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Tobacco use among youth in the South-East Asian region is quite prevalent. This study aims to examine if psychosocial factors (perceived loneliness, peer, and parental relationships) were associated with adolescent smoking, and whether the effects were different according to sex and age. Data came from the Global School-based Student Health Surveys collected between 2012 and 2015 in Brunei, Cambodia, Indonesia, Laos, Malaysia, Philippines, Thailand, Timor-Leste, and Vietnam. 64 578 (males = 48.5%) adolescents aged 13-18 completed the survey. Prevalence of past-month cigarette use was 10.6%. Adolescent smoking was associated with loneliness (OR = 1.75), lack of close friends (OR = 1.43), and lack of parental understanding (OR = 1.35). There was significant interactions between sex with loneliness, close friends, and parental understanding ( p < .001). Interactions indicated having no close friends is associated with smoking and is stronger for females than males. Conversely, loneliness was associated with smoking more strongly in males than females. Results indicate that psychosocial factors are linked to adolescent smoking in South-East Asia, suggesting a further need for research on the relation of psychosocial factors with smoking, and their underlying factors.

Background: Educational attainment is a social determinant of health associated with better quality of life and health outcomes. Current understanding of the association between adolescent smoking and college completion is limited. This study examined the association between adolescent smoking and subsequent college completion and how it varied by parent education in a longitudinal study of U.S. adolescents followed into young adulthood., Methods: Data were collected annually from a nationally representative cohort of 10th graders who participated in the NEXT Generation Health Study (2009 -2017; N = 1407). Participants reported if they smoked during 10th-12th grades (2009-2013). Self-report college completion was assessed in 2017. Parent reported their educational attainment at baseline. Weighted logistic regression models were used to assess the association between adolescent smoking during 10th-12th grades and subsequent college completion in the entire sample and stratified by parent educational attainment, adjusting for demographics, depressive symptoms, alcohol use, and parental monitoring., Results: Overall, adolescents who smoked during 10th-12th grade had lower odds of subsequently completing college compared to those who did not smoke (AOR=0.33, 95%CI=0.20-0.57). This association was stronger among those whose parents had ≤high school education (AOR=0.08, 95% CI=0.02-0.31) and some college education (AOR=0.18, 95%CI=0.08-0.39)., Discussion: Adolescents from lower educational attainment households showed disproportionately stronger association between adolescent smoking and subsequent college completion. Future research needs to determine whether and how strategies to reduce adolescent smoking may promote educational attainment especially among adolescents whose parents have less than a college education., (Copyright © 2022. Published by Elsevier B.V.)

Purpose: Tobacco use initiated during adolescence often leads to continued use in adulthood. There are multiple factors influencing initiation, including low perceived risk of harm. Adolescents involved in school-based extracurricular activities have opportunities to interact with coaches, leaders, and group supervisors who may influence their perception of risk. The purpose of this study was to examine the role of extracurricular activities and adolescents' perceived risks of harm of tobacco use, utilizing an existing dataset. Methods: The 2016 National Survey on Drug Use and Health (NSDUH) dataset was used for a cross-sectional study of youth, ages 12 to <18 years. Adolescents involved in one or more school-based, extracurricular activities were compared with adolescents involved in no activities. The key variable was the response to the NSDUH question regarding perceived risk of harm from daily smoking (≥1 packs of cigarettes). Chi-square tests and multinomial logistic regression were used to analyze the data. Results : At the time of the 2016 NSDUH study period, among the adolescents aged 12 to <18 years (n=4,308), 17.5% indicated that they did not participate in any extracurricular activities and 10.6% reported no/slight perceived risk of harm associated with tobacco use. Adolescents who did not participate in extracurricular activities were more likely to report no/slight risk of harm from smoking (Adjusted Odds Ratio, AOR= 2.21 [95%CI: 1.62, 3.02]) as opposed to the perception of great risk of harm. Conclusion: Adolescents who are not involved in extracurricular activities are more likely to endorse the perception that cigarettes have no/slight risk of harm. School-based extracurricular activities may provide unintended benefits to adolescents; health care professionals, including dental hygienists, should be aware of this associated health benefit., (Copyright © 2020 The American Dental Hygienists’ Association.)

