. BMC Pediatrics 11: e26, 2011. (30 refs.)

Background: How youth perceive marketing messages in sports is poorly understood. We evaluated whether youth perceive that the imagery of a specific sports marketing advertisement contained smoking-related messages. Methods: Twenty grade 7 to 11 classes (397 students) from two high schools in Montreal, Canada were recruited to participate in a cluster randomised single-blind controlled trial. Classes were randomly allocated to either a NIKE advertisement containing the phrase "LIGHT IT UP" (n = 205) or to a neutral advertisement with smoking imagery reduced and the phrase replaced by "GO FOR IT" (n = 192). The NIKE logo was removed from both advertisements. Students responded in class to a questionnaire asking open-ended questions about their perception of the messages in the ad. Reports relating to the appearance and text of the ad, and the product being promoted were evaluated. Results: Relative to the neutral ad, more students reported that the phrase "LIGHT IT UP" was smoking-related (37.6% vs. 0.5%) and that other parts of the ad resembled smoking-related products (50.7% vs. 10.4%). The relative risk of students reporting that the NIKE ad promoted cigarettes was 4.41 (95% confidence interval: 2.64-7.36; P < 0.001). Conclusions: The unbranded imagery of an advertisement in a specific campaign aimed at promoting NIKE hockey products appears to have contained smoking-related messages. This particular marketing campaign may have promoted smoking. This suggests that the regulation of marketing to youth may need to be more tightly controlled.

Bang SJ; Commons KG. Age-dependent effects of initial exposure to nicotine on serotonin neurons. Neuroscience 179: 1- 8, 2011. (59 refs.)

Adolescence is a critical vulnerable period during which exposure to nicotine greatly enhances the possibility to develop drug addiction. Growing evidence suggests that serotonergic (5-HT) neurotransmission may contribute to the initiation and maintenance of addictive behavior. As the dorsal raphe (DR) and median raphe (MnR) nuclei are the primary 5-HT source to the forebrain, the current study tested the hypothesis that there are age-dependent effects of acute nicotine administration on activation of 5-HT neurons within these regions. Both adolescent (Postnatal day 30) and adult (Postnatal day 70) male Sprague Dawley rats received subcutaneous injection of either saline or nicotine (0.2, 0.4, or 0.8 mg/kg). Subsequently, the number of 5-HT cells that were double-labeled for Fos and tryptophan hydroxylase was counted in seven subregions within the DR and the entire MnR. The results show that acute nicotine injection induces Fos expression in 5-HT neurons in a region-specific manner. In addition, adolescents show broader regional activations at either a lower (0.2 mg/kg) and a higher (0.8 mg/kg) dose of nicotine, displaying a unique U-shape response curve across doses. In contrast, 5-HT cells with activated Fos expression were restricted to fewer regions in adults, and the patterns of expression were more consistent across doses. The results reveal dose-dependent effects of nicotine during adolescence with apparent sensitization at different ends of the dosage spectrum examined compared to adults. These data indicate that initial exposure to nicotine may have unique effects in adolescence on the ascending 5-HT system, with the potential for consequences on the affective-motivational qualities of the drug and the subsequent propensity for repeated use.

Becerra D; Castillo J. Culturally protective parenting practices against substance use among adolescents in Mexico. Journal of Substance Use 16(2): 136-149, 2011. (59 refs.)

The results of this study indicated that parental support and parental monitoring were significant predictors of lower lifetime and recent substance use for males and females. Parental support significantly predicted lower lifetime and recent cigarette use among males and lower recent marijuana use among females. Parental monitoring, however, was a stronger predictor of lower recent alcohol, cigarette and marijuana use among adolescent females in the study. Because substance use in Mexico tends to be higher in cities that border the United States, understanding protective factors against adolescent substance use is important in the development of culturally appropriate substance abuse prevention programmes in Mexico. Implications for research and practice are discussed.

Beyerlein A; Ruckinger S; Toschke AM; Rosario AS; von Kries R. Is low birth weight in the causal pathway of the association between maternal smoking in pregnancy and higher BMI in the offspring? European Journal of Epidemiology 26(5): 413-420, 2011. (57 refs.)

A number of cross-sectional and prospective studies suggested a priming effect of maternal smoking in pregnancy on offspring's obesity. It has been hypothesized that this association might be explained by low birth weight and subsequent catch-up growth in the causal pathway. We therefore examined the role of birth weight in children exposed versus not exposed to cigarette smoking in utero on later body mass index (BMI). Using data of 12,383 children and adolescents (3-17 years of age) recorded in a German population-based survey (KiGGS), we assessed mean body mass index standard deviation scores (BMI-SDS) in different birth weight SDS categories, stratified for children with smoking and non-smoking mothers. We calculated spline regression models with BMI-SDS as outcome variable, cubic splines of birth weight SDS, and potential confounding factors. Children whose mothers had been smoking during pregnancy had lower birth weight SDS and higher BMI-SDS at interview compared to children of non-smoking mothers. However, we observed a linear association between birth weight SDS and BMI-SDS in crude analyses for both groups. Similarly, almost linear effects were observed in adjusted spline regression analyses, except for children with very low birth weight. The respective 95% confidence bands did not preclude a linear effect for the whole birth weight SDS distribution. Our findings suggest that low birth weight is unlikely to be the main cause for the association between intrauterine nicotine exposure and higher BMI in later life. Alternative mechanisms, such as alterations in the noradrenergic system or increased food efficiency, have to be considered.

Bhojani UM; Elias MA; Devadasan N. Adolescents' perceptions about smokers in Karnataka, India. BMC Public Health 11(563), 2011. (14 refs.)

Background: Prevalence of tobacco use among adolescents in India is very high. Despite many epidemiological studies exploring tobacco use among youth, there is no published data on adolescents' perceptions about smokers in Indian society and its implications on tobacco control. Methods: A cross-sectional study was conducted using a stratified random sampling with probability proportional to school-type (government or private owned). Data was collected using a pretested, self-administered, anonymous questionnaire with a mix of close and open-ended questions from a sample of 1087 students. Chi-square test was used to measure associations. Qualitative data was analysed through inductive coding. Results: The response rate for the study was 82.5% and the sample population had a mean age of 16.9 years (SD = 1.9) with 57.8% male students. Majority of respondents (84.6%) reported negative perceptions about smokers while 20.4% of respondents reported positive perceptions. Female students reported significantly higher disapproval rate (negative perceptions) for smoking compared to male students (89.7% Vs 71.6% in case of male smoker; 81.2% Vs 67.3% in case of female smoker). Dominant themes defining perceptions about smokers included 'hatred/hostility/Intolerance', 'against family values/norms', 'not aware of tobacco harms' and 'under stress/emotional trauma'. Themes like 'culture', 'character' and 'power' specifically described negative social image of female smoker but projected a neutral or sometimes even a positive image of male smoker. There was a significant association between adolescents' positive perceptions of smokers and tobacco use by themselves as well as their close associates. Conclusions: Adolescents' stereotypes of smokers, especially female smokers are largely negative. We suggest that tobacco control interventions targeting adolescents should be gender specific, should also involve their peers, family and school personnel, and should go beyond providing knowledge on harmful effects of smoking to interventions that influence adolescents' social construct of smoking/smoker.

Borrione P; Marchiaro G; Vincenti M; Sciacca A; Spaccamiglio A; Di Gianfrancesco A et al. Health risk screening in adolescents: A pilot study. Journal of Sports Medicine and Physical Fitness 51(2): 268-274, 2011. (29 refs.)

Aim. Even if youths are generally perceived to be healthy, adolescent years are associated with significant morbidity. Screening and counselling programmes seem to be cost-effective but adolescents prefer to rely on health care services for the treatment of diagnosed diseases or injuries rather than for preventive actions. Age oriented studies are needed for better understanding the health needs of adolescents in order to provide an adequate offer of preventive opportunities. Methods. Eight hundred youths ranging from 13 to 18 years of age were recruited. Health status and risks were clustered into the following five categories: clinical assessment, substance use/abuse, nutritional habits, alcohol and tobacco consumption, physical status. Surprisingly, 33% of the youths were suggested to perform further clinical assessment and even more interestingly a significant number of them received a diagnosis of a symptomatic disorder for which he or she did not previously consider a medical visit to be necessary. Results. As expected, alcohol consumption, tobacco smoking, drug use/abuse and sedentary habit represent the risky lifestyles commonly followed by adolescents. Conclusion. The present study confirms the importance of screening programs addressed to health issues and behavioural attitudes of adolescents even in light of the fact that they may underestimate even indicative symptoms.

Botello-Harbaum M; Haynie DL; Murray KW; Iannotti RJ. Cigarette smoking status and recurrent subjective health complaints among US school-aged adolescents. Child: Care, Health and Development 37(4): 551-558, 2011. (40 refs.)

Background: Subjective health complaints are common among adolescents. There is evidence that girls are more likely to register complaints than boys. This study examines gender differences in the relationship between daily smoking and recurrent subjective health complaints in school-aged adolescents in the. Methods: A cross-sectional design with a multistage probability sample was used to survey 13 339 middle and high school students (grades 6 through 10) with the US 2001-2002 Health Behavior in School-Aged Children Survey. Results: Recurrent subjective health complaints were higher for adolescents who smoke daily and experiment with cigarettes than for those who never smoke. In logistic regression analyses, the odds of daily smoking increased twofold for both boys and girls who report recurrent irritability/bad temper. For girls, the odds of daily smoking were higher among those who reported recurrent headache, stomachache and backache compared with never smokers. For boys only recurrent backache and feeling dizzy were associated with increased odds of daily smoking. Conclusions: The relationship between recurrent subjective health complaints and daily smoking provides new insights into both conditions for school-aged adolescents. Findings from this study suggest different patterns of association between daily smoking and recurrent subjective health complaints occur for girls and boys. Further studies are needed to explore causes and treatment of daily smoking and recurrent health complaints among school-aged children.

Breslau J; Miller E; Chung WJJ; Schweitzer JB. Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research 45(3): 295-301, 2011. (41 refs.)

We examined the joint predictive effects of childhood and adolescent onset psychiatric and substance use disorders on failure to graduate high school (HS) on time. Structured diagnostic interviews were conducted with a US national sample of adults (18 and over). The analysis sample included respondents with at least 8 years of education who were born in the US or arrived in the US prior to age 13 (N = 29,662). Psychiatric disorders, substance use and substance use disorders were examined as predictors of termination or interruption of educational progress prior to HS graduation, with statistical adjustment for demographic characteristics and childhood adversities. Failure to graduate HS on time was more common among respondents with any of the psychiatric and substance use disorders examined, ranging from 18.1% (specific phobia) to 33.2% (ADHD-combined type), compared with respondents with no disorder (15.2%). After adjustment for co-occurring disorders, significant associations with failure to graduate on time remained only for conduct disorder (OR = 1.89, 95% CI 1.57-2.26) and the three ADHD subtypes (Inattentive OR = 1.78, 95% CI 1.44-2.20, Hyperactive Impulsive OR = 1.38, 95% CI 1.14-1.67, and Combined OR = 2.06, 95% CI 1.66-2.56). Adjusting for prior disorders, tobacco use was associated with failure to graduate on time (OR = 1.97, 95% CI 1.80-2.16). Among substance users, substance use disorders were not associated with on-time graduation. The findings suggest that the adverse impact of childhood and adolescent onset psychiatric disorders on HS graduation is largely accounted for by problems of conduct and inattention. Adjusting for these disorders, smoking remains strongly associated with failure to graduate HS on time.

Brook JS; Rubenstone E; Zhang C; Brook DW. Maternal predictors of comorbid trajectories of cigarette smoking and marijuana use from early adolescence to adulthood. Addictive Behaviors 37(1): 139-143, 2012. (24 refs.)

This is the first study to examine maternal predictors of comorbid trajectories of cigarette smoking and marijuana use from adolescence to adulthood. Participants (N=806) are part of an on-going longitudinal psychosocial study of mothers and their children. Mothers were administered structured interviews when participants were adolescents, and participants were interviewed at six time waves, from adolescence to adulthood. Mothers and participants independently reported on their relationships when participants were age 14.1 years. At each time wave, participants answered questions about their cigarette and marijuana use from the previous wave to the present. Latent growth mixture modeling determined the participants' membership in trajectory groups of comorbid smoking and marijuana use, from ages 14.1 to 36.6 years. Multivariate logistic regression was used to assess the association of maternal factors (when participants were adolescents) with participants' comorbid trajectory group membership. Findings showed that most maternal risk (e.g., mother-child conflict, maternal smoking) and protective (e.g., maternal affection) factors predicted participants' membership in trajectory groups of greater and lesser comorbid substance use, respectively. Clinical implications include the importance of addressing the mother-child relationship in prevention and treatment programs for comorbid cigarette smoking and marijuana use.

Burkhart G. Environmental drug prevention in the EU. Why is it so unpopular? (editorial). Adicciones 23(2): 87-100, 2011. (92 refs.)

Adolescents go through changes in their neurobehavioural and psychosocial functioning that can result in their desire to conform to peer norms taking predominance over cognitive impulse control mechanisms. This can help explain why, when peers are present, adolescent behaviour may not be significantly modified by what they know about risks and consequences. This finding has implications for prevention as it points to the importance of responses that actively target the environment in which substance use takes place, and where social norms are formed and supported. In practice however, across Europe information-only prevention approaches - despite a weak evidence for their effectiveness - continue to be most commonly used. Why this is the case is the question addressed by this editorial. A definition for environmental prevention is also provided: as strategies that aim to alter physical, social and economic environment without relying on persuasion. Boundaries of the definition with health promotion are discussed and the available evidence for the efficacy of this perspective reviewed, as is the information on the availability of environmental prevention within Europe. These data do not support the contention made by some member states that their prevention strategies are comprehensive and cover all addictive substances. Overall, although environmental approaches are becoming more common, they are disproportionately found in the North of Europe, and are most noticeable in three areas: at the macro-level in tobacco bans and alcohol policies, in strategies to improve the school environment and ethos, and in local level policies to regulate recreational settings.

Carkaxhiu L; Huseyin K; Berisha M; Botica MV. Problem of substance misuse and lack of national strategy in Kosovo. Central European Journal of Public Health 19(2): 108-114, 2011. (40 refs.)

The aim of this project was to explore the problem of substance misuse among adolescent town dwellers in Kosovo, as a result of lack of a national strategy related to this problem. Design: 261 students from 4 secondary schools took part in cross sectional survey performed in October 2005. The survey was carried out in Gjilan town in south-east of Kosovo. Main results: From all questioned students, 36% smoked cigarettes every day, 12.6% consumed alcohol occasionally and 1.4% consumed all kind of drugs regularly. Girls consumed more cigarettes, whereas boys consumed more alcohol and other drugs. The prevalence of substance misuse was higher among students in their last year of high school attendance. Students in Gjilan continue to smoke, consume alcohol and drugs despite their knowledge about the adverse health consequences of substance misuse, but in the same time, most of them consider information and counselling the best way of substance misuse prevention. Conclusions: The prevalence and trends of substance misuse among students in our survey indicates that it is time to start acting. It is assumed that results of survey may be a very useful source of information for policy-makers, government and ministry of health in developing and implementing national strategy that would address the most important issues in connection with addiction among adolescents.

Carlo G; Crockett LJ; Wilkinson JL; Beal SJ. The longitudinal relationships between rural adolescents' prosocial behaviors and young adult substance use. Journal of Youth and Adolescence 40(9): 1192-1202, 2011. (58 refs.)

While many adolescents and young adults experiment with substances (e.g., alcohol, cigarette smoking, marijuana), recent research suggests that rural youth and young adults may be more at risk for substance use than their urban counterparts. This study was designed to examine the longitudinal relationships between rural adolescents' prosocial behaviors and substance use in young adulthood. Furthermore, we examined the potential mediating effects of adolescent substance use, academic investment, and delinquency. Rural youth (N = 531; 263 girls) were surveyed in grades 10-12 (Time 1; M age = 16.17; SD = .91) and again in early adulthood (Time 2). Measures of prosocial behaviors, substance use, academic investment, and deviant activities were assessed at Time 1. At Time 2, measures of marijuana use, cigarette smoking, and getting drunk were administered. Overall, the findings showed that rural adolescents who frequently exhibit prosocial behaviors are less likely to engage in substance use in young adulthood than those who exhibit relatively low levels of prosocial behaviors. These findings indicate that prosocial behaviors may have positive health consequences, establishing behavioral trajectories that lead to lower levels of risky health behaviors in adulthood in rural populations.

Carson KV; Brinn MP; Labiszewski NA; Esterman AJ; Chang AB; Smith BJ. Community interventions for preventing smoking in young people. (review). Cochrane Database of Systematic Reviews 7(e-article CD001291), 2011. (166 refs.)

Background: Cigarette smoking is one of the leading causes of preventable death in the world. Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people. Objectives: To determine the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people. Search strategy: The Tobacco Addiction group's specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and raw data was requested from study authors. Searches were updated in August 2010. Selection criteria: Randomized and non randomized controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years. Data collection and analysis: Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table. Main results: Twenty-five studies were included in the review and sixty-eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short-term smoking prevalence (twelve months or less), while nine studies detected significant long-term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions. Authors' conclusions: There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws.

Cavazos-Rehg PA; Krauss MJ; Spitznagel EL; Schootman M; Cottler LB; Bierut LJ. Substance use and the risk for sexual intercourse with and without a history of teenage pregnancy among adolescent females. Journal of Studies on Alcohol and Drugs 72(2): 194-198, 2011. (24 refs.)

Objective: The present study examined the associations between initiation and intensity of substance use and with sexual experience with and without a history of teenage pregnancy. Method: Participants: were high school females (weighted n = 3,451) who participated in the 1999-2003 Youth Risk Behavior Surveillance System, a cross-sectional, nationally representative survey. Multinomial multivariable logistic regression was used to assess the likelihood of being sexually experienced (but never pregnant) and teenage pregnancy (reference group: never had sexual intercourse) as a function of age at substance use initiation (i.e., age 12 or younger, 13-14 years of age, and age 15 or older) and intensity of substance use (i.e., nonuser, experimental/new or nondaily, nonexperimental/daily user) for alcohol, cigarettes, and marijuana, while controlling for race/ethnicity, metropolitan location, symptoms of depression, and illegal drug availability at school. Results: A major finding of our study is that substance use behaviors across each substance (alcohol, cigarettes, and marijuana) independently contributed to an increased risk in sexual intercourse experience with and without a history of teenage pregnancy (vs. nonsexually experienced females). A dose-response relationship was also observed between an increased likelihood of a teenage pregnancy and marijuana behaviors. Furthermore, the risk for teenage pregnancy was compounded for daily cigarette smokers who initiated use at age 12 or younger. Conclusions: Screening substance use behaviors can help to identify girls who may benefit from pregnancy prevention strategies. Targeting cigarette and marijuana behaviors as early as age 12 or younger may provide an added benefit. Prevention strategies should also consider the role of race above and beyond substance use behaviors.

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Administration. Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. NSDUH Series H-41. Rockville MD: Substance Abuse and Mental Health Administration, 2011. (57 refs.)

This report presents the first information from the 2010 National Survey on Drug Use and Health (NSDUH), an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The survey is the primary source of information on the use of illicit drugs, alcohol, and tobacco. In respect to illicit drug use, in 2010, an estimated 22.6 million Americans aged 12 or older were current (past month) illicit drug users. This estimate represents 8.9 percent of the population aged 12 or older. The rise in drug use is largely the result of the increasing use of marijuana. Following an introduction, the first chapters deal with illicit drugs, alcohol use, tobacco use, providing information on use patterns by demographics. The next three chapters examine the initiation of substance use, measures related to prevention (risk and protective factors), and substance dependence and abuse and their treatment. The concluding chapter deals with trends in substance use among adolescents and young adults. Data is summarized in 56 figures and 9 tables.

Public Domain

Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. The NSDUH Report: Nicotine Dependence among Persons Who Received Substance Use Treatment. (June 23, 2011). Rockville MD: Substance Abuse and Mental Health Administration, 2011

From 2005 to 2009, more than 2.4 million persons per year (1.0 % of those aged 12 or older) received treatment for an alcohol or illicit drug use problem at a specialty facility in the past year. Of these, 56.3 % met the criteria for nicotine dependence from cigarette smoking in the past month. Males and females who received substance use treatment at a specialty facility in the past year were equally likely to be nicotine dependent in the past month. Among persons who received substance use treatment, the rate of past month nicotine dependence was lower among youths aged 12 to 17 (46.9 %) than among those aged 18 to 25 (57.2 percent) and those aged 26 or older (56.9 %).