Background: Most European countries have seen a decrease in the prevalence of adolescent smoking. This decrease has, however, been patterned by gender. Girls' smoking rates have now overtaken boys' in many European countries. The two genders may not, however, share the same smoking beliefs and this could explain differences between the genders in smoking prevalence. We describe gender differences in smoking beliefs and investigate variations between countries, along with their gender context., Methods: In 2016, we conducted the SILNE R study (Smoking Inequalities Learning from Natural Experiments - Renew) in 55 schools located in seven European countries: Belgium, Italy, The Netherlands, Portugal, Finland, Ireland, and Germany. We surveyed 12,979 students aged 14-16 years (50% were girls). We classified smoking beliefs into four categories: positive individual, positive social, negative individual, and negative social beliefs. We expected girls to score higher on the last three of those categories and we hypothesized that countries with a more gender-equal culture would have less gender difference in beliefs about smoking., Results: One out of two smoking beliefs differed significantly between genders. Negative social beliefs were more common in girls, while beliefs about the dating-related aspects of smoking were more common in boys. We identified Germany and Belgium as the only countries with no gender differences in any of the belief scales. No correlation was found, however, between these scales and the Gender Inequality Index., Conclusions: In some countries, gender-specific interventions might be implemented; however, two opposing strategies might be used, depending on whether such programs are aimed at boys or girls.

Recent scholarship suggests that the genomes of those around us affect our own phenotypes. Much of the empirical evidence for such "metagenomic" effects comes from animal studies, where the socio-genetic environment can be easily manipulated. Among humans, it is more difficult to identify such effects given the nonrandom distribution of genes and environments. Here we leverage the as-if-random distribution of grade-mates' genomes conditional on school-level variation in a nationally representative sample. Specifically, we evaluate whether one's peers' genetic propensity to smoke affects one's own smoking behavior net of one's own genotype. Results show that peer genetic propensity to smoke has a substantial effect on an individual's smoking outcome. This is true not only when the peer group includes direct friends, and therefore where the individual plays an active role in shaping the metagenomic context but also when the peer group includes all grade-mates and thus in cases where the individual does not select the metagenomic environment. We explore these effects further and show that a small minority with high genetic risk to smoke ('bad apples') can greatly affect the smoking behavior of an entire grade. The methodology used in this paper offers a potential solution to many of the challenges inherent in estimating peer effects in nonexperimental settings and can be utilized to study a wide range of outcomes with a genetic basis. On a policy level, our results suggest that efforts to reduce adolescent smoking should take into account metagenomic effects, especially bad apples, within social networks., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 the Author(s). Published by PNAS.)

Introduction: We explored the role of rejection of parental smoking in the association between parental smoking and smoking in adolescents., Methods: In 2010-11 cross-sectional survey, 61,810 Hong Kong secondary school students (mean age 14.6 years, 50.5% boys) reported their smoking (never, not susceptible; never, susceptible; ever, not current; current), paternal and maternal smoking, and whether they accepted paternal and maternal smoking (acceptance/rejection). We used multinomial logistic regression to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of students' smoking in relation to acceptance and rejection of parental smoking, compared with no parental smoking., Results: The OR (95% CI) of "never, susceptible", "ever, not current", and "current", compared with "never, not susceptible", in relation to acceptance of paternal smoking was 1.81 (1.67-1.96), 2.46 (2.25-2.69), and 2.79 (2.51-3.10), respectively. The corresponding ORs for rejection were 0.70 (0.64-0.76), 1.23 (1.13-1.35), and 0.47 (0.40-0.56). The OR (95% CI) of "never, susceptible", "ever, not current", and "current", compared with "never, not susceptible", in relation to acceptance of maternal smoking was 2.05 (1.80-2.33), 2.57 (2.29-2.88), and 6.33 (5.39-7.44), respectively. The corresponding ORs for rejection were 0.85 (0.69-1.05), 1.59 (1.39-1.81), and 2.14 (1.71-2.68). No overlapping was observed between the 95% CIs for acceptance and rejection of paternal or maternal smoking., Conclusions: While adolescent smoking was associated with parental smoking, especially in those who accepted parental smoking, the association was attenuated or reversed in those who rejected parental smoking., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Adverse birth outcomes can lead to problematic long-term outcomes for children, and are also known to transmit socioeconomic disadvantage across generations, thereby amplifying the importance of identifying their social determinants. However, the full set of factors causing adverse birth outcomes remains unknown. Drawing together theory describing intragenerational (life course) processes linking early life adversity to adult health, and intergenerational transmissions of inequality via birthweight, this study tests a chain of risk that originates within early adolescence, impacts young women's risky health behaviors in late adolescence/early adulthood and risky health behaviors during pregnancy, and ultimately decreases offspring's birthweight. We do so using structural equation models and prospective, population-level data on a racially and socioeconomically diverse cohort of young adults (National Longitudinal Study of Adolescent to Adult Health). Results (a) reveal four pathways that fully mediate the association between a young woman's family-of-origin socioeconomic status in adolescence and her offspring's birthweight, and (b) identify a trigger effect-a place in the chain of risk where prevention efforts could be targeted, thereby breaking the chain of risk leading to poor offspring health at birth for vulnerable individuals., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: This study investigates the extent to which friendship network, family relations, and school context are related to adolescent cigarette smoking. Friendship network is measured in terms of delinquent peers; family relations in terms of parental supervision; and school environment in terms of objective (eg, antismoking policy) and subjective (eg, school attachment) characteristics., Methods: Findings are based on the secondary analysis of the health behavior in school-aged children, 2009-2010. Two-level hierarchical generalized linear models are estimated using hierarchical linear modeling 7., Results: At the student level, ties to delinquent friends is significantly related to higher odds of smoking, while greater parental supervision is associated with lower odds. At the school level, antismoking policy and curriculum independently lower smoking behavior. Better within-class peer relations, greater school attachment, and higher academic performance are also negatively related to smoking. Last, the positive association between delinquent friends and smoking is weaker in schools with a formally enacted antismoking policy. However, this association is stronger in schools with better peer relations., Conclusions: Adolescent smoking behavior is embedded in a broader ecological setting. This research reveals that a proper understanding of it requires comprehensive analysis that incorporates factors measured at individual (student) and contextual (school) levels., (© 2018, American School Health Association.)