Public Domain

Choi K; Forster JL; Erickson DJ; Lazovich D; Southwell BG. Prevalence of smoking in movies as perceived by teenagers longitudinal trends and predictors. American Journal of Preventive Medicine 41(2): 167-173, 2011. (32 refs.)

Background: Smoking in movies is prevalent. However, use of content analysis to describe trends in smoking in movies has provided mixed results and has not tapped what adolescents actually perceive. Purpose: To assess the prospective trends in the prevalence of smoking in movies as perceived by teenagers and identify predictors associated with these trends. Methods: Using data from the Minnesota Adolescent Community Cohort Study collected during 2000-2006 when participants were aged between 12 and 18 years (N=4735), latent variable growth models were employed to describe the longitudinal trends in the perceived prevalence of smoking in movies using a four-level scale (never to most of the time) measured every 6 months, and examined associations between these trends and demographic, smoking-related attitudinal and socio-environmental predictors. Analysis was conducted in 2009. Results: At baseline, about 50% of participants reported seeing smoking in movies some of the time, and another 36% reported most of the time. The prevalence of smoking in movies as perceived by teenagers declined over time, and the decline was steeper in those who were aged 14-16 years than those who were younger at baseline (p <= 0.05). Despite the decline, teenagers still reported seeing smoking in movies some of the time. Teenagers who reported more close friends who smoked also reported a higher prevalence of smoking in movies at baseline (regression coefficients=0.04-0.18, p<0.01). Conclusions: Teenagers' perception of the prevalence of smoking in movies declined over time, which may be attributable to changes made by the movie industry. Despite the decline, teenagers were still exposed to a moderate amount of smoking imagery. Interventions that further reduce teenage exposure to smoking in movies may be needed to have an effect on adolescent smoking.

Choi TCK; Toomey TL; Chen V; Forster JL. Awareness and reported consequences of a cigarette tax increase among older adolescents and young adults. American Journal of Health Promotion 25(6): 379-386, 2011. (12 refs.)

Purpose: To determine the prevalence and predictors of the awareness of cigarette price increases following a cigarette tax increase, and assess the association of the tax increase and attempts to quit and reduce smoking among adolescents and young adults. Design: We used a prospective cohort design. Setting: Surveys were conducted in Minnesota before and after a $0.75 cigarette tax increase. Subjects: We surveyed 3167 adolescents and young adults, including a subsample of 781 past-30-day smokers. Measures: Outcome measures were awareness of cigarette price increases and, among past-30-day smokers, reported changes in smoking behaviors because of the tax increase. Predictors included demographics, social factors, and prior smoking behaviors. Analysis: We estimated the prevalence of the outcomes and their associations with the predictors using logistic regression. Results: Among all participants, 42% noticed an increase in cigarette prices after the tax increase, including 76% of past-30-day smokers. Being a heavier smoker, living with smokers, having more smoking close friends, and generally being aware of cigarette price changes prospectively predicted the awareness of the price increase after the tax increase. Among past-30-day smokers, 16.7% reported quit attempts and 24.1% reported reducing smoking because of the tax increase. Conclusion: Because fewer than half of the participants noticed the cigarette tax increase, media campaigns to raise awareness of tax changes may increase their effectiveness.

Chung T; Maisto SA; Mihalo A; Martin CS; Cornelius JR; Clark DB. Brief assessment of readiness to change tobacco use in treated youth. Journal of Substance Abuse Treatment 41(2): 137-147, 2011. (43 refs.)

This study examined the concurrent and predictive validity of four brief measures of readiness to change tobacco use for use with adolescents in clinical practice (Readiness Ruler, Thoughts About Abstinence, motivation to abstain, and confidence to abstain) and a single-item measure of difficulty to abstain. Participants were 154 adolescent smokers recruited from outpatient addictions treatment, who completed assessments shortly after admission and at 6- and 12-month follow-up. Concurrent validity analyses indicated that the four readiness measures were moderately correlated at each time point. Predictive validity analyses indicated that the Ruler and the motivation to abstain ratings predicted number of cigarettes smoked at 6 and 12 months. Perceived difficulty to abstain predicted cigarette use over and above the readiness to change measures. Results:support the clinical utility of the Ruler and motivation to abstain as brief measures of readiness to change, and perceived difficulty to abstain as a tool to aid adolescent tobacco cessation.

Clark HK; Ringwalt CL; Shamblen SR. Predicting adolescent substance use: The effects of depressed mood and positive expectancies. Addictive Behaviors 36(5): 488-493, 2011. (52 refs.)

This study examined whether sixth-graders' depressed mood and positive substance use expectancies predicted increases over the next two years in students' lifetime and 30-day cigarette, alcohol, and marijuana use, and whether sixth graders' positive substance use expectancies moderated the relationship between baseline depressed mood and changes over the next two years in the use of these substances. Study data came from a randomized controlled trial of Project ALERT, a school-based substance use prevention program, in which students from 34 schools completed self-report surveys as sixth (n = 5782), seventh (n = 5065), and eighth graders (n = 4940). Primary analyses were performed using Hierarchical Nonlinear Modeling. Over time, there were significant effects of baseline positive expectancies on each of the six measures of substance use. Baseline depressed mood predicted increases over time only for lifetime use of cigarettes and alcohol, and for 30-day alcohol use. Positive expectancies significantly moderated the effects of adolescent depressed mood only on lifetime marijuana use. Although depressed mood predicted substance use for half of our variables, our results suggest that positive expectancies are a more consistent predictor of adolescent substance use, and that they may moderate the effects of depressed mood on marijuana, but not cigarette or alcohol, use. Substance use prevention programs may benefit from addressing adolescents' perceptions about the positive consequences of drug use.

Coleman T; Bauld L. Preventing adolescents' uptake of smoking. (editorial). Thorax 66(10): 842-844, 2011. (25 refs.)

Cullen J; Mowery P; Delnevo C; Allen JA; Sokol N; Byron MJ et al. Seven-year patterns in US cigar use epidemiology among young adults aged 18-25 years: A focus on race/ethnicity and brand. American Journal of Public Health 101(10): 1955-1962, 2011. (24 refs.)

Objectives. We examined patterns in cigar use among young adults, aged 18-25 years, focusing on race/ethnicity and brand. Methods. We conducted a secondary data analysis of cross-sectional waves of the National Survey on Drug Use and Health, 2002-2008, using multivariate logistic regression to assess time trends in past 30 days cigar use, past 30 days use of a "top 5" cigar brand, cigar use intensity, and age at first cigar use. Results. Cigar use has increased among White non-Hispanic men aged 18 to 25 years, from 12.0% in 2002 to 12.7% in 2008. Common predictors of all outcomes included male gender and past 30 days use of cigarettes, marijuana, and blunts. Additional predictors of past 30 days cigar and "top 5" brand use included younger age, non-Hispanic Black or White race, lower income, and highest level of risk behavior. College enrollment predicted intensity of use and "top 5" brand use. Conclusions. Recent legislative initiatives have changed how cigars are marketed and may affect consumption. National surveys should include measures of cigar brand and little cigar and cigarillo use to improve cigar use estimates.

Dake JA; Price JH; Ward BL; Welch PJ. Midwestern rural adolescents' oral sex experience. Journal of School Health 81(3): 159-165, 2011. (30 refs.)

BACKGROUND: This study examined the prevalence of oral sexual activity in rural Midwestern adolescents. We also examined the correlates of a series of risk behaviors with oral sexual activity. METHODS: A questionnaire based on the Youth Risk Behavior Surveillance System was distributed to 2121 rural middle and high school students in grades 6-12 across 5 rural counties in a Midwestern state. The schools within districts were stratified by grade level and a stratified random sample of schools was used (n = 49). RESULTS: A total of 2000 (94%) students completed the survey. The rural adolescents were: male (51%), White (85%), with an average age of 14.7 years (SD = 1.9). Overall, one-fourth (26%) of the students had engaged in sexual intercourse (8% of middle school and 39% of high school students). Slightly more than one-fourth of the students (29%) had engaged in oral sex (9% of middle school and 44% of high school students). Logistic regression was used to calculate adjusted odds ratios and found 3 risk behaviors were statistically significantly associated with oral sexual behavior: ever having had sexual intercourse (16.6 times more likely to engage in oral sex), having drunk alcohol in the past 30 days (2.2 times more likely), and having smoked 1 or more cigarettes in the past 30 days (2.0 times more likely). CONCLUSIONS: Oral sexual activity is an established component of many rural adolescents' sexual experiences. These findings have important implications for sex education programs targeted to rural adolescent youths.

Dall'Agnol MM; Fassa AG; Facchini LA. Child and adolescent labor and smoking: A cross-sectional study in southern Brazil. Cadernos De Saude Publica 27(1): 46-56, 2011. (38 refs.)

This cross-sectional study assessed the association between smoking and child and adolescent labor among 3,269 individuals 10 to 17 years of age in Pelotas, Rio Grande do Sul State, in southern Brazil (excluding higher income census tracts) in 1998. Adjusted hierarchical analysis was performed using Poisson regression. Prevalence of child labor was 13.8%. Current smoking prevalence was 6.3% in the sample as a whole (15.7% among working versus 3.4% among non-working children). In the multivariate analysis, smoking was significantly associated with child labor, with a prevalence ratio of 1.75 (95% CI: 1.30-2.36). Smoking was also associated with family characteristics (lower maternal schooling, mother currently without husband/partner, household members with alcohol or drug problems, single mother, and history of serious injuries), and the children's characteristics (age greater than 16 years, inadequate school performance, and externalizing behavior). The findings point to smoking as one of the harmful consequences of child labor and suggest the workplace as an appropriate target for smoking prevention.

Dar-Odeh NS; Abu-Hammad OA. The changing trends in tobacco smoking for young Arab women: Narghile, an old habit with a liberal attitude. Harm Reduction Journal 8: article 24, 2011. (28 refs.)

Narghile smoking by young females is becoming more acceptable than cigarettes in the conservative societies of Arab countries. Lack of social constraints on narghile smoking has resulted in an increased prevalence of narghile smoking among young Arab females and an earlier age of onset of this habit when compared to cigarette smoking. Documented health hazards of narghile smoking including pulmonary, cardiovascular and neoplastic ailments are consequently expected to affect this vulnerable sector of the population together with their offspring. In this commentary, we shed some light on the changing trend of tobacco use among young Arabic women as shown by an increasing number of studies investigating habits of tobacco use in young people.

de Araujo VA; Loukas A; Gottlieb NH. Examining differences between light and heavier smoking vocational students: A pilot study. Health Education Journal 70(1): 67-75, 2011. (20 refs.)

Objective: To examine differences between light and heavier smoking vocational/technical students in tobacco use, related behaviors, and cessation. Design: Cross-sectional. Setting and Methods: Two hundred and four smokers attending two vocational/technical colleges in east Texas, USA, completed an anonymous survey during a regularly scheduled class in Fall, 2004 or Spring, 2005. Results: Heavier smokers (39.7 per cent of the sample) were more likely than light smokers to be European American, to be dependent on cigarettes, to use cigarettes in a variety of situations, to use medication to quit smoking, and to be less likely to report a desire to quit on their own. The two groups did not differ on gender or the use of cigars and chewing tobacco. Conclusion: Given the disproportionately high rates of tobacco use among vocational/technical students, results from this study indicate that salient anti-tobacco programs that can be implemented at the vocational school and that target light and heavier smoking students are needed.

de Moor JS; Puleo E; Ford JS; Greenberg M; Hodgson DC; Tyc VL et al. Disseminating a smoking cessation intervention to childhood and young adult cancer survivors: Baseline characteristics and study design of the partnership for health-2 study. BMC Cancer 11(e-article 165), 2011. (40 refs.)

Background: Partnership for Health-2 (PFH-2) is a web-based version of Partnership for Health, an evidence-based smoking cessation intervention for childhood cancer survivors. This paper describes the PFH-2 intervention and baseline data collection. Methods: 374 childhood and young adult cancer survivors were recruited from five cancer centers and participated in the baseline assessment. At baseline, participants completed measures of their smoking behavior, self-efficacy and stage of change for quitting smoking as well as psychological and environmental factors that could impact their smoking behavior. Results: At baseline, 93% of survivors smoked in the past seven days; however, 89% smoked a pack or less during this period. Forty-seven percent were nicotine dependent, and 55% had made at least one quit attempt in the previous year. Twenty-two percent of survivors were in contemplation for quitting smoking; of those 45% were somewhat or very confident that they could quit within six months. Sixty-three percent were in preparation for quitting smoking; however, they had relatively low levels of confidence that they could quit smoking in the next month. In multivariate analyses, stage of change, self-efficacy, social support for smoking cessation, smoking policy at work and home, fear of cancer recurrence, perceived vulnerability, depression, BMI, and contact with the healthcare system were associated with survivors' smoking behavior. Discussions/Conclusions: A large proportion of the sample was nicotine dependent, yet motivated to quit. Individual- interpersonal- and environmental-level factors were associated with survivors' smoking behavior. Smoking is particularly dangerous for childhood and young adult cancer survivors. This population may benefit from a smoking cessation intervention designed to build self-efficacy and address other known predictors of smoking behavior.

Dean AC; Sugar CA; Hellemann G; London ED. Is all risk bad? Young adult cigarette smokers fail to take adaptive risk in a laboratory decision-making test. Psychopharmacology 215(4): 801- 811, 2011. (43 refs.)

Cigarette smoking has been linked to real-world risky behavior, but this association has been based largely on retrospective self-reports. Limitations of self-report data can be avoided by using laboratory, performance-based measures, such as the Balloon Analogue Risk Task (BART; Lejuez et al., J Exp Psychology Applied 8:75-84, 2002). Initial studies have suggested that smokers display greater risk-taking on this task than nonsmokers, but these studies did not account for drug abuse and psychiatric comorbidities, which are commonplace among smokers. We sought to examine the performance of smokers and nonsmokers on the BART after excluding drug abuse and psychiatric comorbidities. We conducted a study of late adolescent/young adult (age 18 to 21) smokers (n = 26) and nonsmokers (n = 38) performing the BART and excluded individuals with positive drug or alcohol toxicology screens, substance abuse or dependence diagnoses, and/or current psychiatric conditions. Contrary to previous findings, smokers did not display greater risk-taking on the BART than nonsmokers. In fact, when performance was examined trial-by-trial, the nonsmokers displayed progressively greater pumping relative to smokers over time (p < .001), earning them a nonsignificantly greater amount of money than the smokers. Controlling for smoking status, additional analyses revealed that pumping on the BART was positively associated with years of education, nonverbal IQ, and employment. The results suggest that in young adults, smoking may be associated with a failure to take risks in situations where risk-taking is adaptive.

Di Cosmo C; Milfont TL; Robinson E; Denny SJ; Ward C; Crengle S et al. Immigrant status and acculturation influence substance use among New Zealand youth. Australian and New Zealand Journal of Public Health 35(5): 434-441, 2011. (24 refs.)

Objective: To investigate the associations between generational status, acculturation and substance use among immigrant and non-immigrant secondary school students in New Zealand. Methods: A nationally representative sample of secondary school students in New Zealand was selected using a two-stage cluster sample design. Of the 8,999 students in the sample, 23.81% were first-generation immigrants and 20.90% were second-generation immigrants; the remaining 55.29% students are collectively referred to as 'non-immigrant' peers. Logistic regression models adjusted the associations of interest for age, gender, ethnicity, socioeconomic status and experience of ethnic discrimination. Results: First and second-generation immigrants showed significantly lower risks of smoking cigarettes compared with their non-immigrant peers. Similar trends were apparent for consuming alcohol and marijuana weekly. The inclusion of some characteristics suggestive of acculturation in multivariable models did not influence the relationship between generational status and smoking cigarettes, but attenuated the apparent protective effect of being a first-generation immigrant with regard to alcohol and marijuana use. Conclusions and implications: The study shows the lower likelihood of substance use among newer immigrants in a nationally representative sample of New Zealand youth. Policies and health programs that build on this positive profile and reduce the risk of adverse changes over time require attention.

Evans GW; Kutcher R. Loosening the link between childhood poverty and adolescent smoking and obesity: The protective effects of social capital. Psychological Science 22(1): 3-7, 2011. (30 refs.)

Pervasive, lifelong inequalities in physical health begin in early childhood and are driven, in part, by social gradients in risk factors such as smoking and obesity. Yet not all low-income children have elevated physical-health risks as adults. The relation between income-to-needs ratio at age 9 and smoking prevalence and body fat (body mass index) at age 17 was examined in a sample of 196 rural adolescents. Income-to-needs ratio is the U. S. federal government's defined index of household income as a proportion of the poverty line. This is the first study to show that links between childhood poverty and subsequent physical-health outcomes can be loosened. At-risk youth in communities with a relatively rich array of social capital did not smoke more or have greater excess body fat compared with their more affluent counterparts.

Fabian LEA; Bernat DH; Lenk KM; Shi Q; Forster JL. Smoke-free laws in bars and restaurants: Does support among teens and young adults change after a statewide smoke-free law? Public Health Reports 126(5): 669-676, 2011. (25 refs.)

Objective. We assessed changes in levels of support for smoke-free bars and restaurants among teens and young adults before and after implementation of a statewide smoke-free law. Methods. We measured support for smoke-free bars and restaurants among teens and young adults aged 16-24 years living in Minnesota (n=2,785) and five comparison states (n=404), up to 12 months before and up to six months after Minnesota's smoke-free law went into effect in October 2007. We compared changes in support among three subgroups Minnesota participants who lived with a previous local smoke-free law, Minnesota participants who did not live with a previous local smoke-free law, and participants from the comparison states before and after Minnesota's statewide smoke-free law went into effect. Results. Support for smoke-free restaurants and bars among participants in Minnesota and comparison states increased after Minnesota's smoke-free law went into effect. Minnesotans, both those living with and without a previous local smoke-free law, showed similar increases in support for smoke-free restaurants as participants in comparison states. However, Minnesotans living without a previous local law showed larger increases in support for smoke-free bars than both those in comparison states and those living in Minnesota with a previous local smoke-free law. Conclusions. Our study employed a more robust design than similar studies and focused on the teen and young adult population. Our results will help advocates and policy makers demonstrate how public support for smoke-free laws increases following smoke-free legislation, particularly among those who were not previously living with a local smoke-free law.

Fakier N; Wild LG. Associations among sleep problems, learning difficulties and substance use in adolescence. Journal of Adolescence 34(4): 717-726, 2011. (68 refs.)

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.

Flory K; Malone PS; Lamis DA. Childhood ADHD symptoms and risk for cigarette smoking during adolescence: School adjustment as a potential mediator. Psychology of Addictive Behaviors 25(2): 320-329, 2011. (69 refs.)

Although a large body of research suggests that children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for cigarette smoking during adolescence compared with their non-ADHD peers, much less research has examined why. The current study addressed this gap in the literature by examining middle school adjustment, broadly defined, as a possible mediator of the relation between childhood ADHD symptoms and cigarette smoking during middle adolescence (10th grade). Longitudinal data were collected from a community sample of 754 youth using self-report and parent report along with school records, and a novel statistical technique was used in the process of testing for mediation. Consistent with hypotheses, school adjustment was found to mediate the relation between childhood ADHD symptoms and later cigarette smoking, even after controlling for early externalizing problems. Results have implications for etiological theories of adolescent deviant behavior and suggest that successful smoking prevention programs targeting youth with ADHD should include a school adjustment component.

Forster J; Chen V; Perry C; Oswald J; Willmorth M. The Minnesota Adolescent Community Cohort Study: Design and baseline results. Prevention Science 12(2): 201-210, 2011. (54 refs.)

The Minnesota Adolescent Community Cohort (MACC) Study is a population-based, longitudinal study that enrolled 3,636 youth from Minnesota and 605 youth from comparison states ages 12 to 16 years in 2000-2001. Participants have been surveyed by telephone semi-annually about their tobacco-related attitudes and behaviors. The goals of the study are to evaluate the effects of the Minnesota Youth Tobacco Prevention Initiative and its shutdown on youth smoking patterns, and to better define the patterns of development of tobacco use in adolescents. A multilevel sample was constructed representing individuals, local jurisdictions and the entire state, and data are collected to characterize each of these levels. This paper presents the details of the multilevel study design. We also provide baseline information about MACC participants including demographics and tobacco-related attitudes and behaviors. This paper describes variability in smoking prevalence and demographic characteristics for local units, and compares MACC participants to the state as a whole.