Adolescent smokers engage in cognitive rationalisation processes that lower perceptions of personal vulnerability to the health consequences of smoking. There is, however, hardly any evidence that provides in-depth insights on adolescents&rsquo; recurring rationalisations. Therefore, we explored how boy smokers deal with the knowledge that they are engaging in potentially fatal behaviour. Interviews were held with 16 boy smokers aged 16 to 17 years old. The qualitative analysis focussed on combining boys&rsquo; reasons about why they think they will not experience severe health consequences into coherent rationalisations that recurred among interviewees. Three rationalisations emerged from the analysis. First, boys trivialize the immediate consequences and think these can be compensated for and are outweighed by the benefits of smoking. Second, boys assume that smoking will only take place during adolescence and they will, therefore, recover from the damage inflicted. Third, boys believe that they have control over the amount and frequency of smoking and, thereby, can ensure that they will not experience fatal consequences. Boys&rsquo; recurring rationalisations build on their view that they are supposed to have fun and will not become typical adult smokers. Interventions should address these rationalisations in order to increase adolescents&rsquo; perceptions of personal vulnerability, and thereby contribute to decreasing adolescent smoking.

Early onset and long-term smoking are associated with physical and psychological health problems. The aim of the presented analysis was to investigate risk and influencing factors for different smoking status in a big sample of European adolescents. In the context of the "saving and empowering young lives in Europe" (SEYLE) study we surveyed 12,328 adolescents at the age of 13-17 from 11 countries. The survey took place in a school-based context using a questionnaire. Overall 58% reported the onset of ever-smoking under the age of 14 and 30.9% smoke on a daily basis. Multinomial logistic regression model showed significant positive associations between adolescent smoking and internalizing problems (suicidal behavior, direct self-injurious behavior, anxiety), externalizing problems (conduct problems, hyperactivity, substance consumption) and family problems (parental substance consumption, broken home). Our data show that smoking among adolescents is still a major public health problem and adolescents who smoke are at higher risk for mental problems. Further, adolescent smoking is associated with broken home families and parental behaviors. Therefore, early preventive measures are necessary not only for adolescents, but also for their parents.

Objective: This article examines gender differences in the transmission of smoking, and the role of parenting, school climate, and negative emotions in the parental smoking-adolescent smoking relationship., Methods: The study used a nationally representative cross-sectional data on 5,290 Filipino secondary students., Results: Results suggest that Filipino adolescents having parents who smoke, tend to smoke cigarettes. Maternal smoking affects both girls' and boys' smoking, but paternal smoking has no effect on both sexes. Further, parenting dimensions (support and knowledge), school climate (bullying victimization and peer support), and negative emotions (loneliness and anxiety) tend to moderate the effects of parental smoking on adolescent smoking. Some of these factors appear to protect adolescents from parental smoking, while others aggravate the effects of parental smoking. Conclusions/Importance: Current findings suggest important theoretical and practical implications on the relationship between parental and adolescent smoking.