Glantz SA; Mitchell S; Titus K; Polansky J; Kaufmann RB; Bauer UE. Smoking in top-grossing movies --- United States, 2010. MMWR. Morbidity and Mortality Weekly Review 60(27): 909-913, 2011. (10 refs.)

The National Cancer Institute has concluded that studies indicate a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. Adolescents in the top quartile of exposures to onscreen tobacco incidents have been found to be approximately twice as likely to begin smoking as those in the bottom quartile. o monitor tobacco use in movies, Thumbs Up! Thumbs Down! (TUTD), a project of Breathe California of Sacramento-Emigrant Trails, counts occurrences of tobacco incidents in U.S. top-grossing movies each year. In 2010, the number of onscreen tobacco incidents in youth-rated (G, PG, or PG-13) movies continued a downward trend, decreasing 71.6% from 2,093 incidents in 2005 to 595 in 2010. Similarly, the average number of incidents per youth-rated movie decreased 66.2%, from 20.1 in 2005 to 6.8 in 2010. The degree of decline, however, varied substantially by motion picture company. The three companies with published policies designed to reduce tobacco use in their movies had an average decrease in tobacco incidents of 95.8%, compared with an average decrease of 41.7% among the three major motion picture companies and independents without policies. This finding indicates that an enforceable policy aimed at reducing tobacco use in youth-rated movies can lead to substantially fewer tobacco incidents in movies and help prevent adolescent initiation of smoking. The findings in this report indicate continuing progress toward the U.S. Department of Health and Human Services goal of reducing youth exposure to onscreen smoking (3). Across all MPAA rating categories, the percentages of 2010 top-grossing movies with no tobacco incidents were the highest observed in 2 decades.

Public Domain

Gray KM; Riggs PD; Min SJ; Mikulich-Gilbertson SK; Bandyopadhyay D; Winhusen T. Cigarette and cannabis use trajectories among adolescents in treatment for attention-deficit/hyperactivity disorder and substance use disorders. Drug and Alcohol Dependence 117(2-3): 242-247, 2011. (52 refs.)

Background: Cigarette smoking is common in adolescents with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, little is known about the relationship between cigarette and cannabis use trajectories in the context of treatment for both ADHD and SUD. To address this research gap, we report collateral analyses from a 16-week randomized, controlled trial (n = 303) of osmotic-release methylphenidate (OROS-MPH) in adolescents with ADHD concurrently receiving cognitive behavioral therapy (CBT) targeting non-nicotine SUD. Methods: Participants completed cigarette and cannabis use self-report at baseline and throughout treatment. Analyses were performed to explore the relationships between cigarette smoking, cannabis use, and other factors, such as medication treatment assignment (OROS-MPH versus placebo). Results: Baseline (pre-treatment) cigarette smoking was positively correlated with cannabis use. Negligible decline in cigarette smoking during treatment for non-nicotine SUD was observed in both medication groups. Regular cigarette and cannabis users at baseline who reduced their cannabis use by >50% also reduced cigarette smoking (from 10.8 +/- 1.1 to 6.2 +/- 1.1 cigarettes per day). Conclusions: Findings highlight the challenging nature of concurrent cannabis and cigarette use in adolescents with ADHD, but demonstrate that changes in use of these substances during treatment may occur in parallel.

Griffiths MA; Harmon TR; Gilly MC. Hubble bubble trouble: The need for education about and regulation of hookah smoking. Journal of Public Policy & Marketing 30(1, special issue): 119- 132, 2011. (57 refs.)

A Middle Eastern tradition, hookah smoking involves burning flavored tobacco heated by charcoal, creating smoke that is filtered through water and ingested through the mouth using a hose. Hookah lounges are increasingly locating around college campuses in the United States, and websites offering hookah paraphernalia target U.S. high school and college students. In two studies involving interviews with college-age hookah smokers and analysis of website marketing practices, the authors investigate consumer beliefs and attitudes toward hookah smoking and the way it is portrayed online. The findings indicate that it is a social phenomenon, with young people introducing peers to the practice and websites promoting shared consumption experiences. Contrary to medical evidence, young people believe smoking sweetened tobacco through a hookah is nonaddictive and safer than cigarettes. Hookah lounges often are exempt from age restriction laws because many double as cafes and other eating establishments. Traditional tobacco warnings are not present in lounges or on websites. The findings highlight potential health dangers of hookah smoking and the need for education regarding this practice and demonstrate that regulatory oversight is needed.

Groth SW; Morrison-Beedy D. Smoking, substance use, and mental health correlates in urban adolescent girls. Journal of Community Health 36(4): 552-558, 2011. (25 refs.)

This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl's age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.

Guilamo-Ramos V; Dittus P; Holloway I; Bouris A; Crossett L. An integrated framework for the analysis of adolescent cigarette smoking in middle school Latino youth. Youth & Society 43(1): 193-224, 2011. (85 refs.)

A framework based on five major theories of health behavior was used to identify the correlates of adolescent cigarette smoking. The framework emphasizes intentions to smoke cigarettes, factors that influence these intentions, and factors that moderate the intention-behavior relationship. Five hundred sixteen randomly selected Latino middle school youth in New York completed self-administered questionnaires. Adolescents reported their intentions to smoke, smoking-related expectancies, normative pressures to smoke, image implications of smoking, emotional reactions to smoking, and self-efficacy with respect to smoking. The framework yielded high levels of association with intentions to smoke. Specific smoking-related emotions, norms, and expectancies were associated with the likelihood of smoking. The framework can help guide the development of effective interventions tailored to specific populations.

Guo H; Reeder AI; McGee R; Darling H. Adolescents' leisure activities, parental monitoring and cigarette smoking: A cross-sectional study. Substance Abuse Treatment, Prevention and Policy 6(e-article 12), 2011. (30 refs.)

Background: Adolescent participation in leisure activities is developmentally beneficial, but certain activities may increase health compromising behaviours, such as tobacco smoking. A limited range of leisure activities has been studied, with little research on out-of-school settings where parental supervision is a potential protective factor. Tobacco smoking is an important, potentially modifiable health determinant, so understanding associations between adolescent leisure activities, parental monitoring, demographic factors and daily smoking may inform preventive strategies. These associations are reported for a New Zealand adolescent sample. Methods: Randomly selected schools (n = 145) participated in the 2006 Youth In-depth Survey, a national, biennial study of Year 10 students (predominantly 14-15 years). School classes were randomly selected and students completed a self-report questionnaire in class time. Adjustment for clustering at the school level was included in all analyses. Since parental monitoring and demographic variables potentially confound relations between adolescent leisure activities and smoking, variables were screened before multivariable modelling. Given prior indications of demographic differences, gender and ethnic specific regression models were built. Results. and Discussion: Overall, 8.5% of the 3,161 students were daily smokers, including more females (10.5%) than males (6.5%). In gender and ethnic specific multivariate analysis of associations with daily smoking (adjusted for age, school socioeconomic decile rating, leisure activities and ethnicity or gender, respectively), parental monitoring exhibited a consistently protective, dose response effect, although less strongly among Maori. Attending a place of worship and going to the movies were protective for non-Maori, as was watching sports, whereas playing team sport was protective for all, except males. Attending a skate park was a risk factor for females and Maori which demonstrated a strong dose response effect. Conclusions: There were significant differences in the risk of daily smoking across leisure activities by gender and ethnicity. This reinforces the need to be alert for, and respond to, gender and ethnic differences in the pattern of risk and protective factors. However, given the consistently protective, dose response effect of parental monitoring, our findings confirm that assisting oversight of adolescent leisure activities may be a key component in public health policy and prevention programmes.

Gutman LM; Eccles JS; Peck S; Malanchuk O. The influence of family relations on trajectories of cigarette and alcohol use from early to late adolescence. Journal of Adolescence 34(1): 119-128, 2011. (41 refs.)

The present study examines growth curve trajectories of cigarette and alcohol use from 13 to 19 years, and investigates how family relations (i.e., decision-making opportunities, negative family interactions, and positive identification with parents) relate to contemporaneous and predictive alcohol and cigarette use during adolescence. Data came from a longitudinal study of European American and African American families from a range of socioeconomic backgrounds (n = 1160 for alcohol use; n = 1102 for cigarette use). European Americans had higher levels and faster rates of alcohol and cigarette use than African Americans. European Americans females had the greatest likelihood of increased cigarette use. Negative family interactions and positive identification had contemporaneous and predictive associations with alcohol and/or cigarette use. Negative family interactions were related to increased smoking and drinking, whereas positive identification was associated with decreased use. Family relations differentially affected cigarette use according to ethnicity and gender, but had similar effects on alcohol use.

Hawkins SS; Berkman L. Increased tobacco exposure in older children and its effect on asthma and ear infections. Journal of Adolescent Health 48(6): 647- 650, 2011. (10 refs.)

Purpose: To examine selected social determinants of children's exposure to household tobacco use and smoking inside the home and to assess the effect of second-hand smoke exposure on asthma and ear infections across children's age groups. Methods: A total of 90,961 parents of children aged 0-17 years from the 2007 National Survey of Children's Health were included in the study. Results: In all, 26.2% of parents reported that anyone in the household used tobacco products. Parents of children aged 6-11 and 12-17 years were 1.97 (adjusted OR; 95% CI, 1.65-2.36) and 2.93 (2.46-3.49) times more likely, respectively, to report that someone smoked inside the house than parents of younger children. Second-hand smoke exposure varied by children's race/ethnicity, and children from more disadvantaged circumstances were more likely to be exposed. For all children, they were more likely to ever have asthma if someone in their household used tobacco. Although young children's likelihood of recurrent ear infections did not increase with household tobacco use, children aged 12-17 were 1.67 (1.02-2.72) times more likely to have recurrent ear infections if someone smoked inside their home. Conclusion: Family members are increasingly likely to smoke indoors as children age, which may increase adolescents' vulnerability to ear infections. Parents and health professionals should monitor second-hand smoke exposure at home and encourage a smoke-free environment.

Hong T; Rice J; Johnson C. Social, environmental and individual factors associated with smoking among a panel of adolescent girls. Women & Health 51(3): 187- 203, 2011. (49 refs.)

This study assessed changes in the influence of social environmental and individual factorsand the interaction of these factors with timeon smoking prevalence for girls. Longitudinal panel surveys of adolescent girls (N = 921 in both 2000 and 2004) from schools in Louisiana were completed in the ninth grade (2000) and then again in the twelfth grade (2004). A fixed effects hierarchical multiple regression model assessed the relation of changes in social environmental and individual factors to smoking prevalence. Increases in smoking prevalence over time among adolescent girls were associated with their perceptions of themselves as overweight and perceiving low risk associated with smoking. Increases in smoking prevalence over time were also associated with having friends who smoked, perceptions of friends' approval of smoking, having family members who smoked, and having monetary discretionary spending. Having friends who smoked was more strongly associated with smoking in the twelfth grade than in the ninth grade. While more black adolescent girls smoked than did white girls in the ninth grade, by the twelfth grade, more white adolescents girls smoked than did black girls. Interventions that target adolescent girls should consider the temporal variability of individual and social environmental factors.

Horn K; Dino G; Branstetter SA; Zhang JJ; Noerachmanto N; Jarrett T et al. Effects of physical activity on teen smoking cessation. Pediatrics 128(4): E801-E811, 2011. (51 refs.)

OBJECTIVE: To understand the influence of physical activity on teen smoking-cessation outcomes. METHODS: Teens (N = 233; 14-19 years of age) from West Virginia high schools who smoked >1 cigarette in the previous 30 days were included. High schools with >300 students were selected randomly and assigned to brief intervention (BI), Not on Tobacco (N-O-T) (a proven teen cessation program), or N-O-T plus a physical activity module (N-O-T + FIT). Quit rates were determined 3 and 6 months after baseline by using self-classified and 7-day point prevalence quit rates, and carbon monoxide validation was obtained at the 3-month follow-up evaluation. RESULTS: Trends for observed and imputed self-classified and 7-day point prevalence rates indicated that teens in the N-O-T + FIT group had significantly higher cessation rates compared with those in the N-O-T and BI groups. Effect sizes were large. Overall, girls quit more successfully with N-O-T compared with BI (relative risk [RR]: >infinity) 3 months after baseline, and boys responded better to N-O-T + FIT than to BI (RR: 2-3) or to N-O-T (RR: 1-2). Youths in the N-O-T + FIT group, compared with those in the N-O-T group, had greater likelihood of cessation (RR: 1.48) at 6 months. The control group included an unusually large proportion of participants in the precontemplation stage at enrollment, but there were no significant differences in outcomes between BI and N-O-T (z = 0.94; P = .17) or N-O-T + FIT (z = 1.12; P = .13) participants in the precontemplation stage. CONCLUSIONS: Adding physical activity to N-O-T may enhance cessation success, particularly among boys.

Houser-Marko L; Curry SJ; Mermelstein RJ; Emery S; Pugach O. A comparison of mandated versus volunteer adolescent participants in youth tobacco cessation programs. Addictive Behaviors 36(9): 937-940, 2011. (14 refs.)

A national evaluation of community-based youth cessation programs delivered in group format provided the opportunity to compare mandated and volunteer program participants on demographics, smoking patterns, other health behaviors and motivation to quit. A total of 857 youth participants completed surveys prior to the start of their treatment program. Mandated youth comprised 24% of the sample (n = 202). Both bivariate and multivariate comparisons were conducted. Mandated participants reported lower levels of stress, higher extrinsic motivation and lower intrinsic motivation to quit, and were more likely to be in the earlier (precontemplation) stage of readiness to quit. Mandated and volunteer smokers did not differ in their smoking patterns, school-related smoking behaviors, or binge drinking. Rates of smoking, school problems, and binge drinking were higher among cessation program participants than in general samples of youth. Programs with mixed voluntaty-mandatory participation may benefit from extra attention to motivational issues.

Hum AM; Robinson LA; Jackson AA; Ali KS. Physician communication regarding smoking and adolescent tobacco use. Pediatrics 127(6): E1368-E1374, 2011. (27 refs.)

BACKGROUND: Physician advice increases quit rates 1% to 3% above unassisted quit rates among adults, an increase sufficient to be ranked as a high-priority, evidence-based preventive service. However, there is little research on the potential impact of physician advice on adolescent smoking. OBJECTIVE: The purpose of this study was to examine the association between recalled physician communication and adolescents' attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. METHODS: This study was a retrospective observational study of 5154 students (82.9% black, 17.1% white) from an urban, mid-South school system. Outcome variables included adolescents' self-rated attitudes toward smoking, knowledge about smoking, intentions to smoke, tobacco use, and quitting behaviors. RESULTS: Physician advice and the combination of screening and advice were associated with healthier attitudes about smoking. Physician screening and advice were also associated with a more accurate knowledge regarding tobacco-related damage. Among current smokers, recalled physician advice was also associated with reduced intentions to smoke in 5 years. Importantly, advised teens were more likely to plan to quit smoking in 6 months. Furthermore, teens who were screened by their physician reported significantly more quit attempts than those who were neither screened nor advised (P = .007). CONCLUSIONS: Physician's tobacco-related interactions with adolescents seemed to positively impact their attitudes, knowledge, intentions to smoke, and quitting behaviors. Brief physician interventions have the potential to be a key intervention on a public health level through the prevention, cessation, and reduction of smoking and smoking-related disease.

Hunt K; Henderson M; Wight D; Sargent JD. Exposure to smoking in films and own smoking among Scottish adolescents: A cross-sectional study. Thorax 66(10): 866-874, 2011. (37 refs.)

Background: Evidence of high exposure of UK youth to images of smoking in films has led to calls for an 18 rating for films with smoking to reduce smoking in youth. However, the only study to date in the UK to test for an association showed no relation between film-smoking exposure and smoking among young adults. Objective To assess whether there is an association between exposure to film images of smoking and own smoking among UK adolescents and whether repeated viewings of films has an impact. Design: Cross-sectional study. Participants 1999 pupils aged 15-16 years from 13 Scottish schools. Outcome Smoked tobacco in the past year. Exposure measure: Film-smoking exposure was assessed using the Beach method; account for repeated viewings of films was then used to modify estimated exposure. Covariates included: media usage, parental restriction on and context of TV/film viewing, family connectedness, parental monitoring and friends' smoking. Results Most (71%) students had not smoked in the past year. About half reported no parental restrictions on TV/film viewing. Many reported repeated viewings of films; accounting for this more than doubled exposure estimates and strengthened the association with smoking. Adolescents with high exposure to film smoking were more likely to have smoked than those with low exposure (adjusted odds ratio (AOR) 2.08, 95% CI 1.22 to 3.55). Additionally, adolescents who reported parental rules about TV/film watching were less likely to smoke (AOR 0.37 (0.27 to 0.52)) than those who did not. Adolescents who mainly watched films with friends had higher exposure to film smoking and were more likely to smoke (AOR 2.19 (1.10 to 4.38)). Conclusions: Exposure to film smoking is associated with smoking among Scottish adolescents. These data lend support to calls for an 18 rating for films with images of smoking.

James JE; Kristjansson AL; Sigfusdottir ID. Adolescent substance use, sleep, and academic achievement: Evidence of harm due to caffeine. Journal of Adolescence 34(4): 665-673, 2011. (45 refs.)

Using academic achievement as the key outcome variable, 7377 Icelandic adolescents were surveyed for cigarette smoking, alcohol use, daytime sleepiness, caffeine use, and potential confounders. Structural equation modeling (SEM) was used to examine direct and indirect effects of measured and latent variables in two models: the first with caffeine excluded and the second with caffeine included. A substantial proportion of variance in academic achievement, which might otherwise have been attributed to the harmful effects of cigarette smoking and alcohol use, was found to be attributable to caffeine. Evidence was obtained that daytime sleepiness, which was found to be independently associated with usage of licit substances (nicotine and alcohol) and caffeine, may be an important mediator of the negative impact of those substances on academic achievement. Findings suggest the importance of including measurements of caffeine consumption in future studies of adolescent substance use.

Jaworska N; McIntosh J; Villeneuve C; Thompson A; Fisher D; Milin R et al. Effects of nicotine on electroencephalography and affect in adolescent females with major depressive disorder: A pilot study. Journal of Addiction Medicine 5(2): 123- 133, 2011. (124 refs.)

Background: Given that smoking is typically initiated during adolescence, and that this period in brain development seems to be uniquely sensitive to nicotine, depressed youth may be most susceptible to the neuromodulatory and mood-altering effects of nicotine. Electroencephalographic (EEG) studies suggest that individuals with major depressive disorder (MDD) exhibit left frontal lobe hypoactivation (indexed by increased EEG alpha), a region implicated in positive affect regulation, as well as right parietal hypoactivation. Smoking/nicotine abstinence has been associated with increased left frontal and right parietal alpha activity (reduced activation), which has been correlated with increased depression ratings; nicotine administration seems to normalize this depression-associated asymmetry. Objectives: This pilot study investigated whether acute nicotine administration in adolescent female smokers with MDD would alter resting EEG activity and affect. Methods: Subjective mood ratings and EEG recordings were acquired before and 2 hours after administering a transdermal placebo or nicotine (21 mg) patch to 8 adolescent female smokers with MDD. Results: Nicotine induced a modest increase in alpha 1 amplitude in the right hemisphere and simultaneously decreased left-favoring alpha(1) amplitude asymmetry. It also attenuated left alpha(1) and alpha(2) amplitude in the central region. Consistent with nicotine's stimulatory action, nicotine decreased theta amplitude in the right parietal region. No accompanying mood alterations were found, although smoking withdrawal and craving as well as physical symptom scores were reduced with nicotine. Conclusions: The results of this pilot study, the first to examine the electrocortical effects of nicotine in depressed adolescents, indicate that nicotine modulates EEG asymmetry measures, laying the stage for further research regarding the role of nicotine on affective neurocircuitry in this population.

Jones SE; Kann L; Pechacek TF. Cigarettes smoked per day among high school students in the US, 1991-2009. American Journal of Preventive Medicine 41(3): 297-299, 2011. (16 refs.)