Exposure to cigarette coupons is associated with smoking initiation and likelihood of cigarette purchase among adolescents. Some adolescents who are exposed to cigarette coupons take a step further by choosing to save or collect these coupons, a further risk factor for cigarette smoking. This study examines historical trends and disparities in cigarette coupon saving among adolescents in the United States from 1997 to 2013. National samples of 10th and 12th grade students (n=129,111) were obtained from Monitoring the Future surveys in 1997-2013. Prevalence of lifetime and current cigarette coupon saving was estimated in each year in the overall adolescent population, and in race/ethnicity, parent education level, sex, and urban/rural subgroups. Prevalence of lifetime and current cigarette coupon saving was then estimated in each year based on smoking status. Prevalence of cigarette coupon saving has decreased dramatically among adolescents; only 1.2% reported currently saving coupons in 2013. However, disparities in cigarette coupon saving remain with prevalence higher among rural, White, and low parental education level students. Adolescent smokers continue to save coupons at high rates; 21.2% had ever saved coupons and 6.9% currently saved coupons as of 2013. Despite overall declines in adolescent cigarette coupon saving, existing sociodemographic disparities and the considerably high prevalence of coupon saving among adolescent smokers suggest that cigarette coupons remain a threat to smoking prevention among youth. Additional research is needed to further elucidate longitudinal associations between cigarette coupon saving and smoking initiation and maintenance among adolescents., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health. N=1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age=11.8 (SD=0.8), and 26.0% were born in Mexico. By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR=1.30; CI=1.07-1.57), male (OR=1.88, CI=1.40-2.53), having higher levels of anxiety (OR=1.03, CI=1.02-1.05), intending to smoke (OR=1.70, CI=1.18-2.46), having friends who smoke (OR=1.73, CI=1.12-2.70) and having parents' friends who smoke (OR=1.38, CI=1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR=0.91, CI=0.83-0.99) were protective against smoking escalation. Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: Prior research has found that the protective effect of parental engagement on adolescent smoking behaviors may be weaker if parents smoke. We examine parental influence on adolescent smoking using a social learning theory framework. We hypothesize that adolescents are more likely to mimic parental smoking behavior if they perceive parents as being more engaged and if the parent is the same gender of the adolescent., Methods: Hypotheses were tested using a diverse sample of 6,998 adolescents who were followed for seven waves (grades 6-12). Adolescent gender, time-stable and time-varying effects of parental engagement, adolescent perceptions of parental smoking, and interactions among the effects of these variables are tested using multilevel mediation models. We use a traditional measure of past 3-month adolescent smoking and a novel measure of smoking identity., Results: Parental smoking was associated with a developmental increase in adolescent smoking and time-stable and time-varying parental engagement protected against adolescent smoking, whereas maternal engagement and smoking exerted independent and opposite effects with no moderation and time-stable paternal engagement moderated the effects of perceived paternal smoking on adolescent smoking outcomes. Parental smoking was more strongly associated with adolescent smoking outcomes when adolescent gender was congruent with parent gender., Conclusions: Even when parents smoke, parental engagement confers protection. Protective effects of engagement may be enhanced among parents who smoke through increased antismoking communication, particularly as adolescents reach the legal smoking age., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: This study examines a diverse set of social motives (e.g. peer support, peer pressure, social loneliness) for e-cigarette use, through the mediating effects of opinion leadership, among both male and female adolescents., Study Design: Prospective cohort study., Methods: The data were obtained from a survey conducted among 666 adolescents across 14 school classes, namely, students at three urban schools, public and private, in Lille, France. The proposed integrative model includes social motives, opinion leadership and e-cigarette use in a trilateral relationship; gender is proposed and tested as a potential moderator in a structural equation model., Results: More positive peer support is negatively associated with opinion leadership and e-cigarette use. Both loneliness and susceptibility to peer influence are positively related to opinion leadership and e-cigarette use. Moreover, social support from peers and opinion leadership shape e-cigarette use differently across genders., Conclusions: Policy makers should account for the various (positive and negative) roles of peers and consider the gender of their audience when designing anti-e-cigarette policies., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Aims: To study the predictive associations between maternal smoking and the impact of quitting smoking during pregnancy and offspring daily smoking at age 15-16 years., Design: The Northern Finland Birth Cohort 1986 (NFBC86) includes 99% of all births in the region and has an ongoing follow-up. Data were collected using questionnaires at 24th gestational week during pregnancy and after delivery, and at follow-up in 2001-02, when the offspring were aged 15-16 years., Setting: Northern Finland., Participants: NFBC86 included 9432 live born children. Data regarding maternal smoking during pregnancy and offspring smoking at age 15-16 years were available for 4462 subjects (47.3% of the original sample)., Measurements: The outcome was offspring's self-reported daily smoking. Maternal smoking during pregnancy was considered using a four-class variable: (1) no smoking, (2) mother had smoked, but had quit smoking before becoming pregnant, (3) mother quit smoking during the 1st trimester and (4) mother quit smoking after the 1st trimester or continued smoking throughout the pregnancy. Information regarding paternal smoking during pregnancy, maternal and paternal smoking and education level, family structure and dwelling at offspring's age 15-16 years were considered potential confounding variables., Findings: Continuing smoking after the 1st trimester increased the odds of daily smoking among offspring, independently of confounding factors [odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.3-2.5]. Continuing to smoke after the 1st trimester was associated with higher odds compared with quitting smoking during the 1st trimester. Also, parental smoking at offspring age 15-16 years increased the odds of offspring daily smoking, independently of prenatal smoking exposure., Conclusions: Prenatal smoking exposure increases the risk for offspring adolescent daily smoking. Quitting smoking during the early stages of pregnancy may decrease the odds for offspring smoking., (© 2016 Society for the Study of Addiction.)

Cigarette smoking is an economically and epidemiologically expensive public health concern. Most adult smokers become addicted during adolescence, rendering it a crucial period for prevention and intervention. Although litigation claims have delayed implementation, graphic warning labels proposed by the U.S. Food and Drug Administration (FDA) may be a promising way to achieve this goal. We aimed to determine the efficacy of the labels in reducing in-scanner craving and to characterize the neurobiological responses in adolescent and adult smokers and non-smokers. While undergoing functional magnetic resonance imaging, thirty-nine 13- to 18-year-old adolescent and forty-one 25- to 30-year-old adult smokers and non-smokers rated their desire to smoke when presented with emotionally graphic warning labels and comparison non-graphic labels. Compared with adult smokers, adolescent smokers exhibited greater craving reduction in response to the warning labels. Although smokers evinced overall blunted recruitment of insula and dorsolateral prefrontal cortex (DLPFC) relative to non-smokers, an effect that was stronger in adolescent smokers, parametrically increasing activation of these regions was associated with greater craving reduction. Functional connectivity analyses suggest that greater DLPFC regulation of limbic regions predicted cigarette craving. These data underscore a prominent role of frontoinsular circuitry in predicting the efficacy of FDA graphic warning labels in craving reduction in adult and adolescent smokers., (© The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.)

Although stressful life events during adolescence are associated with the adoption of unhealthy behaviors such as smoking, both social circumstances and physical traits can moderate the relationship. This study builds on the stress paradigm and gene-environment approach to social behavior by examining how a polymorphism in the serotonin transporter gene 5-HTTLPR moderates the effect of life events on adolescent smoking. Tests of interaction hypotheses use data from the Family Transitions Project, a longitudinal study of 7th graders followed for 5years. A sibling-pair design with separate models for the gender composition of pairs (brothers, sisters, or brother/sister) controls for unmeasured family background. The results show that negative life events are significantly and positively associated with smoking. Among brother pairs but not other pairs, the results provide evidence of gene-environment interaction by showing that life events more strongly influence smoking behavior for those with more copies of the 5-HTTLPR S allele., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Secondhand smoke (SHS) exposure is responsible for numerous diseases of the lungs and other bodily systems among children. In addition to the adverse health effects of SHS exposure, studies show that children exposed to SHS are more likely to smoke in adolescence. Susceptibility to smoking is a measure used to identify adolescent never-smokers who are at risk for smoking. Limited research has been conducted on the influence of SHS on susceptibility to smoking. The purpose of this study was to determine a robust measure of the strength of correlation between SHS exposure and susceptibility to smoking among never-smoking U.S. adolescents. This study used data from the 2009 National Youth Tobacco Survey to identify predictors of susceptibility to smoking in the full (pre-match) sample of adolescents and a smaller (post-match) sample created by propensity score matching. Results showed a significant association between SHS exposure and susceptibility to smoking among never-smoking adolescents in the pre-match (OR=1.47) and post-match (OR=1.52) samples. The odds ratio increase after matching suggests that the strength of the relationship was underestimated in the pre-match sample. Other significant correlates of susceptibility to smoking identified include: gender, race/ethnicity, personal income, smoke-free home rules, number of smoking friends, perception of SHS harm, perceived benefits of smoking, and exposure to pro-tobacco media messages. The use of propensity score matching procedures reduced bias in the post-match sample, and provided a more robust estimate of the influence of SHS exposure on susceptibility to smoking, compared to the pre-match sample estimates., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Aims: To evaluate gender differences in the role of positive and negative affect on smoking uptake., Design: Prospective longitudinal cohort study of adolescent health behaviors., Setting: Four suburban secondary schools outside Philadelphia, Pennsylvania, USA., Participants: Adolescents (n = 1357) were surveyed every 6 months for 4 years (age 14-18 years)., Measurements: Smoking and affect were measured via survey at each of the eight time-points., Findings: A two-group associative process latent growth curve model revealed that baseline positive affect was related negatively to smoking progression for females (b = -0.031, Z = -4.00, P < 0.0001) but not for males (P = 0.33). This gender difference was significant, χ(2)((df = 1))  = 8.24, P = 0.0041, indicating that for every standard deviation (SD) decrease in positive affect (SD = 2.90), there was a 10% increase [odds ratio (OR) = 1.10, 95% confidence interval (CI) = 1.04, 1.14] in the odds of smoking progression for females. Baseline negative affect was related significantly and positively to smoking progression for males (b = 0.038, Z =2.874, P = 0.004) and females (b = 0.025, Z =3.609, P < 0.0001), but the gender difference was not significant, χ(2)((df = 1)) = 0.82, P = 0.37. Thus, on average, for every standard deviation (SD = 4.40) increase in baseline negative affect there was a 15% (OR = 1.15, 95% CI = 1.06, 1.26) increase in the odds of smoking progression for males and for females., Conclusions: The impact of affect on adolescent smoking uptake varies by gender. Low positive affect (low experience of positive feelings or emotions) for females and high negative affect (high experience of negative feelings or emotions) for both males and females increases the risk for adolescent smoking., (© 2014 Society for the Study of Addiction.)