Background: Recent declines in current cigarette smoking among youth are encouraging, but less is known about the trends in the number of cigarettes smoked per day among youth. Purpose: This study examined trends in the number of cigarettes smoked per day among U. S. high school students during 1991-2009. Methods: Nationally representative data from the 1991-2009 national Youth Risk Behavior Surveys (YRBS) were analyzed in 2010. The YRBS is a biennial, school-based survey representative of 9th-through 12th-grade students in the U. S. Each survey year, students completed anonymous, self-administered questionnaires that included identically worded questions about cigarette use. The number of cigarettes smoked per day on smoking days was categorized as light smoking (< 1-5 cigarettes per day); moderate smoking (6-10 cigarettes per day); and heavy smoking (>= 11 cigarettes per day). Sample sizes ranged from 10,904 to 16,410. Overall response rates ranged from 60% to 71%. Results: During 1991-2009, among current cigarette users overall, light smoking increased from 67.2% to 79.4% and heavy smoking decreased from 18.0% to 7.8%. These trends were found among female and male students overall and white students. Among Hispanic students, light smoking remained stable, but heavy smoking significantly increased from 3.1% in 1991 to 6.4% in 2009. The prevalence of light, moderate, and heavy smoking did not change during 1991-2009 among black students. Conclusions: The finding that during 1991-2009 light smoking increased and heavy smoking decreased among current cigarette users is encouraging; however, even light smoking is detrimental to health and efforts to reduce all cigarette use should continue.

Kahn JA; Huang B; Ding LL; Geller A; Frazier AL. Impact of maternal communication about skin, cervical, and lung cancer prevention on adolescent prevention behaviors. Journal of Adolescent Health 49(1): 93-96, 2011. (10 refs.)

Purpose: To explore whether maternal communication about behaviors that prevent skin, cervical, and lung cancer is associated with adolescent cancer prevention behaviors. Methods: The study sample consisted of 10,409 girls and boys (14-21 years) who participated in a longitudinal survey study of U. S. adolescents. The independent variables were adolescent report of how often mothers had spoken with them (never, once, occasionally, sometimes, often) about sunscreen use, Pap screening, and quitting smoking. Outcome variables included adolescent self-report of sunscreen use, Pap screening, and quitting smoking (among past-year smokers). We used multivariate logistic regression models to determine whether maternal communication in 2001 was associated independently with the three adolescent cancer prevention behaviors in 2001 and 2003. Results: In adjusted logistic regression models, maternal communication about sunscreen use and Pap screening was positively associated with adolescent behaviors in 2001 and 2003, and maternal communication about quitting smoking was positively associated with adolescent behavior in 2001. Conclusions: In a national sample, maternal communication encouraging sunscreen use, Pap screening, and quitting smoking was associated with the corresponding behaviors in their adolescent children. The findings suggest that intergenerational interventions could enhance adolescent practice of cancer prevention behaviors.

Kalkhuis-Beam S; Stevens SL; Baumritter A; Carlson EC; Pletcher JR; Rodriguez D et al. Participant- and study-related characteristics predicting treatment completion and study retention in an adolescent smoking cessation trial. Journal of Adolescent Health 49(4): 371-378, 2011. (38 refs.)

Purpose: To determine which factors predict smoking cessation treatment completion and retention among adolescents. Methods: In a multisite, randomized, controlled trial, the efficacy of motivational interviewing was compared with structured brief advice for smoking cessation and reduction in adolescents (n = 355) aged 14-18 years (55% female, 45% black, 12% Hispanic). Treatment spanned 12 weeks, with follow-up assessments at 24 weeks. Treatment completion was defined as completion of all five counseling sessions. Study retention was defined as completing the 24-week assessment. Participant and study variables served as predictors of treatment completion and retention. Results: In all, 79% of participants completed all five counseling sessions and the same percent completed the 24-week assessment. Black race, precontemplation stage to cut back, and shorter length of time between the baseline assessment and the first counseling session were significantly associated with treatment completion. For every 7.5-day delay in starting treatment after the baseline visit, there was a 50% decrease in the odds of completing all five treatment sessions. Retention at 24 weeks was predicted by black race, younger age, greater maternal education, expectations of graduating college, and structured brief advice intervention. Conclusions: High rates of treatment completion and study retention can be achieved in a multisession, behavioral intervention for adolescent smoking cessation. Findings suggest that treatment should begin soon after the intake session to maximize treatment completion. Enhanced efforts to retain older adolescents and youth with lower academic goals and lower family income will be important in future studies.

Kaltiala-Heino R; Koivisto AM; Marttunen M; Frojd S. Pubertal timing and substance use in middle adolescence: A 2-year follow-up study. Journal of Youth and Adolescence 40(10, special issue): 1288-1301, 2011. (45 refs.)

Earlier research has associated early puberty with emotional and behavioral symptoms particularly among girls, while among boys, findings have been contradictory as to whether risks are associated with early or late pubertal timing. We studied the association between pubertal timing and substance use behaviors in middle adolescence in a 2-year follow up study of 2,070 (mean age 15.5 years, SD 0.36; 56.4% females) Finnish adolescents. Pubertal timing was measured by age at menarche/oigarche. Eleven years or less was classified as early, 12-13 years as normative and 14 years or later as late pubertal timing. Substance use behaviors were elicited by a number of questions related to alcohol use patterns, smoking and cannabis use. As factors that could explain the association between pubertal timing and substance use, we studied depressive symptoms, delinquency and aggression, and parental monitoring. In boys, all these substance use behaviors were the more common the earlier the puberty and the associations persisted at age 17. Among girls, early pubertal timing was similarly associated with substance use behaviors at age 15, but no longer at age 17. The associations between pubertal timing and substance use behaviors persisted when symptom dimensions and parental monitoring were added into the models. Early puberty is a risk factor for substance use particularly among boys. Among girls, the impact of pubertal timing already tempers off during adolescence.

Keeshin BR; Campbell K. Screening homeless youth for histories of abuse: Prevalence, enduring effects, and interest in treatment. Child Abuse & Neglect 35(6): 401-407, 2011. (34 refs.)

Objectives: To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse. Methods: Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse. Results: Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse. Conclusions: Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.

Kelly B; Baur LA; Bauman AE; King L. Tobacco and alcohol sponsorship of sporting events provide insights about how food and beverage sponsorship may affect children's health. Health Promotion Journal of Australia 22(2): 91-96, 2011. (48 refs.)

Issue addressed: Determining children's exposure to food and beverage company sponsorship, and the effect of this exposure, is important in establishing the extent to which there may be health and societal consequences. This paper aimed to provide preliminary evidence on the scope and potential effects on children of unhealthy food and beverage sponsorship. Methods: A review of published literature and media and marketing reports was conducted to determine the types of food and beverage sponsorship campaigns that children are exposed to, and the effect of corporate sponsorship (including tobacco and alcohol) on children and adolescents. Results: A large range of food and beverage sponsorship activities, in Australia and internationally, were identified for both school and sport settings. In particular, food and beverage companies have attempted to develop a marketing presence at all levels of professional and community sport. No information was identified measuring the effect of food and beverage company sponsorship on children and adolescents. However, empirical evidence from consumer studies relating to tobacco and alcohol sponsorship has repeatedly demonstrated that sponsorship has an impact on children's product recall and product-related attitudes and behavioural intentions. Conclusions: While there is no available research on the direct effect of food and beverage sponsorship, the demonstrated effects of tobacco and alcohol sponsorship on children's product awareness, preferences and consumption are likely to be applicable to food companies.

King G; Gilreath TD; Albert EH; Flisher AJ. Smoking among high school male students in rural South Africa. Journal of Substance Use 16(4): 282-294, 2011. (46 refs.)

Few studies examine smoking in rural areas of countries in Africa. This study examines the roles of families, community influences, and key sociodemographic factors and school-age smoking among adolescent boys in rural South Africa. A total of 1,116 black male students were included in this analysis. Descriptive analyses were conducted, and multiple logistic regression (MLR) models were developed to analyze outcomes. The dependent variables were lifetime smoking, recent smoking, and age of smoking initiation. Sociodemographic variables and students' perceptions of community, family, and school were employed as independent variables. MLR analysis revealed family structure and discipline were found to be significant predictors of adolescent male smoking behavior as well as age, number of household amenities, town and smoking behavior. Adolescents in developing countries are increasingly subjected to tobacco industry promotion and exploitation. The results show that males in rural South Africa are not isolated from the tobacco epidemic.

Kostova D; Ross H; Blecher E; Markowitz S. Is youth smoking responsive to cigarette prices? Evidence from low- and middle-income countries. Tobacco Control 20(6): 419-424, 2011

Objective: To estimate the price elasticity of cigarette demand among youth in low- and middle-income countries (LMIC). Data The Global Youth Tobacco Survey was used to obtain data on the smoking behaviour of 315�353 adolescents from 17 LMIC. Design: Two-part model of cigarette demand with country fixed effects. The first part estimates the impact of prices on smoking participation while the second part estimates the impact of prices on the number of cigarettes smoked among current smokers. Besides controlling for individual characteristics such as age, gender, parental smoking and availability of pocket money, the authors control for confounding environmental factors such as anti-smoking sentiment, the prevalence of cigarette advertising and anti-tobacco media messages, and ease of purchasing cigarettes. All countries in this study are represented with at least two observations over time, which allows us to control for unobserved country characteristics and/or policies that may influence smoking patterns within countries. Results: Cigarette price is an important determinant of smoking. The estimated price elasticity of smoking participation is -0.74, and the estimated price elasticity of conditional cigarette demand is approximately -1.37. The total price elasticity of cigarette demand is -2.11, implying that an increase in price of 10% would reduce youth cigarette consumption by 21.1% at the mean.

Kracmarova L; Klusonova H; Petrelli F; Grappasonni I. Tobacco, alcohol and illegal substances: Experiences and attitudes among Italian university students. Revista da Associacao Medica Brasileira 57(5): 523-528, 2011

The purpose of this research was to assess the prevalence of addictive drug use among students of University of Camerino (Italy) and to verify aspects related to substance use in this population. The survey was carried out in the form of anonymous questionnaires completed by 345 participants. Chi-square test was used for statistic evaluation. Most students have experienced legal addictive substances: 28.0 % of participants smoke cigarettes regularly and 23.2 % of respondents have admitted regular alcohol consumption. In addition, 50.4 % of subjects have already tried an illegal drug; the most used substance was cannabis (46.7 %), followed by cocaine (13.3 %). Our results confirmed the increased experimental use of cannabis among young people in Europe and showed a long-term use of drugs, particularly cocaine, among university students.

Kulis S; Marsiglia FF; Ayers SL; Calderon-Tena CO; Nuno-Gutierrez BL. Gender Differences in Drug Resistance Skills of Youth in Guanajuato, Mexico. Journal of Primary Prevention 32(2): 113-127, 2011. (55 refs.)

Research is limited or absent on Mexican adolescents' exposure to substance offers, ways of dealing with these offers, and possible gender differences in responses to offers. Extending U.S.-based research, this study examines how youth living in the Mexican state of Guanajuato employ the four drug resistance strategies-refuse, explain, avoid, and leave-that are part of the Keepin' It REAL evidence-based drug prevention intervention. The analysis uses cross-sectional survey data from 702 students enrolled in eight alternative secondary education sites in 2007. Participants reported the drug resistance behaviors they used to deal with offers of alcohol, cigarettes, and marijuana. Using multivariate regression, findings indicate most youth had developed repertoires of drug resistance strategies that involved multiple REAL strategies and some other strategy as well. For those receiving offers, the most common strategy was to refuse the offer with a simple "no." However, males used all the strategies significantly more often than females for situations involving cigarettes and marijuana as well as when using refuse and non-REAL strategies for alcohol. Possible reasons for the gender difference in use of strategies are discussed. The findings can help inform effective prevention programs based on teaching culturally appropriate drug resistance and communication skills.

Laffman-Johnson E. Understanding the long-term effects of nicotine addiction in adolescence. (editorial). Clinical Pharmacology & Therapeutics 90(1): 15-15, 2011. (0 refs.)

Lane NE; Leatherdale ST; Ahmed R. Use of nicotine replacement therapy among Canadian youth: Data from the 2006-2007 National Youth Smoking Survey. Nicotine & Tobacco Research 13(10): 1009-1014, 2011. (34 refs.)

Introduction: In Canada, nicotine replacement therapy (NRT) is a best practice for adult smoking cessation, but it is not recommended for use among youth smokers. The purpose of this study was to determine the prevalence of NRT use among youth smokers in Canada and examine factors associated with its use. Methods: Data from 41,886, Grade 9-12 students who participated in the 2006-2007 Youth Smoking Survey were used to determine prevalence of NRT use. Logistic regression models were conducted to examine the association between NRT use by smoking status, demographic characteristics, and exposure to tobacco control programs. Results: In 2006-2007, 20.4% of current and former youth smokers in Canada had ever used NRT and 7.4% were currently using NRT. Among ever and current NRT users, 17.7% and 23.7%, respectively, had never tried to quit smoking. Odds of NRT use were highest among current smokers, older youths, boys, youths who had made multiple quit attempts, and youths with no disposable income. Participation in cessation counseling was significantly associated with increased NRT use, whereas attending antismoking classes in school was inversely associated with using NRT. Conclusions: A substantial number of Canadian youth use NRT, despite restrictions on its sale to this population. This study identifies characteristics associated with youths using NRT. Research is needed to elucidate mechanisms by which characteristics identified in this study affect NRT use. For example, it may be important to understand whether attending smoking cessation counseling induces NRT use in youths or vice versa.

Langley TE; Huang Y; Lewis S; McNeill A; Coleman T; Szatkowski L. Prescribing of nicotine replacement therapy to adolescents in England. Addiction 106(8): 1513-1519, 2011. (24 refs.)

Aims: In November 2005, the indications for nicotine replacement therapy (NRT) were broadened in the United Kingdom, making all forms available to 12-17-year-olds. This study aimed to estimate the effects of this change on prescribing of NRT to adolescents in England. Design Segmented regression analysis of primary care data on prescribing of nicotine replacement therapy using general additive mixed models. Setting A total of 350 general practices in England included in The Health Improvement Network (THIN), a database of UK electronic primary care records. Participants All 12-17-year-old patients registered with a THIN practice in England. Measurements Monthly rates of prescribing of NRT per 100 000 12-17-year-old patients registered with a THIN practice between January 2002 and June 2009. Findings Prescribing of NRT was highest in 16-17-year-olds and extremely low in 12-13-year-olds, generally fewer than 10 prescriptions per 100 000 adolescents per month. Girls tended to be prescribed NRT more frequently than boys. In 12-17-year-olds rates of prescribing were increasing prior to the broadening of indications, and there was no step change, but the rate of increase was lower, after the indications were broadened. Conclusions: Recent changes to the marketing licence for nicotine replacement therapy in England to include adolescents appear to have had little or no effect on prescribing practices.

Leatherdale ST; Ahmed R; Vu M. Factors associated with different cigarette access behaviours among underage smoking youth who usually smoke contraband (native) cigarettes. Canadian Journal of Public Health 102(2): 103- 107, 2011. (24 refs.)

Objectives: Given that little is known about how youth access contraband cigarettes, the current study seeks to examine factors associated with how underage smoking youth report usually accessing contraband cigarettes. Methods: This study used nationally representative data collected from 41,886 students (grades 9 to 12) as part of the 2006-07 Canadian Youth Smoking Survey (YSS). Using data from current smokers who report that their usual brand of cigarettes is contraband, three logistic regression models were used to examine factors associated with buying cigarettes from a store, getting cigarettes from a family member, or getting cigarettes from friends or strangers. Results: In 2006, 7.9% (n=13,300) of Canadian youth who were current smokers reported that their usual brand of cigarettes was contraband. Among these youth, the majority reported that they usually get their cigarettes from a friend or stranger (54.8%), whereas 26.4% report usually getting them from a family member and 18.8% usually buying their own from a store. Boys were more likely to buy contraband cigarettes from a store, whereas youth with a parent who smokes contraband cigarettes were substantially more likely to get contraband cigarettes from a family member and youth with friends who smoke contraband cigarettes were substantially more likely to get contraband cigarettes from a friend or stranger. Conclusion: Ongoing surveillance of contraband cigarette use among youth and how youth access contraband cigarettes is required for guiding future tobacco control policy and programming activities.

Leatherdale ST; Rios P; Elton-Marshall T; Burkhalter R. Cigar, cigarillo, and little cigar use among Canadian youth: Are we underestimating the magnitude of this problem? Journal of Primary Prevention 32(3-4): 161-170, 2011. (30 refs.)

Data from 29,296 students in grades 9-12 as part of the 2008-2009 Youth Smoking Survey were used to examine the prevalence of cigar, cigarillo, and little cigar use and factors associated with their use. Among Canadian youth in grades 9-12, 12.9% reported current use of cigarillos or little cigars, and 8.1% reported current use of cigars. The characteristics of youth most likely to use either cigars or cigarillos and little cigars were being male, being in grade 11 or 12, being a daily or occasional cigarette smoker, having more than $20 of weekly spending money, and having ever tried flavored tobacco. Our findings suggest that cigars, cigarillos, and little cigars are used by a substantial number of Canadian youth, many of whom do not smoke cigarettes. As such, current national prevalence estimates of youth smoking may be underestimated, and existing tobacco control prevention programs and policies may be overlooking a large population of at-risk youth.

Legleye S; Baumann M; Peretti-Watel P; Beck F; Chau N. Gender and age disparities in the associations of occupational factors with alcohol abuse and smoking in the French working population. Revue d'Epidemiologie et de Sante Publique 59(4): 223-232, 2011. (52 refs.)

Background. - This study assessed the associations of short-term employment, physical and psychological occupational demands, and job dissatisfaction with alcohol abuse (using the Audit-C test) and daily smoking among working French men and women in different age groups. Methods. - The sample included 13,241 working people, 18-29, 30-39, and 40-59-years-old, randomly selected in France and interviewed by phone. Occupation, type of employment, physical demands, psychological demands, job dissatisfaction, gender, age, educational level, and income were considered. Data were analyzed with logistic models. Results. - Alcohol abuse affected 20.4% of men and 7.5% of women; smoking 32.1% and 24.2%, respectively. Their patterns of association with the occupational factors varied with gender and age. Job dissatisfaction was the leading factor among young men (adjusted odds ratio for alcohol abuse and smoking: 1.71 and 2.02), whereas short-term employment was the leading factor among young women (1.69 and 1.58), this pattern being reversed in older generations. The pattern of associations of physical and psychological demands with outcomes is more complex, but overall psychological demands were more important for women (especially the younger ones) than men, especially for smoking (OR > 1.6). Smoking within 5 min after waking was much more common among male and female smokers with these occupational factors, suggesting a potential dependency. Conclusions. - Workers with short-term employment and occupational demands are subject to a higher risk for alcohol abuse and smoking with high gender and age disparities. Gender and age should be considered when designing measures to prevent substance abuse related to occupation.

Legleye S; Janssen E; Beck F; Chau N; Khlat M. Social gradient in initiation and transition to daily use of tobacco and cannabis during adolescence: A retrospective cohort study. Addiction 106(8): 1520-1531, 2011. (81 refs.)

Aims: This study explores whether the family socio-economic status (F-SES) and school situation could have an impact on tobacco and cannabis initiation and transition to daily use during adolescence. Design and setting A French cross-sectional nation-wide survey conducted in 2005 containing retrospective data. Participants French teenagers aged 17 (n = 29 393). Measurement The F-SES was defined by the highest occupational category of either parent, with seven categories ranging from unemployed/inactive to managers/professionals. Ages at repeat school years, at leaving school, at the first episode of drunkenness and at initiation of illicit drug use were used to model tobacco and cannabis initiation and transition to daily use with time-discrete logistic regressions. Findings The risk for tobacco initiation was almost equally distributed across F-SES groups, but the risk of a progression to daily use was higher in every F-SES category compared to managers/professionals [ odds ratio (OR) from 1.17 to 1.90]. Compared to managers/professionals, risk of cannabis initiation was lower in all F-SES categories (OR from 0.63 to 0.87), but all categories except farmers were at increased risk of transition to daily use: the OR range between 1.29 (intermediate) and 1.98 (unemployed/inactive). Repeating school years and leaving school predicted daily use of tobacco (OR = 2.00 and 2.37) and cannabis (4.58 and 2.07). Conclusions: Adolescents from the highest family socio-economic status categories are at risk for tobacco and cannabis experimentation but are less prone to engage in daily use. Psychological and social mechanisms that inhibit transition to daily use should be investigated, including school attainment and performance.

Lessov-Schlaggar CN; Wahlgren DR; Liles S; Jones JA; Ji M; Hughes SC et al. Sensitivity to secondhand smoke exposure predicts smoking susceptibility in 8-13-year-old never smokers. Journal of Adolescent Health 48(3): 234-240, 2011. (41 refs.)

Purpose: To investigate the sensitivity to secondhand smoke exposure (SHSe) in preteens aged 8-13 years who have never smoked, and to determine whether it predicts smoking susceptibility. Methods: We assessed the sensitivity to SHSe using reactions commonly used for the assessment of sensitivity to the first-smoked cigarette (e. g., feeling dizzy), and investigated the factor structure of these reactions for the purpose of data reduction. We examined the association of each reaction measure and summary score with demographic characteristics and smoking susceptibility, using logistic regression and ordinal logistic regression. Results: One factor was identified that captured the physical and/or unpleasant reactions. Older preteens and preteens with more highly educated parents reported fewer reactions to SHSe. More African American preteens reported feeling relaxed or calm compared with all other racial/ethnic groups. Experiencing physical and/or unpleasant reactions to SHSe predicted lower risk for smoking susceptibility. Conclusions: This was the first study to extend analytical methodology for sensitivity to active smoking to sensitivity to SHSe in youth who had never smoked. Results suggest a desensitization process with age and lower sensitivity to some reactions in preteens from more highly educated households. Preteens who have more aversive experiences with SHSe tend to be less susceptible to smoking than those who experience fewer aversive reactions. Assessment of sensitivity to SHSe is a novel approach to the study of cigarette use etiology and may contribute to better prediction of smoking initiation.

Lin DH; Li XM; Fan XH; Fang XY. Child sexual abuse and its relationship with health risk behaviors among rural children and adolescents in Hunan, China. Child Abuse & Neglect 35(9): 680-687, 2011. (40 refs.)

Objective: The current study was designed to explore the prevalence of child sexual abuse (CSA) and its association with health risk behaviors (i.e., smoking, alcohol use, binge drinking, suicidal ideation, and suicide attempt) among rural children and adolescents in China. Methods: A sample of 683 rural children and adolescents (8 to 18 years of age) completed an anonymous questionnaire which assessed experiences of CSA and 5 health risk behaviors. Data on several potential confounding factors were also collected. Results: A total of 123(18%) respondents reported experiencing at least 1 kind of CSA before 16 years of age, with more boys reporting CSA than girls (21.5% vs. 14.2%). In addition, attending non-boarding schools, lower levels of self-esteem, and higher levels of perceived peer pressure for engagement in health risk behaviors were associated with higher rates of CSA. Multivariate logistic regression analyses revealed that CSA experience was significantly associated with cigarette smoking (aOR = 2.14), binge drinking (aOR = 2.68), suicidal ideation (aOR = 1.69), and suicide attempt (aOR = 2.69) after controlling for several demographic and psychological factors. Conclusion: More attention should be paid to the issues of CSA among rural children and adolescents in China. Effective CSA prevention intervention needs to address the vulnerabilities of the population, increase children's and parents' awareness of CSA and ability of self-protection.

Lyons A; Britton J. Protecting young people from smoking imagery in films: Whose responsibility? (editorial). Thorax 66(10): 844-846, 2011. (20 refs.)

Malmberg K; Edbom T; Wargelius HL; Larsson JO. Psychiatric problems associated with subthreshold ADHD and disruptive behaviour diagnoses in teenagers. Acta Paediatrica 100(11): 1468-1475, 2011. (31 refs.)

Aim: To study the coexistence of subthreshold diagnoses of both attention deficit hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD) with other symptoms of child and adolescent psychiatric disorders as well as risk behaviours associated with smoking, alcohol and drug use. Methods: A population-based sample of twins including 177 girls and 135 boys was interviewed using the Swedish version of Kiddie-SADS Present and Lifetime Version (K-SADS-PL). Subthreshold diagnoses were compiled based on the ADHD and DBD criteria, where each criterion was assessed as 'possible' or 'certain' according to K-SADS-PL. The odds ratios (OR) between the subthreshold diagnoses and each of the screening questions in K-SADS-PL were calculated. Results: Subthreshold diagnoses of ADHD and DBD coexisted with the screening questions concerning depression, mania, panic attack, phobias, anorexia nervosa, motor tics and posttraumatic stress disorder (PTSD) in girls. In boys, these subthreshold diagnoses coexisted with symptoms of depression and PTSD. For both boys and girls, smoking and high alcohol consumption contributed to a high OR with regard to ADHD and DBD. Conclusion: Subthreshold diagnoses of ADHD and DBD were risk factors for several other psychiatric symptoms as well as smoking and high alcohol consumption. Thus, a broad clinical assessment is needed for adolescents with such preliminary diagnoses.

Martin V; Molina AJ; Fernandez D; Fernandez T; de Abajo S; Delgado M. Effectiveness of a course on the prevention and control of the smoking habit on its prevalence and incidence among students of health sciences. Journal of Advanced Nursing 67(4): 747-755, 2011. (31 refs.)

Aim. This paper is a report of the effectiveness of a tobacco use prevention and control course on health sciences students' smoking prevalence and incidence. Background. Although it is known that the intervention of health professionals in their patients' tobacco use can be affected by their own habit, very few studies have analysed the effect of specific tobacco-oriented training on smoking among health science students. Methods. This study is a quasi-experimental study of community intervention. During the years 2005-2008, a total of 290 health science students on the intervention campus and 256 on the control campus took part in the study. In the former, the intervention consisted of a course on the prevention and control of tobacco use for students, which was not offered on the control campus. Data about tobacco use and socio-demographic variables were collected by means of a questionnaire before and 6 months after the intervention. Results. Prevalence of tobacco use decreased in the intervention group (-1 center dot 1%) and increased in the control group (1 center dot 5%). The risk of acquiring the habit was almost three times higher in the control group than in the intervention group and the probability of cessation was 40% higher in the intervention group and correlated with nicotine dependence. Conclusion. The intervention suggests the effect on habit acquisition was slight but not so on cessation. Preventive interventions should be carried out before students go to university, while more specific cessation programmes are required to reduce tobacco use among students.

McCart MR; Zajac K; Danielson CK; Strachan M; Ruggiero KJ; Smith DW et al. Interpersonal victimization, posttraumatic stress disorder, and change in adolescent substance use prevalence over a ten-year period. Journal of Clinical Child and Adolescent Psychology 40(1): 136-143, 2011. (30 refs.)

Epidemiological studies have identified recent declines in specific types of adolescent substance use. The current study examined whether these declines varied among youth with and without a history of interpersonal victimization or posttraumatic stress disorder (PTSD). Data for this study come from two distinct samples of youth (12-17 years of age) participating in the 1995 National Survey of Adolescents (N=3,906) and the 2005 National Survey of Adolescents-Replication (N=3,423). Results revealed significant declines in adolescents' use of cigarettes and alcohol between 1995 and 2005; use of marijuana and hard drugs remained stable. Of importance, declines in nonexperimental cigarette use were significantly greater among youth without versus with a history of victimization and declines in alcohol use were significantly greater among youth without versus with a history of PTSD.

McDade TW; Chyu L; Duncan GJ; Hoyt LT; Doane LD; Adam EK. Adolescents' expectations for the future predict health behaviors in early adulthood. Social Science & Medicine 73(3): 391-398, 2011. (49 refs.)

Health-related behaviors in adolescence establish trajectories of risk for obesity and chronic degenerative diseases, and they represent an important pathway through which socio-economic environments shape patterns of morbidity and mortality. Most behaviors that promote health involve making choices that may not pay off until the future, but the factors that predict an individual's investment in future health are not known. In this paper we consider whether expectations for the future in two domains relevant to adolescents in the U.S.-perceived chances of living to middle age and perceived chances of attending college-are associated with an individual's engagement in behaviors that protect health in the long run. We focus on adolescence as an important life stage during which habits formed may shape trajectories of disease risk later in life. We use data from a large, nationally representative sample of American youth (the US National Longitudinal Study of Adolescent Health) to predict levels of physical activity, fast food consumption, and cigarette smoking in young adulthood in relation to perceived life chances in adolescence, controlling for baseline health behaviors and a wide range of potentially confounding factors. We found that adolescents who rated their chances of attending college more highly exercised more frequently and smoked fewer cigarettes in young adulthood. Adolescents with higher expectations of living to age 35 smoked fewer cigarettes as young adults. Parental education was a significant predictor of perceived life chances, as well as health behaviors, but for each outcome the effects of perceived life chances were independent of, and often stronger than, parental education. Perceived life chances in adolescence may therefore play an important role in establishing individual trajectories of health, and in contributing to social gradients in population health.

Millett C; Polansky JR; Glantz SA. Government inaction on ratings and government subsidies to the US film industry help promote youth smoking. (editorial). PLoS Mediciine 8(8): e1001077, 2011. (38 refs.)

Minnix JA; Blalock JA; Marani S; Prokhorov AV; Cinciripini PM. Self-efficacy mediates the effect of depression on smoking; Susceptibility in adolescents. Nicotine & Tobacco Research 13(8): 699-705, 2011. (42 refs.)

Introduction: Research indicates that negative affect and/or depression is associated with increased prevalence for smoking and higher levels of nicotine dependence in adults and adolescents. A previous study with adult smokers attempting to quit indicated that low levels of self-efficacy partially mediated depression's adverse effect on posttreatment cessation. Method: The current study attempted to test self-efficacy as a potential mediator between depressive symptoms and smoking susceptibility in adolescents. One thousand and ninety-three nonsmoking high-school students who were part of a large clinical trial evaluating an interactive CD-ROM-based smoking prevention/cessation curriculum (project ASPIRE) were included in this analysis. These students completed an extensive battery before treatment and 18 months after treatment, which included measures of depression, self-efficacy, smoking status, and smoking susceptibility. Results: Results indicated that self-efficacy partially mediated the positive relationship between baseline depressive symptoms and susceptibility to smoke at 18 months, accounting for approximately 27% of the variance. Conclusions: Perhaps future interventions to prevent smoking in adolescents can target self-efficacy potentially resulting in more effective outcomes, particularly in adolescents with current depressive symptoms or who may be at risk for future depression.

Mistry R; McCarthy WJ; de Vogli R; Crespi CM; Wu QA; Patel M. Adolescent smoking risk increases with wider income gaps between rich and poor. Health & Place 17(1): 222-229, 2011. (45 refs.)

Data from a state-wide survey of California middle and high school students (N=20,203) were used to assess whether county income inequality and poverty rates were associated with adolescent smoking. Greater county income inequality, but not poverty rates, was associated with higher established smoking risk (p=0.0019). The association was stronger in males than females, whites than other ethnic groups, and urban than rural settings. Neither county income inequality nor poverty rates were associated with experimental smoking. The findings suggest that it may be important to consider and address economic inequality in the prevention and control of adolescent tobacco use.

Mlinaric A; Grle SP; Nadalin S; Skurla B; Munivrana H; Milosevic M. Passive smoking and respiratory allergies in adolescents. European Review for Medical and Pharmacological Sciences 15(8): 973-977, 2011. (23 refs.)

Objective: The aim of our study was to investigate impact of active and passive smoking on total and specific serum IgE levels and on incidence of developing allergic diseases (i.e. asthma, rhinitis) in a group of Croatian adolescents. Methods: Our study consisted of random sample of one hundred fifty-five (155) voluntary pupils (80 males and 75 females), with mean age of 16.72 +/- 1.25 years, from one high school in the city of Varazdin (north-west part of Croatia). Their smoking habits were examined by interview administered by a single trained survey worker while diagnosis of allergic disease (i.e. asthma and allergic rhinits) had to be previously confirmed by physician. Total and specific serum IgE levels were determined using enzyme-linked immunosorbent assay (ELISA) method in Central Laboratory of Clinic for lung diseases Jordanovac, Zagreb (Croatia). Results: Statistically significant higher prevalence of allergic diseases was found in the group of passive smokers as opposed to nonsmokers (chi(2)=9.29, p=0.002) as well as in active smokers compared to nonsmokers (chi(2)=4.45, p=0.034). Also, total IgE (IU/ml) was significantly higher in passive smokers when compared to non-smokers (t=13.039, p < 0.01), and in passive smokers as opposed to active smokers as well (t=4.960, p < 0.01), while difference in its level between active smokers and non-smokers was not statistically significant. The level of specific IgE to Dermatophagoides pteronyssinus between active smokers, passive smokers and non-smokers resulted to be not statistically significant. Conclusions: Results of the study indicate that clinical manifestations of allergic diseases are more frequent in smokers (both active and passive) than in nonsmokers. Our investigation leads us to a presumption of a possibly more harmful effect of passive than active smoking in the adolescent high school population. Statistically highest IgE level in passive smokers as opposed to non-smokers or smokers could be attributed to longer duration of exposure to tobacco smoke in passive smokers and tobacco's potential cumulative effect on allergic senzitisation, although investigations with more precised and detailed mesures including higher number of participants are warranted.

Morgenstern M; Poelen EAP; Scholte R; Karlsdottir S; Jonsson SH; Mathis F et al. Smoking in movies and adolescent smoking: Cross-cultural study in six European countries. Thorax 66(10): 875-883, 2011. (41 refs.)

Aim To investigate whether the association between exposure to smoking in movies and smoking among youth is independent of cultural context. Method: Cross-sectional survey of 16 551 pupils recruited in Germany, Iceland, Italy, the Netherlands, Poland and Scotland with a mean age of 13.4 years (SD = 1.18) and an equal gender distribution. School-based surveys were conducted between November 2009 and June 2010. Using previously validated methods, exposure to movie smoking was estimated from the 250 top-grossing movies of each country (years 2004-2009) and related to ever smoking. Results: Overall, 29% of the sample had tried smoking. The sample quartile (Q) of movie smoking exposure was significantly associated with the prevalence of ever smoking: 14% of adolescents in Q1 had tried smoking, 21% in Q2, 29% in Q3 and 36% in Q4. After controlling for age, gender, family affluence, school performance, television screen time, number of movies seen, sensation seeking and rebelliousness and smoking within the social environment (peers, parents and siblings), the adjusted ORs for having tried smoking in the entire sample were 1.3 (95% CI 1.1 to 1.5) for adolescents in Q2, 1.6 (95% CI 1.4 to 1.9) for Q3 and 1.7 (95% CI 1.4 to 2.0) for Q4 compared with Q1. The adjusted relationship between ever smoking and higher movie smoking exposure levels was significant in all countries with a non-linear association in Italy and Poland. Conclusions: The link between smoking in movies and adolescent smoking is robust and transcends different cultural contexts. Limiting young people's exposure to movie smoking could have important public health implications.

Morrell HER; Song AV; Halpern-Felsher BL. Earlier age of smoking initiation may not predict heavier cigarette consumption in later adolescence. Prevention Science 12(3): 247-254, 2011. (55 refs.)

Previous studies suggest that earlier cigarette smoking initiation in adolescence predicts greater cigarette consumption later in adolescence or adulthood. Results from these studies have been used to inform interventions for adolescent smoking. However, previous studies suffer from several important methodological limitations. The objective of the present study was to address these limitations by longitudinally and prospectively examining whether and how age of initiation of smoking among adolescents predicts cigarette consumption by age 16 or 17. Participants completed an in-class survey every 6 months for 2-3 school years. Participants included 395 adolescents (Mean age = 14 years at baseline; 53.2% female) from two public high schools in Northern California (Schools A and B) who completed self-report measures of smoking initiation, number of friends who smoke, and number of whole cigarettes smoked by the final survey time point. Adolescents who were older when they first smoked one whole cigarette were 5.3 to 14.6 times more likely in School A and 2.9 to 4.3 times more likely in School B to have smoked a greater number of cigarettes by age 16 or 17. Results suggested that earlier smoking initiation may not lead to heavier cigarette consumption later in time, as has been previously shown. There may be a period of heightened vulnerability in mid- or late adolescence where smoking experimentation is more likely to lead to greater cigarette consumption. Targeting prevention efforts to adolescents aged 14 to 17 years may further reduce smoking initiation among youth, thus limiting subsequent smoking-related morbidity and mortality in adulthood.

Morris CD; May MG; Devine K; Smith S; DeHay T; Mahalik J. Multiple perspectives on tobacco use among youth with mental health disorders and addictions. American Journal of Health Promotion 25(5, Supplement S): S31-S37, 2011. (53 refs.)

Purpose. Youth and young adults with mental health disorders and addictions are at a high risk of becoming nicotine dependent, and at least half will die of tobacco-related diseases. In comparison to the general population, this population also faces neurobiological and psychosocial vulnerabilities. There is a critical need for community services and research targeting tobacco interventions for these individuals. Methods. A concurrent mixed methods study was conducted by collecting data from in-depth key informant interviews, focus groups, and a survey. Qualitative key informant interviews with healthcare professionals (n = 11) and youth focus groups (n = 32) were conducted by using semi-structured questioning regarding barriers and facilitators to tobacco interventions. Content analysis was used to code transcripts and categorize themes. Survey data were also collected from 230 smokers ages 13 to 17 years (n = 62) and young adults ages 18 to 25 years (n = 40) at three community mental health centers. The survey inquired about tobacco use, motivation to quit, history of quit attempts, and treatment preferences. Results. Five thematic categories were identified in both the adult key informant interviews and the focus groups with youth: (1) motivation to quit, (2) cessation treatment needs, (3) social influence, (4) barriers to treatment, and (5) tobacco-free policy. Among those surveyed, 44% currently smoked. Youth and young adult survey respondents who smoked were often motivated to quit, few had used proven tobacco cessation aids, but there was interest in access to nicotine replacement therapy. Conclusion. Merged qualitative and quantitative findings support past literature regarding youth in the general population but also expand upon our knowledge of issues specific to youth and young adults with mental health disorders and addictions. Findings suggest interventions warranting further attention in community treatment settings.

Muenster E; Zier U; Letzel S; Ochsmann E; Weirich HH; Toschke AM. Low social support and further risk factors for nicotine abuse in childhood and adolescence in Germany. Social Work in Health Care 50(3): 230-241, 2011. (46 refs.)

The health hazards of tobacco consumption are well known; numerous prevention programs exist, but knowledge of risk factors for starting to smoke is scarce. This study addressed the question if school-related factors influence smoking behavior in 7-17-year-old pupils. A cross-sectional study including 2459 pupils of schools in Rhineland-Palatinate, Germany, was conducted. Roughly every twentieth child (n = 135, 4.5%) had smoked at least once. In the multivariate model the probability of smoking was associated with older age, being male, not being content, and having inadequate family support, as well as with feeling unfairly treated at school. These findings suggest the imposition of gender- and age-adequate prevention with a focus on social support from school and parents to decrease the number of juvenile smokers.

Myers MG; Gwaltney CJ; Strong DR; Ramsey SE; Brown RA; Monti PM et al. Adolescent first lapse following smoking cessation: Situation characteristics, precipitants and proximal influences. Addictive Behaviors 36(12): 1253-1260, 2011. (46 refs.)

Despite increased attention to adolescent smoking cessation, little is known about adolescent relapse following a quit attempt. To address this issue, the present study was designed to provide initial information regarding the characteristics of adolescent lapses to smoking following abstinence. Included in the present study were 204 adolescent participants in four independent smoking cessation trials. For the full sample, participants averaged 15.99 (1.27) years of age; 56% were female and 78% were white. Lapse characteristics and precipitants were assessed using the Adolescent Smoking Relapse Review. Three domains of the lapse experience were assessed: lapse situation characteristics. precipitants of use in the situation, and proximal influences (i.e., potential precipitants occurring on the same day, prior to the lapse situation). Participant reports indicated that the modal lapse situation occurred in the evening while socializing with friends at home. Urges or cravings and social pressure were commonly endorsed as occurring in lapse situations. The most frequently reported proximal influence was desire for a cigarette, followed by abstinence-violation cognitions (okay to smoke occasionally, wanted to see what it would be like) and negative emotions. The findings indicate that a broad range of factors appear to influence adolescent smoking lapse and commend the value of incorporating content relevant to managing social and affective cues, strategies for inhibiting the prepotent response to ask for a cigarette, addressing cognitions regarding the difficulty of not smoking (i.e., cessation expectancies) and combating perceptions of the ability to smoke occasionally.

Ningombam S; Hutin Y; Murhekar MV. Prevalence and pattern of substance use among the higher secondary school students of Imphal, Manipur, India. National Medical Journal of India 24(1): 11- 15, 2011. (17 refs.)