Background: A more comprehensive understanding of factors that affect smoking cessation outcomes among adolescents may help enhance treatment interventions. One promising but underexplored factor that may influence cessation success is teens' specific expectancies or beliefs about smoking outcomes. The present study evaluated the validity and reliability of a new measure of expectancies and its association with cessation outcomes among 762 adolescent smokers participating in studies of the American Lung Association's Not On Tobacco cessation program., Methods: Self-report questionnaires were collected prior to and following participation in a smoking cessation program. Self-reported cigarette use was verified with expired-air carbon monoxide. A multistep exploratory and confirmatory factor analysis and reliability and validity analyses were performed., Results: Four theoretically related yet empirically independent factors were identified by the Smoking Expectancies Questionnaire (SEQ): (1) Positive Reinforcement, (2) Negative Reinforcement-Emotional Regulation, (3) Negative Reinforcement-Addiction and Withdrawal, and (4) Negative Outcomes/Risk. These factors could be subsumed by a single SEQ factor that reflected an overall concept of smoking expectancies relevant for adolescent smoking cessation. An overall SEQ Function score reflecting the balance between positive and negative expectancies predicted both preintervention cigarettes per day and cessation outcomes., Conclusions: A single, overall SEQ Function score may prove useful for understanding the associations among individual, social, and contextual factors in predicting treatment outcomes. Additionally, study findings may assist with modifying smoking expectancies among cessation program participants, thereby enhancing treatment outcomes with diverse youth smoking populations.

Purpose: To improve smoking prevention efforts, better methods for identifying at-risk youth are needed. The widely used measure of susceptibility to smoking identifies at-risk adolescents; however, it correctly identifies only about one third of future smokers. Adding curiosity about smoking to this susceptibility index may allow us to identify a greater proportion of future smokers while they are still pre-teens., Methods: We use longitudinal data from a recent national study on parenting to prevent problem behaviors. Only oldest children between 10 and 13years of age were eligible. Participants were identified by RDD survey and followed for 6years. All baseline never smokers with at least one follow-up assessment were included (n=878). The association of curiosity about smoking with future smoking behavior was assessed. Then, curiosity was added to form an enhanced susceptibility index and sensitivity, specificity and positive predictive value were calculated., Results: Among committed never smokers at baseline, those who were 'definitely not curious' were less likely to progress toward smoking than both those who were 'probably not curious' (ORadj=1.89; 95% CI=1.03-3.47) or 'probably/definitely curious' (ORadj=2.88; 95% CI=1.11-7.45). Incorporating curiosity into the susceptibility index increased the proportion identified as at-risk to smoke from 25.1% to 46.9%. The sensitivity (true positives) for this enhanced susceptibility index for both experimentation and established smoking increased from 37-40% to over 50%, although the positive predictive value did not improve., Conclusion: The addition of curiosity significantly improves the identification and classification of which adolescents will experiment with smoking or become established smokers., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Introduction: Intermittent smoking is common among adolescent smokers, but little is known about adolescent intermittent smokers (ITS). This study describes a cohort of adolescent ITS and compares them to adolescent daily smokers (DS) for the purpose of providing a more detailed characterization of adolescent ITS, specifically patterns of smoking, level of self-reported addiction, and experience with cessation, Methods: Participants were 124 ITS and 55 DS. ITS were defined as smoking at least monthly but <30 days per month; and DS as smoking daily. Participants completed demographic, smoking and addiction surveys including the HONC and mFTQ., Results: ITS started smoking at an older age, smoked fewer cigarettes per day and scored significantly lower on addiction scales, but had similar difficulty to DS in quitting smoking with similar numbers of reported quit attempts. These differences remained after adjusting for years of smoking. ITS were more likely to smoke in social situations, while DS were more likely to smoke when angry. Both groups were equally likely to report smoking when drinking alcohol., Conclusions: We documented significant differences in smoking related behaviors between adolescent ITS and DS. Importantly, we also found that, despite low level infrequent smoking, ITS reported difficulty in quitting smoking. Given the risks from light and intermittent smoking, it is essential that we develop a greater understanding of adolescent ITS, including their difficulty in quitting and the contextual factors influencing their smoking, so that we may develop new targeted interventions., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