Background. Substance use often begins in adolescence. We did a study to describe substance use and its associated factors among adolescent students in Imphal. Methods. We defined substance use as the use of licit and illicit substance other than when medically indicated. Using a WHO self-administered questionnaire, we collected information about substance use from 61 randomly selected students of 17 government/private higher secondary schools. We calculated the prevalence of substance use according to selected characteristics. Results. We surveyed 1020 students, 551 of whom reported prior substance use (prevalence of ever use: 54%, 95% confidence interval [CI] 42%-67%). Prevalence of recent and current user was 35% (95% CI 28%-43%) and 22% (95% CI 17%-28%), respectively. Among ever users, tobacco (46%) was used most commonly, followed by alcohol (29%), cannabis (14%) and opiates (12%). On multivariate analysis, substance use was significantly higher among boys (adjusted odds ratio [AOR] 2.6, 95% CI [2.0-3.4]), whose father (AOR 2.0, 95% CI 1.6-2.7) or sibling (AOR 2.1, 95% CI 1.5-3.0) used substance. It was significantly lower among children of Hindu/Jain religion (AOR 0.5, 95% CI 0.4-0.7). Conclusion. Prevalence of tobacco and alcohol use was high among students. Familial use of substances was associated with the behaviour of adolescents. Friends were the key proximal determinant. We recommend introducing a substance use prevention policy in schools to educate students about various adverse effects and to impart refusal skills.

Nonnemaker JM; Farrelly MC. Smoking initiation among youth: The role of cigarette excise taxes and prices by race/ethnicity and gender. Journal of Health Economics 30(3): 560-567, 2011. (35 refs.)

Existing evidence for the role of cigarette excise taxes and prices as significant determinants of youth smoking initiation is mixed. A few studies have considered the possibility that the impact of cigarette taxes and prices might differ by gender or race/ethnicity. In this paper, we address the role of cigarette taxes and prices on youth smoking initiation using the National Longitudinal Survey of Youth 1997 cohort and discrete-time survival methods. We present results overall and by gender, race/ethnicity, and gender by race/ethnicity. We examine initiation over the age range during which youth are most at risk of initiation and over a period in which substantial changes have occurred in tax and price. The result for cigarette excise taxes is small and mixed across alternative specifications, with the effect strongest for black youth. Cigarette prices are more consistently a significant determinant of youth smoking initiation, especially for black youth.

Nuno VL; Zhang QH; Harris RB; Wilkinson-Lee AM; Wilhelm MS. Smoking susceptibility among students followed from grade six to eight. Addictive Behaviors 36(12): 1261-1266, 2011. (27 refs.)

Background: Smoking is a leading risk factor for heart disease and cancer. By identifying factors associated with smoking onset, more effective prevention programs can be developed. Research questions are 1) does smoking susceptibility status change from grade six to eight, 2) are indicators of risk (perceived harm, smoking susceptibility status, positive peers, and resilience) measured in sixth grade associated with smoking susceptibility status in eighth grade and, 3) are there differences by gender in either research question? Methods: The current study is a secondary analysis of data collected during the evaluation of a Safe Schools Healthy Students Project. Students were followed from grade six to grade eight, with survey data collected in each grade from August 2006 to December 2008. Participants (n = 577) were in grade six at baseline, 52% were girls and 57% identified as White, non-Hispanic. Results: From grade six to grade eight the number of students in the high smoking susceptibility status doubled (5% to 17%). More boys than girls moved into the high susceptibility group over time. By eighth grade, boys were twice as likely to belong to the high smoking susceptibility group compared to girls (p = 0.01). Multiple logistic regression models showed that the positive peers' variable in grade six was protective for girls in their reported smoking susceptibility in grade eight. In contrast, higher resilience scores in grade six were protective for boys' reported smoking susceptibility in grade eight. Conclusions: Smoking susceptibility rose over time for all adolescents, but boys had notably sharper increases. Positive peers and having resources important to resilience may be beneficial in preventing the attitudes that support smoking initiation. Based on these results, we recommend gender-tailored, school-based smoking prevention programs that begin in grade six.

O'Cathail SM; O'Connell OJ; Long N; Morgan M; Eustace JA; Plant BJ et al. Association of cigarette smoking with drug use and risk taking behaviour in Irish teenagers. Addictive Behaviors 36(5): 547-550, 2011. (20 refs.)

Background: Cigarette smoking has been shown to act as a 'gateway' to cannabis use and further risk taking behaviours. This study aims to (1) establish the prevalence of cigarette smoking and cannabis use in Irish teenagers, (2) to quantify the strength and significance of the association of cigarette smoking and cannabis use and other high risk behaviours and (3) examine whether the above associations are independent of the extent of social networking. Methods: Adolescent students across five urban, non-fee paying schools completed an abridged European schools survey project on alcohol and other drugs (ESPAD) questionnaire. Results: 370/417 (88.7%) students completed the questionnaire. 228 (61.6%) were female, 349 (94.3%) were aged 15-16 years. 48.4% of those surveyed had smoked tobacco at some stage in their lifetime, 18.1% in the last 30 days. 15.1% have used cannabis with 5.7% using it in the last 30 days. 29.6% of cigarette smokers have used cannabis in comparison to 1.6% of non-smokers. On multivariate analysis lifetime cigarette smoking status was independently associated with hard drug use, adjusted OR = 6.0, p < 0.01: soft drug use, adjusted OR = 4.6, p < 0.01 and high risk sex practises, adjusted OR = 10.6, p < 0.05. Conclusions: Cigarette smoking prevalence remains high in Irish teenagers and is significantly associated with drug use and other risk taking behaviours. Specific teenage smoking cessation strategies need to be developed targeting these combined high risk health behaviours.

Oesterle S; Hawkins JD; Hill KG. Men's and women's pathways to adulthood and associated substance misuse. Journal of Studies on Alcohol and Drugs 72(5): 763-773, 2011. (62 refs.)

Objective: Social role transitions have been linked to changes in substance use and misuse during young adulthood. This study examined how commonly observed pathways to adulthood, defined by education, employment, marriage, and parenthood, were associated with alcohol, tobacco, and marijuana misuse from ages 18 to 33. Method: Data came from a longitudinal panel of 412 men and 396 women recruited when they were in fifth grade in Seattle public schools in 1985. Participants were followed through age 33 in 2008, with 92% retention. Results: Young adults who had little postsecondary education and remained unmarried through age 30 generally had the highest rates of substance misuse. Those who were involved in postsecondary education and postponed family formation had the lowest rates, particularly with respect to daily smoking and nicotine dependence. Parenting during the young adult years was associated with lower rates of substance misuse for both men and women. However, taking on parenting responsibilities early, during the late teen years and early 20s (observed mostly for women), was associated with higher rates of tobacco misuse. Differences in substance misuse by pathways to adulthood were fairly constant across the young adulthood years and were already observed at age 18, suggesting that substance misuse patterns are established early. Conclusions: Young adults may change their substance use only partially in response to new freedoms and responsibilities in young adulthood. Preventive efforts should include a focus on early initiation of substance use and educational experiences that move people into life trajectories and associated substance misuse patterns.

Page RM; Danielson M. Multi-country, cross-national comparison of youth tobacco use: Findings from Global School-based Health Surveys. Addictive Behaviors 36(5): 470-478, 2011. (38 refs.)

Objective: Describe the prevalence of current cigarette smoking and other tobacco use among 13-15 year olds across 44 countries and 110 sites participating in the Global School-based Health Survey (GSHS), and compare these results with previous findings from the Global Youth Tobacco Survey. Methods: The GSHS is conducted in countries using standardized sampling and survey methodology procedures. Smoking and other tobacco use prevalence was compiled from fact sheets available on the GSHS web site from the available 110 sites where the survey has been conducted and resulting data processed. Tobacco use prevalence rates are weighted to adjust for the probabilities of nonresponse and varying probabilities of selection. Boy to girl ratios were calculated to examine gender differences in tobacco use prevalence. Results: Current smoking rates ranged widely from a low of approximately 1 in 100 students in Tajikistan and India to a high of more than 1 in 4 students in certain sites in Chile and Colombia, and more than 1 in 5 in other sites in Chile, Ecuador, Argentina, and Colombia. Other tobacco use prevalence ranged from a low of 1.0% in Hangzhou, China to a high of 43.7% in Northwest Namibia. Conclusion: This is the first multi-country, cross-national study of tobacco use involving GSHS data. Results provide an opportunity to examine youth tobacco use in several countries and compare results with the Global Youth Tobacco Survey (GYTS) which is a more extensive global surveillance of youth tobacco use.

Page RM; Piko BF; Balazs MA; Struk T. Social normative beliefs regarding cigarette smoking in Hungarian adolescents. Pediatrics International 53(5): 662-668, 2011. (35 refs.)

Background: Hungary will continue to experience a high burden of disease and death from lung cancer and other tobacco-induced disease unless there is a significant reduction in youth smoking. Social factors have been found to be among the most important determinants of adolescent smoking, yet few studies have investigated social normative beliefs in Hungarian youth. The purpose of the current study was to investigate three measures of smoking normative beliefs thought to influence adolescent smoking: perceived prevalence of smoking; perceived popularity of smoking among successful/elite elements of society; and perceived disapproval by friends and family. Methods: A cross-sectional school-based survey of eighth grade (n = 258) and 12th grade (n = 288) students in Mako, Hungary was conducted to assess social normative beliefs about smoking, current smoking, ever smoking, and susceptibility to smoking. The association of the normative beliefs with the smoking behavior variables was examined through logistic regression analysis, and the underlying factor structure of the normative belief items in the current sample was determined through factor analysis. Results: The percent of boys reporting current smoking was 40.5% in 12th grade and 27.0% in eighth grade. Among girls, the percent was 44.0% of 12th graders and 29.1% of eighth graders. Parent/peer disapproval was the most consistently associated normative belief with smoking behavior and susceptibility to smoking across both samples. Conclusions: Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

Park SE; Yoon SN; Yi Y; Cui W; Nam B. Prevalence and risk factors of adolescents smoking: Difference between Korean and Korean-Chinese. Asian Nursing Research 5(3): 189-195, 2011. (54 refs.)

Purpose: The purpose of this study was to compare smoking prevalence and risk factors of smoking between Korean and Korean-Chinese middle school students. Methods: Data was collected from seventh and eighth grade students from 12 schools in Korea and 6 schools in China. Descriptive statistics, Chi-square test, and t test were performed. Results: For data analysis 10,002 usable surveys were utilized. The smoking prevalence was higher in Korean-Chinese students than in Korean students. Risk factors, such as father smoking, friends smoking, gender, grade, academic achievement, alcohol use, and family income were associated with current smoking, and the differences in the two samples were significant. Korean-Chinese students were more likely than Korean students to have friends who smoked and a father who smoked. Smokers had a significantly higher rate of friends smoking, father smoking, and alcohol use. Korean-Chinese male students smoking prevalence was more than three times higher than Korean students. Korean students could sense a more anti-tobacco atmosphere in their environment. Korean-Chinese students were more likely than Korean students to perceive that it was easy to buy cigarettes and to smoke cigarettes in a public computer room. Conclusion: These results highlight the differences of smoking prevalence and risk factors between Korean-Chinese students and Korean students. The findings may help health educators and researchers to better understand adolescent smoking and risk factors cross culturally and aid in the development of more effective education programs, which could lead to preventing tobacco use among these populations.

Patten CA; Hughes CA; Lopez KN; Thomas JL; Brockman TA; Smith C et al. Web-based intervention for adolescent nonsmokers to help parents stop smoking: A pilot feasibility study. Addictive Behaviors 31(1): 85-91, 2011. (38 refs.)

A novel approach to tobacco control is to engage adolescent nonsmokers in support roles to encourage and help their parents stop smoking. This pilot study examined the feasibility and potential efficacy of a web-based support skills training (SST) intervention for adolescents to help a parent stop smoking. Forty nonsmoking adolescents 13-19years of age (70% female, 93% White) were enrolled and randomly assigned to a health education (HE) control group (n=20) or SST (n=20). Both consisted of written materials and five weekly, 30min, web-based, counselor-facilitated group sessions. Parents were enrolled for assessments only. Adolescents and parents completed assessments at baseline, week 6 (post-treatment), week 12 and 6-months follow-up. Both interventions were feasible based on treatment acceptability ratings, study retention and treatment compliance. The biochemically confirmed 6-month smoking abstinence rate was higher for parents linked to teens in HE (35%, 7/20) than in SST (10%, 2/20), p=0.13. About half of parents in each group reported a quit attempt since study enrollment. Teens can be engaged to help parents stop smoking. Future research is warranted on determining effective intervention approaches.

Peters J; Bromberg U; Schneider S; Brassen S; Menz M; Banaschewski T et al. Lower ventral striatal activation during reward anticipation in adolescent smokers. American Journal of Psychiatry 168(5): 540- 549, 2011. (32 refs.)

Objective: Adolescents are particularly vulnerable to addiction, and in the case of smoking, this often leads to long-lasting nicotine dependence. The authors investigated a possible neural mechanism underlying this vulnerability. Method: Functional MRI was performed during reward anticipation in 43 adolescent smokers and 43 subjects matched on age, gender, and IQ. The authors also assessed group differences in novelty seeking, impulsivity, and reward delay discounting. Results: In relation to the comparison subjects, the adolescent smokers showed greater reward delay discounting and higher scores for novelty seeking. Neural responses in the ventral striatum during reward anticipation were significantly lower in the smokers than in the comparison subjects, and in the smokers this response was correlated with smoking frequency. Notably, the lower response to reward anticipation in the ventral striatum was also observed in smokers (N= 14) who had smoked on fewer than 10 occasions. Conclusions: The present findings suggest that a lower response to reward anticipation in the ventral striatum may be a vulnerability factor for the development of early nicotine use.

Pierce JP; Messer K. Commentary on White et al. (2011): Smoke-free policies within a comprehensive program coincident with major declines in teen smoking. (editorial). Addiction 106(8): 1503-1504, 2011. (11 refs.)

Pisarska A; Ostaszewski K. Medicine use among Warsaw ninth-grade students. Drugs: Education, Prevention and Policy 18(5): 361-370, 2011. (45 refs.)

Aim: This study examined the prevalence of medicine use for headache, stomachache, difficulties in getting to sleep, nervousness, depression and lack of energy among 15- to 16-year-old students; the relationship between medicine use and students' health status; and the relationship between medicine and nicotine, illegal drug, and alcohol use. Methods: Data were collected from a random sample of ninth-grade students attending Warsaw middle schools (N = 722, 47% females). The self-administered anonymous questionnaire was completed during school lessons. Findings: For a period of 1 month, 52% of the students used medicines for headache and 41% for stomachache at least 1-2 times. The most prevalent pain relievers were over-the-counter medicines based on paracetamol, ibuprofen and drotaverine. A smaller proportion of students (10-13%) used herbal agents to address mental health problems, including difficulties in getting to sleep, nervousness and bad mood. Girls were more likely to use pain relievers and medicines for nervousness. The results of logistic regression showed that after controlling for gender, all variables related to health status increased risk of medicine use for mental health problems. Cigarette smoking was associated with medicine use for headache. No association was found, however, between medicine use and use of alcohol and illicit drugs. This may suggest that medicine use and consumption of other psychoactive substances constitute two distinct phenomena.

Poulin F; Kiesner J; Pedersen S; Dishion TJ. A short-term longitudinal analysis of friendship selection on early adolescent substance use. Journal of Adolescence 34(2): 249- 256, 2011. (31 refs.)

There is a strong empirical connection between individual and peer substance use during adolescence. The determination of whether this level of covariation reflects influence or selection is obscured by both the design and measurement strategies used. This present study utilizes a short-term longitudinal design with bi-monthly assessments to address the following two hypotheses: a) Adolescents select friends on the basis of their substance use, and b) New friend substance use predicts changes in future use. French Canadian adolescents (n = 143) were interviewed on their friendship networks and substance use behaviors (e.g., tobacco, alcohol and marijuana) four times during a school year. Cross-lag panel models revealed that adolescents who use substances tend to select new friends who use. Moreover, once in the network, these new friends also contribute to changes in the adolescents' substance use. These findings are relevant to understanding the multiple functions of adolescent substance use.

Qing Y; Termsirikulchai L; Vatanasomboon P; Sujirarat D; Tanasugarn C; Kengganpanich M. Factors related to tobacco use among middle school students in China. Southeast Asian Journal of Tropical Medicine and Public Health 42(5): 1249-1261, 2011. (29 refs.)

The objectives of this study were to determine the status of tobacco use among middle school students in China, and to identify factors related to tobacco use. The study was conducted in December 2009. An ecological model was used to formulate the conceptual framework of the study. Three thousand two hundred twenty-one middle school students aged 12-17 years were selected by three stage stratified cluster sampling. Data were collected by self-completed questionnaires and interviews. The prevalence of current smoking was 10.6%; 16.2% among males and 4.3% among females. The prevalence of ever having smoked was 19.7%, 25.3% among males and 13.4% among females. Zero point seven percent of middle school students used other forms of smoked tobacco products other than cigarettes. Multinomial logistical regression analysis found gender, age, knowledge, attitude, life skills, self-concept, parental smoking, friends smoking, friends attitudes toward smoking, peer pressure, family rules, availability of cigarettes, tobacco-free school environment, smoking intervention program, community tobacco control activities, and tobacco control policies had significant associations with smoking behavior. Structural equation modeling (SEM) analysis found intrapersonal factors had direct relationships with smoking behavior among smoking middle school students. Interpersonal factors, organizational factors and policies had indirect relationships with smoking behavior, and through intrapersonal factors affected smoker behavior among middle school smoking students.

Racicot S; McGrath JJ; O'Loughlin J. An investigation of social and pharmacological exposure to secondhand tobacco smoke as possible predictors of perceived nicotine dependence, smoking susceptibility, and smoking expectancies among never-smoking youth. Nicotine & Tobacco Research 13(10): 926-933, 2011. (36 refs.)

Introduction: Recent studies evidenced that adolescent never-smokers exposed to secondhand tobacco smoke (SHS) endorsed nicotine dependence symptoms. Other studies showed that SHS exposure measured with biomarkers among never-smokers independently predicted withdrawal sensations and prospective smoking initiation. The aim of the present study was to replicate and extend these findings by investigating whether social and pharmacological measures of SHS exposure predicted precursors to smoking among never-smoking adolescents. Methods: Participants included 327 never-smokers aged 11-15 years attending sixth or seventh grade in French language schools in Montreal, Canada. They completed self-report questionnaires measuring their smoking status, social smoke exposure (number of smokers in their environment and number of situations where SHS exposure occurs), and precursors to smoking initiation (smoking expectancies, perceived nicotine dependence, and smoking susceptibility). Each participant provided a saliva sample from which cotinine biomarkers were derived to measure pharmacological exposure to SHS. Results: When predictors were modeled individually, number of smokers predicted perceived nicotine dependence (p <= .05), smoking susceptibility (p <= .001), and expected benefits (p <= .05), whereas number of situations predicted smoking susceptibility (p <= .01). When predictors were modeled simultaneously, number of smokers predicted perceived nicotine dependence (p <= .01), smoking susceptibility (p <= .01), and expected benefits (p <= .05). Conclusions: Social smoke exposure was a predictor for smoking precursors. Pharmacological exposure to SHS did not predict smoking precursors, which may be partly attributable to the low cotinine values observed in our sample. Suggestions for improved pharmacological measurement of SHS and implications for public health are discussed.

Rahman MM; Ahmad SA; Karim MJ; Chia HA. Determinants of smoking behaviour among secondary school students in Bangladesh. Journal of Community Health 36(5): 831-838, 2011. (30 refs.)

Despite established country's tobacco control law, cigarette smoking by the young people and the magnitude of nicotine dependence among the students is alarming in Bangladesh. This study was aimed to determine the prevalence of smoking and factors influencing it among the secondary school students. A two-stage cluster sampling was used for selection of schools with probability proportional to enrollment size followed by stratified random sampling of government and private schools. The 70-item questionnaire included 'core GYTS' (Global Youth Tobacco Survey) and other additional questions were used to collect relevant information. Analysis showed that the prevalence of smoking was 12.3% among boys and 4.5% among girls, respectively. The mean age at initiation of smoking was 10.8 years with standard deviation of 2.7 years. Logistic regression analysis revealed that boys are 2.282 times likely to smoked than girls and it was 1.786 times higher among the students aged 16 years and above than their younger counterparts. Smoking by teachers appeared to be the strong predictor for students smoking behaviour (OR 2.206, 95% CI: 1.576, 3.088) followed by peer influence (OR 1.988, 95% CI: 1.178, 3.356). Effective smoking prevention program should to be taken to reduce smoking behaviour. The school curricula had less impact in preventing smoking except teacher's smoking behaviour.

Raisamo SU; Doku DT; Rimpela AH. Adolescents' self-reported reasons for using nicotine replacement therapy products: A population-based study. Addictive Behaviors 36(9): 945-947, 2011. (11 refs.)

Background: Available research provides evidence that adolescents use nicotine replacement therapy (NRT) products. Yet, little is known about reasons and motives behind their use. The present study examined the reasons for NRT use among 14-18-year-old Finnish adolescents. Method: A national Adolescent Health and Lifestyle Survey was conducted in Finland in 2009 (N=4834, response rate 55%). Main measures were prevalence of NRT use, self-reported reasons for using NRT and smoking status. Results: Overall, 10% had used NRT. Boys used NRT more often than girls (11.5% versus 8.7%, p<.001). The three most commonly reported reasons were 'just try' (56%), 'to quit' (33%) and 'smoking not possible' (24%). "Just try" was the most common reason given by non-smokers/experimental smokers whereas daily/occasional smokers used NRT mainly for quitting purposes and when smoking was impossible. Conclusions: These findings suggest that when planning treatment plans for adolescent smokers, health care personnel should pay particular attention to adolescents' primary reasons and motives for using NRT before suggesting its use.

Ratcliff MB; Jenkins TM; Reiter-Purtill J; Noll JG; Zeller MH. Risk-taking behaviors of adolescents with extreme obesity: Normative or not? Pediatrics 127(5): 827- 834, 2011. (67 refs.)

OBJECTIVE: Present first published data detailing high-risk behaviors of adolescent high school students (HSS) with extreme obesity (BMI >= 99th percentile for age and gender) compared with healthy weight peers (5th-84th percentile). METHODS: The 2007 Youth Risk Behavior Survey was used to compare HSS with extreme obesity (N = 410) and healthy weight peers (N = 8669) in their engagement in (1) tobacco use, (2) alcohol/other drug use, (3) high-risk sexual behaviors, and (4) suicidal behaviors. Logistic regression was used to calculate gender-stratified odds ratios (OR) and 95% confidence intervals (CI), controlling for age and race. RESULTS: HSS with extreme obesity were similar to healthy weight peers in the prevalence of most behaviors related to alcohol/drug use, high-risk sexual activities, and suicide, with the following exceptions: relative to healthy weight HSS, both male and female students with extreme obesity more frequently reported ever trying cigarettes (female students, adjusted OR: 2.0 [95% CI: 1.3-3.2]; male students, OR: 1.5 [CI: 1.2-2.0]). Compared with healthy weight female students, female students with extreme obesity had lower odds of ever having sex (OR: 0.5 [CI: 0.3-0.9]), but greater odds of drinking alcohol/using drugs before their last sexual encounter (OR: 4.6 [CI: 1.2-17.6]), currently smoking (OR: 2.3 [CI: 1.2-4.4]), and using smokeless tobacco (OR: 4.6 [CI: 1.2-17.2]). Compared with healthy weight male students, male students with extreme obesity had greater odds of smoking before age 13 (OR: 1.4 [CI: 1.0-2.0]). CONCLUSIONS: With few exceptions, HSS with extreme obesity engage in high-risk behaviors at rates comparable with healthy weight peers, sometimes in even more dangerous ways. Health care providers should assess risk-taking behaviors in this cohort.

Richardson CG; Memetovic J; Ratner PA; Johnson JL. Examining gender differences in emerging tobacco use using the Adolescents' Need for Smoking Scale. Addiction 106(10): 1846-1854, 2011. (37 refs.)

Aims: To investigate the influence of gender on emerging tobacco use by testing for gender-based measurement invariance of the Adolescents' Need for Smoking Scale (ANSS) and examining gender differences on each dimension across increasing levels of amount smoked. Design: Cross-sectional survey. Setting Thirteen secondary schools located in British Columbia, Canada. Participants Data from 1425 youth who reported smoking at least once in the past month. Measurements Survey questions about demographic characteristics, tobacco smoking history and need for smoking. Findings The multi-dimensional structure of the ANSS is equivalent in boys and girls and the ANSS questions are not gender-biased. There were no significant gender differences in the levels of physical dependence across increasing levels of amount smoked. Girls scored higher than boys on levels of emotional dependence across increasing levels of life-time cigarette exposure. Girls also had higher scores on the social dimension of the ANSS compared to boys among those who smoked 100 or more cigarettes. Conclusions: Canadian girls score higher than boys on measures of emotional dependence and social attitudes associated with tobacco smoking.

Ringlever L; Otten R; de Leeuw RNH; Engels RCME. Effects of parents' education and occupation on adolescent smoking and the mediating role of smoking-specific parenting and parent smoking. European Addiction Research 17(2): 55-63, 2011. (40 refs.)

The current study examined the independent effects of parents' educational attainment and occupational status on adolescent smoking and mediation of smoking-specific communication and parents' smoking behaviours on this link. Data were collected in a multi-informant, full-family design in two sampling waves separated by 3 years (n = 358). Education, occupational status, communication, and smoking were assessed via parent and child report. Different effects were found for the indicators of father and mother's socioeconomic status (education and occupation) for three study outcomes (adolescent lifetime smoking, smoking onset, and smoking continuation). Bootstrapping procedures revealed no mediation in any of the socioeconomic status adolescent smoking associations. Study limitations and implications are discussed.

Ross L. Sustaining youth participation in a long-term tobacco control initiative: Consideration of a social justice perspective. Youth & Society 43(2, special issue): 681- 704, 2011. (45 refs.)

This article presents an in-depth case study of the Healthy Options for Prevention and Education Coalition's Teens Tackle Tobacco initiative, a 3-year community-based participatory research (CBPR) project about the distribution of tobacco vendors and tobacco advertising in Worcester, Massachusetts. Using two theoretical frameworks, positive youth development (PYD) and social justice youth development (SJYD), the case reveals personal and community conditions that drove youth to get engaged in this project, how CBPR guided the group's research and action strategy, and results of the work to date. Analysis of this case highlights factors that facilitate and pose barriers to active youth involvement in a long-term, tobacco-related community change initiative. Specifically, to affect oppressive community conditions, a blend of PYD's focus on individual skill building, participation, and empowerment-joined with SJYD emphasis on community organizing and building youth's self-awareness of how race, class, and other dimensions of power affect their lives on a daily basis-is needed.

Rubinstein ML; Luks TL; Dryden WY; Rait MA; Simpson GV. Adolescent smokers show decreased brain responses to pleasurable food images compared with nonsmokers. Nicotine & Tobacco Research 13(8): 751-755, 2011. (22 refs.)

Introduction: Nicotine acts on the mesocorticolimbic circuits of the brain leading to the release of dopamine. Repeated elevations of dopamine in the brain may cause smokers to become less sensitive to "natural reinforcers." To test the theory that adolescents with low nicotine exposure may already have decreased activation when exposed to a natural reinforcer, we looked at the effect of visual cues representing "pleasurable" food on light adolescent smokers compared with nonsmokers. Methods: Twelve adolescent light smokers (aged 13-17 years, smoked 1-5 cigarettes/day) and 12 nonsmokers (aged 13-17 years, never smoked a cigarette) from the San Francisco Bay Area underwent functional magnetic resonance imaging scanning. During scanning, they viewed blocks of photographic images representing pleasurable foods (sweet, high fat, and salty foods) and control cues. Results: Smokers reported smoking a mean of 3.6 cigarettes/day. There was no difference in body mass index between groups (24.1 vs. 24.0, respectively, p = .99). Food images elicited greater activations in nonsmokers in multiple areas including the insula (T = 4.38, p < .001), inferior frontal region (T = 5.12, p < .001), and rolandic operculum (T = 6.18, p < .001). There were no regions where smokers demonstrated greater blood oxygenation level-dependent activations compared with nonsmokers when viewing food versus neutral images. Conclusions: The finding of decreased activation to pleasurable food among adolescent light smokers supports the theory that these adolescents are displaying decreased sensitivity to at least one natural reinforcer. This also supports the theory that nicotine may affect the brain early in the trajectory of smoking, thus underscoring the need for early intervention among adolescent smokers.

Saunders C. Access to cigarettes by daily smokers in Florida's public middle schools and high schools. Nicotine & Tobacco Research 13(7): 589-598, 2011. (84 refs.)

Youth who smoke daily have diverse methods for obtaining cigarettes, which range from commercial sources to essentially black market transactions. This study examines access to cigarettes, attitudes toward tobacco, and the demographic characteristics of youth who are daily cigarette smokers. Biennial data from the Florida Youth Tobacco Survey, a representative sample of Florida public middle- and high-school students, were used. Daily smoking was categorized into ordinal categories of increasing intensity. Analysis was done with a logistic partial proportional odds model, which allowed the effects of the independent predictors to vary according to smoking intensity. The multivariate analysis revealed that males and females have different methods of obtaining cigarettes. Moreover, certain modes of access to cigarettes were related to daily smoking intensity. Males who obtained cigarettes from their parents or stole them from a store were much more likely to have a higher intensity of daily smoking. Females who gave someone money to buy their cigarettes or bought them from a person were more likely to smoke more cigarettes per day. Males, but not females, also perceived that increasing the number of cigarettes smoked per day provides social benefits in the form of more friends. Understanding how daily youth smokers obtain cigarettes is necessary if effective antitobacco policies are to be developed for these individuals. Daily youth smokers are at increased risk of becoming addicted to nicotine, making them more likely to transition to daily adult smoking.

Schepis TS; McFetridge A; Chaplin TM; Sinha R; Krishnan-Sarin S. A pilot examination of stress-related changes in impulsivity and risk taking as related to smoking status and cessation outcome in adolescents. Nicotine & Tobacco Research 13(7): 611-615, 2011. (32 refs.)

Introduction: Psychosocial stress and impulsivity are each associated with smoking in adolescents. There is also evidence that stress can increase impulsive responding, and impulsive adolescent smokers attempting cessation are at greater risk of relapse. We performed a pilot investigation to examine stress-induced changes in response inhibition, inattention, and risk taking as related to smoking status and posttreatment smoking abstinence. Methods: Twelve adolescent smokers participating in a smoking cessation intervention and 15 adolescent nonsmokers completed a 2-session protocol assessing stress-related change in response inhibition and inattention (on the Conners' Continuous Performance Test-II), risk taking (on the Balloon Analogue Risk Task), nicotine withdrawal symptoms, and self-reported stress. Results: At baseline, smokers had greater inattentive responding and risk taking when compared with nonsmokers. Stress exposure led to significant increases in stress, anger, and depression in all participants and also increased nicotine craving (on the Minnesota Nicotine Withdrawal Scale item) and impulsive responding in smokers. After covarying for baseline differences in impulsivity/risk taking, smokers who were not abstinent at the end of treatment experienced greater stress-induced risk taking when compared with those who were abstinent. Conclusions: In all, it appears that response inhibition and risk taking may be differentially altered by stress exposure in adolescent smokers and nonsmokers and that adolescent smoking cessation success may be associated with less risk taking in the face of stress.

Schneider S; Gruber J; Yamamoto S; Weidmann C. What happens after the implementation of electronic locking devices for adolescents at cigarette vending machines? A natural longitudinal experiment from 2005 to 2009 in Germany. Nicotine & Tobacco Research 13(8): 732-740, 2011. (36 refs.)

Introduction: As of January 01, 2007, electronic locking devices based on proof of age (electronic cash cards or European driving licenses) were installed on 500,000 cigarette vending machines across Germany to restrict the purchase of cigarettes to those over the age of 16 years. In 2009, the age limit was raised to 18 years. The aim of this study was to compare the number of cigarette vending machines and other commercial sources before and after the enactment of the new law and to examine the association between commercial cigarette sources and area socioeconomic status (SES). Methods: We recorded and mapped using Geographical Information System software the total number of commercial cigarette sources in 4 selected districts in the major German city of Cologne. The city was the ideal setting for this study as we were able to use existing sociogeographical data from this area. We compiled a complete inventory of commercial cigarette sources in autumn 2005 and 2009. An interim inventory was also completed in 2007. Results: Between 2005 and 2009, the total number of cigarette sources decreased from 369 to 325 within the study area. Although the most obvious reduction was detected in the number of outdoor vending machines (-44%), the number of indoor vending machines also decreased by 5%. In 2005 as well as in 2009, we found significantly fewer commercial cigarette sources in districts with above-average SES than in districts with below-average SES. Conclusions: Although the number of overall cigarette vending machines decreased, the disparity in distribution of cigarette sources between socially advantaged and disadvantaged areas increased.

Schuck K; Otten R; Engels R; Kleinjan M. The relative role of nicotine dependence and smoking-related cognitions in adolescents' process of smoking cessation. Psychology & Health 26(10): 1310-1326, 2011

The present study evaluates the role of distinct components of nicotine dependence (craving, withdrawal, behavioural dependence) in comparison to smoking-related cognitions (attitudes, perceived social approval, self-efficacy) in adolescent smoking cessation. In the process towards smoking cessation, we distinguish between distinct behavioural transitions, respectively, short-term abstinence, reduction in smoking behaviour and prolonged cessation, to evaluate differences in cessation-related antecedents as a function of varying behavioural outcomes. A total of 850 adolescent smokers (age 14-16) participated in the present study. Smoking behaviour was assessed 1 year after baseline. Results showed that all dependence components had a distinct role in the prediction of behavioural change towards cessation. Furthermore, each behavioural transition was predicted by a distinct set of variables, indicating that contributions of cessation-related factors vary across the course towards cessation. Overall, our findings suggest that smoking-related cognitions are particularly relevant in the initiation of behavioural change, such as short-term abstinence, whereas nicotine dependence, craving in particular, becomes increasingly important in the prediction of maintained behavioural change, such as prolonged cessation. Implications encompass enhanced attention to the multidimensional nature of nicotine dependence and the value of comparing different behavioural outcomes in a comprehensive understanding of cessation-related factors.

Sharp EH; Coffman DL; Caldwell LL; Smith EA; Wegner L; Vergnani T et al. Predicting substance use behavior among South African adolescents: The role of leisure experiences across time. International Journal of Behavioral Development 35(4): 343-351, 2011. (66 refs.)

Using seven waves of data, collected twice a year from the 8th through the 11th grades in a low-resource community in Cape Town, South Africa, we aimed to describe the developmental trends in three specific leisure experiences (leisure boredom, new leisure interests, and healthy leisure) and substance use (cigarettes, alcohol, and marijuana) behaviors and to investigate the ways in which changes in leisure experiences predict changes in substance use behaviors over time. Results. indicated that adolescents' substance use increased significantly across adolescence, but that leisure experiences remained fairly stable over time. We also found that adolescent leisure experiences predicted baseline substance use and that changes in leisure experiences predicted changes in substance use behaviors over time, with leisure boredom emerging as the most consistent and strongest predictor of alcohol, cigarette, and marijuana use. Implications for interventions that target time use and leisure experiences are discussed.

Sloan F; Platt A. Information, risk perceptions, and smoking choices of youth. Journal of Risk and Uncertainty 42(2): 161-193, 2011. (58 refs.)

Conventional wisdom maintains that youths take risks because they underestimate probabilities of harm. Presumably if they knew the true probabilities, they would behave differently. We used the National Longitudinal Survey of Youth 1997 to assess whether differences between subjective and objective probabilities that an adverse outcome to self will occur are systematically related to a harmful behavior, initiating smoking. We find that youths are generally pessimistic about probabilities of their own deaths and being violent crime victims. After smoking initiation, youths increase subjective probabilities of death by more than the objective increase in mortality risk, implying recognition of potential harms. Virtually all 12-14 year-olds know that smoking causes heart disease. The minority who believe that smoking causes AIDS are less likely to become smokers; i.e., risk misperceptions deter rather than cause smoking initiation. Messages designed to deter smoking initiation should stress other disadvantages of smoking than just probabilities of harm.

Smith JR; Edland SD; Novotny TE; Hofstetter CR; White MM; Lindsay SP et al. Increasing hookah use in California. American Journal of Public Health 101(10): 1876-1879, 2011. (37 refs.)

Hookah use is gaining popularity nationwide. We determined the correlates and trends for hookah use from the California Tobacco Survey. Between 2005 and 2008 hookah use increased more than 40%, and in 2008, 24.5% of young men reported ever using a hookah. Hookah use was more common among the young (18-24 years), the educated, the non-Hispanic Whites, and the cigarette smokers. Hookah use is increasing in California, especially among young adults, and in 2008 reached the highest prevalence ever reported for both genders.

Smith JR; Novotny TE; Edland SD; Hofstetter CR; Lindsay SP; Al-Delaimy WK. Determinants of hookah use among high school students. Nicotine & Tobacco Research 13(7): 565-572, 2011. (43 refs.)

Hookah use is increasing among young people, but there are limited data on its use among high school-age populations. We examined hookah use initiation, prevalence, cessation, and psychosocial risk factors of hookah use among high school students. A cross-sectional survey of 689 students from three high schools in San Diego County was used to compare characteristics of hookah ever-users to nonusers and factors associated with current and former hookah use. Hookah ever-use in the study population was 26.1%, previous month hookah use was 10.9%, and current hookah use was 10.3%. Most students first learned about hookah from friends (50.3%) or saw a hookah lounge (20.9%). Students believed hookah to be more socially acceptable than cigarettes and less harmful than cigarettes, cigars, and smokeless tobacco. Hookah ever-users were significantly more likely than nonusers to have smoked cigarettes, to know of a hookah lounge in their community, and to believe hookah is safer and more socially acceptable than cigarettes. In comparison to former users, current users were more likely to have recently smoked a cigarette, to know of a hookah lounge in their community, and to believe hookah is more socially acceptable than cigarettes. Hookah use is becoming a commonly acceptable behavior among adolescents, and risk perception is a significant factor. Presence of hookah lounges are associated with increased hookah use among high school students and should be a target of further regulation.

Stigler MH; Perry CL; Smolenski D; Arora M; Reddy KS. A mediation analysis of a tobacco prevention program for adolescents in India: How did Project Mytri work? Health Education & Behavior 38(3): 231- 240, 2011. (56 refs.)

This article presents the results of a mediation analysis of Project MYTRI (Mobilizing Youth for Tobacco Related Initiatives in India), a randomized, controlled trial of a multiple-component, school-based tobacco prevention program for sixth-to ninth-graders (n = 14,085) in Delhi and Chennai, India. A mediation analysis identifies how an intervention achieves its effects. In MYTRI, changes in students' (a) knowledge about the negative health effects of tobacco, (b) beliefs about its social consequences, (c) reasons to use tobacco, (d) reasons not to use tobacco, (e) advocacy skills self-efficacy, and (f) normative beliefs about tobacco use were significantly associated with reductions in students' intentions to use tobacco and tobacco use behaviors. In contrast, changes in students' perceptions of the prevalence of smoking and chewing tobacco were significantly related to increases in students' intentions to use and use of tobacco. Implications for intervention design are considered.

Storholm ED; Halkitis PN; Siconolfi DE; Moeller RW. Cigarette smoking as part of a syndemic among young men who have sex with men ages 13-29 in New York City. Journal of Urban Health 88(4): 663-676, 2011. (55 refs.)

The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13-29, in New York City. Cross-sectional data were collected as part of larger study of risk behaviors using palm devices and targeted active recruitment strategies across all five boroughs of the city. Multivariate modeling suggests that Asian or Pacific Islander and White YMSM are more likely to report cigarette smoking than other racial and ethnic groups, as are men reporting a middle class socioeconomic status. In addition, smoking was related to the likelihood of using a variety of illicit substances, as well as alcohol and pharmaceuticals without a prescription, during the period of assessment. YMSM who smoke cigarettes reported a greater number of casual sex partners and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded as part of larger more holistic health and wellness programs targeting YMSM.

Tagmat D; Wolff J; Schumann A; John U; Thyrian JR. Development and psychometric properties of a short Situational Urge to Smoke Scale (SUS) for smoking adolescents. Substance Use & Misuse 46(8): 959-968, 2011. (34 refs.)

As urges are associated with positive-social, negative-affective, and habitual situations, we developed a sound scale to assess urges in these situations. In Northeastern Germany in 2005/2006, a sample of 1,093 smoking adolescents from 7th to 10th grade, aged 12-18 years, was used. Reliability analysis and exploratory and confirmatory factor analyses were applied. A three-factorial structure of the final situational urge to smoke scale (SUS) was found. Internal consistency of the scale was high (alpha = .89). The SUS is a new internally consistent scale that assesses the urge to smoke in adolescents. Further research needs to examine its predictive validity. The study's limitations are noted.

Tebes JK; Cook EC; Vanderploeg JJ; Feinn R; Chinman MJ; Shepard JK et al. Parental knowledge and substance use among African American adolescents: Influence of gender and grade level. Journal of Child and Family Studies 20(4): 406-413, 2011. (42 refs.)