C-reactive protein (CRP), smoking, and oral contraceptive (OC) use are associated with CVD risk in adults. This study examines the effect of smoking on high-sensitivity CRP (hs-CRP) levels, and the interactive effects of sex and OC use on this relationship in an adolescent cohort. A total of 1,050 adolescents (mean age 17 ± 0.25 years) from the Western Australian Pregnancy Cohort (Raine) Study had anthropometric, lifestyle, and metabolic measures recorded. The association between smoking status and log-transformed hs-CRP was analyzed using multivariable Tobit linear regression models, with adjustment for adiposity, lifestyle, and early-life confounders. A three-level variable (girls not using OCs, girls using OCs, and boys) was employed to assess the interactive effects of sex, OC use, and smoking. Smoking associated with higher hs-CRP levels in girls not using OCs (b = 0.571; P = 0.001), but not in girls using OCs (b = -0.117; P = 0.598) or in boys (b = 0.183; P = 0.2). OC use in nonsmoking girls was the strongest factor associated with higher hs-CRP levels (b = 1.189; P < 0.001). This study has demonstrated a more robust effect of smoking on hs-CRP levels in girls not using OCs compared with boys. The findings may explain why CVD risk conferred by smoking is higher in women than in men.

Background: Tobacco use is a global public health threat and a leading preventable cause of death in the world. While cigarette use among youth has been decreasing in high-income countries, low- and middle-income countries have contrastingly high rates of adolescent smoking. In Ghana, smoking prevalence is lower than in other parts of the African continent and more common among men than women; however the gender gap in tobacco use among adolescents has narrowed, with shisha use among girls recently surpassing boys. These trends toward increased relative use among adolescent girls are a cause for concern and highlight the need for interventions to prevent and/or reduce tobacco use in this population. Methods: We conducted in-depth interviews with girls aged 13–20 (n = 148) and their parents (n = 7) in Ghana's largest two cities – Accra and Kumasi, to explore the physical, social, and psychological context underlying smoking perceptions and behavior. Results: We identified 11 key insights into influences on smoking behavior, organized into the broader themes of perceptions of smoking, environmental factors, and internal factors. Findings underscore that perceptions around smoking are very much driven by girls' social world, which is generally small and parent-centric for non-smokers at younger ages but can start to expand as girls get farther along in school or leave school entirely. After what may have been a sheltered adolescence, many older girls in Ghana look for ways to express their independence in decision-making and a few may use their developing agency to rationalize limited or infrequent tobacco use if they perceive the benefits to them outweigh the potential consequences. Conclusions: Our findings highlight strong social influences on girls' perceptions, exposure to opportunities, and decision-making in ways that can often be protective against smoking, particularly at younger ages, but may also leave girls unprepared to manage challenging situations later in life. Understanding this context in Ghana will be important for any future programming aiming to prevent smoking initiation among adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Risky behaviours, including tobacco use, are highly prevalent among adolescents worldwide. Although these behaviours are largely influenced by various sociodemographic factors, including sex, there is a paucity of regionally representative literature on the sex-related inequalities in cigarette smoking among adolescents in Africa. This study examined the sex-based disparities in current cigarette smoking among adolescents aged 13–15 years in Africa. Methods: The present study employed a secondary analysis of nationally representative data on 45 African countries obtained from the Global Youth Tobacco Survey, accessible through the World Health Organization (WHO) Global Health Observatory. We used the online version of the WHO Health Equity Assessment Toolkit (HEAT) to generate the results. Results: The prevalence of current cigarette smoking among the adolescents surveyed ranged from 1.6% in Eritrea to 10.4% in Mali among the low-income countries, from 1.3% in Tanzania to 13.1% in Mauritania among the lower-middle-income countries, from 5.2% in Gabon to 15.3% in Mauritius among the upper-middle-income countries, and 14.7% in Seychelles, the only high-income country in the study. The absolute summary measure (D) showed diverse sex-related disparities in the burden of current cigarette smoking among adolescents across the sub-regions. In all countries surveyed, the prevalence of cigarette smoking was higher among male adolescents compared to females, except in Liberia and Mozambique, where female adolescents bore a more significant burden than their male counterparts. Furthermore, male adolescents were more burdened with high cigarette smoking prevalence than females in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia, where such disparities were most pronounced. Meanwhile, we found less disparity in the burden of cigarette smoking between male and female adolescents in most of the lower and upper-middle-income countries surveyed. Conclusion: This study sheds light on the sex-based inequalities in the prevalence of current cigarette smoking among adolescents in Africa. In contrast to female adolescents, male adolescents bear a greater burden of current cigarette smoking. The burden of cigarette smoking is most pronounced in low-income countries such as Mali, Madagascar, Guinea, Burkina Faso, and The Gambia. Conversely, in most of the lower and upper-middle-income countries surveyed, the burdens of current cigarette smoking among male and female adolescents were found to be less disparate. Consequently, cigarette smoking prevention programmes and strategies must be implemented in all African nations. There is also the need to intensify interventions aimed at altering the smoking behaviour of male adolescents. Policymakers can develop and implement evidence-based interventions to address the burden of cigarette smoking among the adolescents. Finally, existing policies and programmes addressing adolescents' cigarette smoking should be re-assessed and strengthened to achieve their objectives. [ABSTRACT FROM AUTHOR]