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use 1 year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across 1 year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

Tohid H; Ishak NM; Muhammad NA; Abu Hassan H; Ahmad FNM; Omar K. What determines teenagers' smoking behaviour? A qualitative study. International Medical Journal 18(3): 194-198, 2011. (35 refs.)

Objective: The study aimed to explore smoking behaviour among Malaysian teenagers that were related to their smoking initiation, cigarette consumption, quit intention, and quit attempts. Methods: It was a qualitative study that used multiple case study design, involving 26 teenagers (23 smokers and three former smokers) from three public schools. Data was collected via questionnaires, three focus group interviews and three in-depth interviews over 20 months. A standardised semi-structured interview protocol was utilised. Results: Among the participants, 74% of them started smoking after the age of 12 years old. The majority (20/23) of the teenage smokers admitted to smoking every day and 74% of them smoked not more than 5 cigarettes a day. All of the smokers had the intention to quit but only 22 out of the 23 teenage smokers had attempted quitting. Sixty percent of these teenagers had more than three quit attempts. In general, this study captured the complexity of the teenagers' smoking behaviour that could be influenced by multiple factors, including behavioural (e.g. nicotine addiction), personal (e.g. conception of smoking and quitting, curiosity, sensation seeking, knowledge about smoking cessation, stress, maintaining athletic performance, and finance.) and environmental (e.g. socialisation, peer pressure, parental smoking, parental disapproval, and boy- or girlfriend aversion) factors. Conclusions: This study described the complex and multidimensional nature of teenage smoking behaviour. The findings also correspondingly matched the Social Cognitive Theory (SCT), therefore suggesting the theory's suitability in elucidating smoking behaviour among the Malaysian teenagers.

Toprak S; Cetin I; Guven T; Can G; Demircan C. Self-harm, suicidal ideation and suicide attempts among college students. Psychiatry Research 187(1-2): 140- 144, 2011. (45 refs.)

Self-harm, suicidal ideation, and suicide attempts are well represented behaviours in the general population of both developed and developing countries. These behaviours are indicative of underlying risk factors that show a strong interdependent correlation. In this study we attempted to define correlates for and prevalence of self-harm, suicidal ideation, and suicide attempts among Turkish college students. This 2006 study included 636 students from two Turkish state universities. Our results showed that the lifetime prevalence of self-harm was 15.4%, the prevalence of suicidal ideation was 11.4%, and the prevalence of suicide attempts was 7.1%. We uncovered correlates for self-harm, including low income, unsatisfying familial relationships, smoking, and alcohol, inhalant, and tranquilizer abuse. Tranquilizer abuse shared a dual role as a correlate for suicide ideation and as a means to attempt suicide. Additionally, we found that drug abusers and adolescents who practise self-harm presented the highest suicide risk.

Trucco EM; Colder CR; Bowker JC; Wieczorek WF. Interpersonal goals and susceptibility to peer influence: Risk factors for intentions to initiate substance use during early adolescence. Journal of Early Adolescence 31(4): 526-547, 2011. (51 refs.)

Though peer socialization theories are prominent in the adolescent substance use literature, variability in the degree to which adolescents are vulnerable to peer influence is likely, and few studies have examined this issue. This study examines the association between perceived peer substance use/approval of substance use and adolescent intentions to initiate alcohol and cigarette use and how social goals moderate this relationship. Results support the moderating role of social goals and suggest important differences across alcohol and cigarette use. Peer use and approval of cigarette use is associated with future intentions to smoke for adolescents with strong agentic goals, and peer use and approval of alcohol is associated with intentions to drink for adolescents with strong communal goals. These findings suggest that adolescent substance use theories and prevention programs focusing on peer socialization should consider individual differences in social goals and potential differences in peer influence across drugs.

Tucker JS; Green HD; Zhou AJ; Miles JNV; Shih RA; D'Amico EJ. Substance use among middle school students: Associations with self-rated and peer-nominated popularity. Journal of Adolescence 34(3): 513-519, 2011. (41 refs.)

Associations of popularity with adolescent substance use were examined among 1793 6-8th grade students who completed an in-school survey. Popularity was assessed through both self-ratings and peer nominations. Students who scored higher on either measure of popularity were more likely to be lifetime cigarette smokers, drinkers, and marijuana users, as well as past month drinkers. Self-rated popularity was positively associated with past month marijuana use and heavy drinking, and peer-nominated popularity showed a quadratic association with past month heavy drinking. These results extend previous work and highlight that popularity, whether based on self-perceptions or peer friendship nominations, is a risk factor for substance use during middle school. Given the substantial increase in peer influence during early adolescence, prevention program effectiveness may be enhanced by addressing popularity as a risk factor for substance use or working with popular students to be peer leaders to influence social norms and promote healthier choices.

Van Ryzin MJ; Johnson AB; Leve LD; Kim HK. The number of sexual partners and health-risking sexual behavior: Prediction from high school entry to high school exit. Archives of Sexual Behavior 40(5): 939-949, 2011. (45 refs.)

Precursors to adolescent health-risking sexual behavior (HRSB) were examined in a normative sample of 373 adolescents (48.0% female, n = 178). Using a variable-oriented approach, we regressed the number of sexual partners at high school exit (age 17) on parental monitoring, association with delinquent peers, romantic relationship status, problem behavior, physical maturity, and tobacco and alcohol use at high school entry (age 14); all emerged as significant predictors except alcohol use and physical maturity (we found sex differences in physical maturity and romantic relationship status, with females being more advanced in both areas). Sexual experimentation at high school entry served to partially or fully mediate the impact of these factors. A person-oriented approach, using a broader measure of HRSB, found three subgroups of adolescents: abstainers, low-risk-takers, and high-risk-takers. Results predicting membership in these groups generally followed those from the variable-oriented analysis. Implications for the prevention of HRSB and future research directions are discussed.

Van Zundert RMP; Engels RCME; Kuntsche E. Contextual correlates of adolescents' self-efficacy after smoking cessation. Psychology of Addictive Behaviors 25(2): 301-311, 2011. (55 refs.)

Recent research has shown that daily changes in self-efficacy predict lapses and relapse into smoking after quitting among adolescent daily smokers, but it is not known if and how momentary self-efficacy is associated with affect-motivational states and external contexts. In the present study, 134 adolescent daily smokers were monitored daily during 1 week prior to and 3 weeks after they began their quit attempt. Participants completed questions on smoking, self-efficacy, affect-motivational states (craving and negative affect), and external contexts (seeing others smoke, experiencing a stressful event, and alcohol and coffee consumption) three times a day. Affect-motivational states as well as all external contexts (except for coffee consumption) were associated with lower self-efficacy when participants were still abstinent, but also after they had lapsed. Associations between the situational contexts and self-efficacy did not largely depend on individual characteristics such as baseline self-efficacy and age. Among girls, however, the negative associations between self-efficacy and negative affect and drinking alcohol were found to be stronger. These results show that adolescents' self-efficacy during a quit attempt may be responsive to affect-motivational states and external contexts, both before and after lapsing.

Veselska Z; Geckova AM; .Reijneveld SA; van Dijk JP. Self-efficacy, affectivity and smoking behavior in adolescence. European Addiction Research 17(4): 172-177, 2011. (34 refs.)

Background: Research on health-related behaviors confirms the contribution of self-efficacy and affective factors to the initiation and continuation of smoking behavior. The aim was to assess the degree to which affectivity contributes to the association between self-efficacy and smoking behavior in adolescence. Methods: A sample of 501 elementary school students (mean age 14.7 +/- 8 0.9 years, 48.5% males) from the Slovak and Czech Republics filled out the Self-Efficacy Scale, the Positive and Negative Affect Schedule and answered questions about smoking behavior. Results: Logistic regression showed that social self-efficacy increased the likelihood of smoking behavior but only after adding positive and negative affectivity to the model. Adjustment for age and gender as covariates did not change these findings. Conclusion: Results show the need to prepare programs aimed at enhancing appropriate social self-efficacy and especially improving skills to resist the pressures emerging from peers. Adolescents should also learn to handle their negative emotions differently, instead of through smoking behavior.

Vieno A; Gini G; Santinello M. Different forms of bullying and their association to smoking and drinking behavior in Italian adolescents. Journal of School Health 81(7): 393-399, 2011. (36 refs.)

BACKGROUND: Using data from the 2006 Health Behavior in School-aged Children (HBSC) survey, the prevalence of 6 forms of bullying (physical, verbal, relational, sexual, cyber, and racist), and the role of smoking and drinking in bullying was examined among Italian adolescents for this study. METHODS: The sample was composed of 2667 Italian middle and secondary school students (49.9% girls) randomly selected. The revised Olweus Bully/Victim Questionnaire was used to measure physical, verbal, relational, sexual, cyber, and racist forms of bullying. For each form, 3 categories were created and compared with students "not involved in bullying": bully, victim, and bully-victim. Logistic regressions were applied to test the connections among the 3 forms of involvement in different types of bullying and smoking and drinking. RESULTS: Prevalence of having been bullied or having bullied others at school at least once in the last 2 months was 11.6% for physical, 52% for verbal, 47.9% for relational, 18.5% for sexual, 19.4% for cyber, and 9.4% for racist bullying. Compared to girls, boys were more likely to be involved in physical bullying; moreover, boys were more involved as bullies in verbal, sexual, cyber, and racist bullying. In contrast, girls were more likely to be victims of verbal, relational, sexual, and cyber bullying than were boys. Logistic regressions showed the connection between the different forms of involvement in bullying and smoking and drinking. CONCLUSIONS: Our results indicate that all forms of bullying behavior are associated with legal substance use. Implication for prevention program was discussed.

Vu M; Leatherdale ST; Ahmed R. Examining correlates of different cigarette access behaviours among Canadian youth: Data from the Canadian Youth Smoking Survey (2006). Addictive Behaviors 36(12): 1313-1316, 2011. (21 refs.)

Understanding factors associated with youth cigarette access behaviours can provide insight into the development of more effective means of preventing youth from accessing cigarettes. This cross-sectional study used self-reported data collected from 41,886 students in grades 9 to 12 who participated in the 200607 Youth Smoking Survey to examine the student- and school-level characteristics that differentiate youth smokers who usually access cigarettes from a social source versus buying their own from retailers. Multi-level regression analyses revealed significant between-school variability in the odds of a smoking student reporting that they usually buy their own cigarettes. Important student-level characteristics associated with how youth usually access their cigarettes included binge drinking and being asked for age or photo identification when purchasing cigarettes from a retailer. Future studies should further explore the school- and student-level characteristics associated with youth cigarette access behaviour.

Waylen AE; Leary SD; Ness AR; Tanski SE; Sargent JD. Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study. Thorax 66(10): 856-861, 2011. (36 refs.)

Objective: To assess associations between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort. Methods: Data on exposure to smoking in films and smoking behaviour were collected from 5166 15-year-old adolescents in the UK. Main outcome measures were smoking initiation (ever tried a cigarette) and current smoking status. Social, family and behavioural factors were adjusted for, together with alcohol use and peer smoking as potential mediators. Data from all existing cross-sectional studies examining the effects of exposure to smoking in films were summarised in a meta-analysis. Results: Higher exposure to smoking in films was associated with a dose-response increase in the risk of smoking initiation even after adjusting for confounders. Adolescents in the highest exposure quartile were 1.73 (95% CI 1.55 to 1.93) times (RR) more likely to initiate smoking than those in the lowest quartile. They were more likely to report current smoking after adjusting for social and familial factors (RR 1.47 (95% CI 1.07 to 2.02)), but the association attenuated after including behavioural factors (RR 1.34 (95% CI 0.95 to 1.87)). The meta-analysis shows that, after aggregation of all relevant data, viewing smoking in films increases the risk of smoking onset by over 100% (combined RR 2.13 (95% CI 1.76 to 2.57)) and the risk of current or established smoking behaviour by 68% (combined RR 1.68 (95% CI 0.40 to 2.01)). Conclusions: This study provides evidence that adolescents in the UK and elsewhere who are exposed to smoking depictions in films are more likely to initiate smoking. Given the association between smoking and poor health outcomes, these data justify a review of film ratings.

Weiss JW; Mouttapa M; Cen S; Johnson CA; Unger J. Longitudinal effects of hostility, depression, and bullying on adolescent smoking initiation. Journal of Adolescent Health 48(6): 591- 596, 2011. (39 refs.)

Purpose: The present study examined the associations between smoking initiation and, hostility, depressive symptoms, and bullying (bullies and bully-victims) among a culturally diverse sample of 1,771 adolescents who reported never having smoked at baseline. Methods: Data were obtained from a longitudinal school-based experimental trial of smoking prevention programs in Southern California. Annual survey was performed for students of the sixth, seventh, and eighth grades. All students in the 24 participating schools were invited to participate in the study during the sixth grade. Results: The risk of smoking initiation was significantly higher among students who scored higher on hostility and depressive symptoms, and were bully-victims. Conclusion: The findings suggest that tobacco prevention programs should include strategies for managing hostile feelings and negative effect as part of the curriculum. In addition, it might be helpful to identify youth who score high on these psychosocial factors and teach them skills to handle interpersonal conflict and negative feelings to prevent their involvement in substance use.

White VM; Warne CD; Spittal MJ; Durkin S; Purcell K; Wakefield MA. What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction 106(8): 1493-1502, 2011. (35 refs.)

Aims: To assess the impact of tobacco control policies relating to youth access, clean indoor air and tobacco advertising at point-of-sale and outdoors, in addition to cigarette price and per capita tobacco control spending, on adolescent smoking prevalence. Design Repeated cross-sectional surveys. Logistic regression analyses examined association between policies and smoking prevalence. Setting Australia, 1990-2005. Participants A nationally representative sample of secondary students (aged 12-17 years) participating in a triennial survey (sample size per survey range: 20 560 to 27 480). Measurements: Students' report of past-month smoking. In each jurisdiction, extent of implementation of the three policies for the year of the survey was determined. For each survey year, national per capita tobacco control spending was determined and jurisdiction-specific 12-month change in cigarette price obtained. Findings Extent of implementation of the three policy areas varied between states and over the survey years. Multivariate analyses that adjusted for demographic factors, year and all tobacco control variables showed that 12-month cigarette price increases [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99], greater per capita tobacco control spending (OR: 0.99, 95% CI: 0.98-0.99) and stronger implementation of clean indoor air policies (OR: 0.93, 95% CI: 0.92-0.94) were associated with reduced smoking prevalence. Conclusions Adult-directed, population-based tobacco control policies such as clean indoor air laws and increased prices of cigarettes, implemented as part of a well-funded comprehensive tobacco control programme are associated with lower adolescent smoking.

Wiium N; Wold B. Actions taken by schools when tobacco policies are violated: Associations with adolescent smoking prevalence. Scandinavian Journal of Psychology 52(5): 494-501, 2011. (39 refs.)

This study examined the association of adolescent smoking prevalence with actions taken by schools (i.e., informing parents or disciplining pupils at school) for violating the school tobacco policy. Interaction terms between actions taken by schools and role models' smoking behavior or support for adolescents were also examined. Data were collected using self-completed questionnaires from a nationally representative Norwegian sample of 15-year-olds (1,404 pupils, 51% males) and 73 staff members. Informing parents when the school tobacco policy was violated by contrast with other actions taken by schools was not associated with lower levels of adolescent smoking. Disciplining pupils was associated with lower levels of adolescent smoking but the association was no longer significant when examined together with parents' and teachers' smoking behavior or support. Exposure to parents' and teachers' smoking, and teachers' support were associated with adolescent smoking prevalence, irrespective of actions taken by schools. Identifying the mechanism under which these different home and school factors relate to adolescent smoking may be worthwhile to inform intervention initiatives.

Winickoff JP; Tanski SE; McMillen RC; Ross KM; Lipstein EA; Hipple BJ et al. Acceptability of testing children for tobacco-smoke exposure: A national parent survey. Pediatrics 127(4): 628-634, 2011. (30 refs.)

BACKGROUND: Tests are available to measure children's exposure to tobacco smoke. One potential barrier to testing children for tobacco-smoke exposure is the belief that parents who smoke would not want their child tested. No previous surveys have assessed whether testing children for exposure to tobacco smoke in the context of their child's primary care visit is acceptable to parents. OBJECTIVE: To assess whether testing children for tobacco-smoke exposure is acceptable to parents. DESIGN AND METHODS: We conducted a national random-digit-dial telephone survey of households from September to November 2006. The sample was weighted by race and gender, based on the 2005 US Census, to be representative of the US population. RESULTS: Of 2070 eligible respondents contacted, 1803 (87.1%) completed the surveys. Among 477 parents in the sample, 60.1% thought that children should be tested for tobacco-smoke exposure at their child's doctor visit. Among the parental smokers sampled, 62.0% thought that children should be tested for tobacco-smoke exposure at the child's doctor visit. In bivariate analysis, lower parental education level, allowing smoking in the home, nonwhite race, and female gender were each associated (P < .05) with wanting the child tested for tobacco-smoke exposure. CONCLUSIONS: The majority of nonsmoking and smoking parents want their children tested for tobacco-smoke exposure during the child's health care visit.

Yang WS; Leatherdale ST; Ahmed R. Smoking susceptibility among never-smokers: Data from the 2006-07 National Youth Smoking Survey. Canadian Journal of Public Health 102(4): 254-257, 2011. (25 refs.)

Objectives: The purpose of this study was to explore school and individual characteristics associated with smoking susceptibility among a nationally representative sample of Canadian youth who were never-smokers. Methods: Using data from the 2006-07 Youth Smoking Survey, multi-level logistic regression modeling was used to examine if student-level and school-level characteristics were associated with smoking susceptibility among grade 9 to 12 never-smokers. Results: In 2006, 88.2% of Canadian youth in grades 9 to 12 were considered never-smokers, of whom 28.2% (n=255,840) were considered to be susceptible to future smoking. Significant between-school random variation in smoking susceptibility was identified, although the school-level smoking rate was not significantly associated with the risk of an individual student being susceptible. At the student level, smoking susceptibility was associated with having a sibling who smokes, having 1 or 2 close friends who smoke, having ever used alcohol or marijuana, being female and being in grade 9. Parental smoking and exposure to smoking in a car or in the home were not significantly associated with smoking susceptibility. Conclusion: One way to prevent smoking onset among youth is to interfere with the development of susceptibility to smoking in non-smoking youth population. We found that over 1 in 4 Canadian youth who were never-smokers in 2006 were considered susceptible to smoking in the future. Ongoing tobacco control prevention initiatives are crucial for reducing the prevalence of smoking susceptibility among non-smoking Canadian youth.

Zaidi SMA; Bikak AL; Shaheryar A; Imam SH; Khan JA. Perceptions of anti-smoking messages amongst high school students in Pakistan. BMC Public Health 11: article 117, 2011. (20 refs.)

Background: Surveys have provided evidence that tobacco use is widely prevalent amongst the youth in Pakistan. Several reviews have evaluated the effectiveness of various tobacco control programs, however, few have taken into account the perceptions of students themselves regarding these measures. The aim of this study was to determine the most effective anti-smoking messages that can be delivered to high-school students in Pakistan, based on their self-rated perceptions. It also aimed to assess the impact of pictorial/multi-media messages compared with written health warnings and to discover differences in perceptions of smokers to those of non-smokers to health warning messages. Methods: This study was carried out in five major cities of Pakistan in private English-medium schools. A presentation was delivered at each school that highlighted the well-established health consequences of smoking using both written health warnings and pictorial/multi-media health messages. Following the presentation, the participants filled out a graded questionnaire form, using which they rated the risk-factors and messages that they thought were most effective in stopping or preventing them from smoking. The Friedman test was used to rank responses to each of the questions in the form. The Wilcoxon Signed Rank test used to analyze the impact of pictorial/multi-media messages over written statements. The Mann Whitney U test was used to compare responses of smokers with those of non-smokers. Results: Picture of an oral cavity cancer, videos of a cancer patient using an electronic voice box and a patient on a ventilator, were perceived to be the most effective anti-smoking messages by students. Addiction, harming others through passive smoking and impact of smoking on disposable incomes were perceived to be less effective messages. Pictorial/multi-media messages were perceived to be more effective than written health warnings. Health warnings were perceived as less effective amongst smokers compared to non-smokers. Conclusion: Graphic pictorial/multi-media health warnings that depict cosmetic and functional distortions were perceived as effective anti-smoking messages by English-medium high school students in Pakistan. Smokers demonstrated greater resistance to health promotion messages compared with non-smokers. Targeted interventions for high school students may be beneficial.