Objective: The present study sought to assess the prevalence and determinants of tobacco use (cigarette smoking and shisha use) and khat chewing among Yemeni adolescents, and to evaluate their knowledge and attitudes toward these habits. Methods: This school-based cross-sectional study was conducted among 13 to 19-year-old students attending middle/high schools (both private and public) across five main cities in Yemen. Data were collected using self-administered questionnaires comprising questions/items related to sociodemographic data, cigarette smoking, shisha use, khat chewing, and knowledge on and attitudes toward these habits. Bivariate and multivariate analyses were used to explore the most determinant factors. Results: A total of 7505 students were recruited from 42 schools across five major cities in Yemen. The prevalence rates of khat chewing, cigarette smoking, and shisha use were 42.4%, 6.8%, and 19.3%, respectively. Compared to females, male subjects reported significantly higher prevalence of khat chewing (51.4% vs. 23.5%, p < 0.001), shisha use (20.3% vs. 17.2%, p < 0.01), and cigarette smoking (8.8% vs. 2.6%, p < 0.001). Male gender, older age, poor knowledge, khat chewing, parents' low education level, and parents' and peers' smoking habits were significant determinants of adolescents' cigarette smoking status. Private education, male gender, older age, poor knowledge, parents' low education level, and parents' and peers' khat chewing habits were significant determinants of adolescents' khat chewing status. The participant's knowledge of and attitudes toward tobacco use and khat chewing were inadequate. Conclusion: The prevalence of khat chewing, shisha use, and to lesser extent cigarette smoking among Yemeni adolescents is high that needs immediate intervention. The results highlight the urgent need to implement prevention strategies to tackle these habits among the youth in Yemen. [ABSTRACT FROM AUTHOR]

Exposure to secondhand smoke is one of the leading causes of death for non-smokers worldwide. The prevalence of exposure to secondhand smoke is higher among adolescents. Research on predictors of secondhand smoke exposure in adolescents is still rarely conducted in Indonesia. This study aimed to analyze the predictors of exposure to secondhand smoke among non-smoking adolescents in Indonesia. This study used data from the Global Youth Tobacco Survey (GYTS) Indonesia 2019 with a cross-sectional design. A total of 7,594 adolescents aged 13 to 15 were selected using purposive sampling. The dependent variables were exposure to secondhand smoke at home and in public. The independent variables included age, gender, smoking parents, smoking friends, and knowledge of the dangers of secondhand smoke. Data were analyzed using STATA with inferential tests, namely chi-square and logistic regression. The prevalence of adolescents exposed to secondhand smoke at home and in public was 49.57% and 71.86%, respectively. At-home exposure was significantly associated with smoking parents [AOR=3.50, 95% CI=2.97 to 4.12], smoking friends [AOR=1.50, 95% CI=1.30 to 1.73], and knowledge of the dangers of secondhand smoke [AOR=2.11, 95% CI=1.52 to 2.93]. Public exposure was associated with ages 13-15 [AOR=1.32, 95% CI=1.10 to 1.58] and older than 15 [AOR=1.77, 95% CI=1.39 to 2.25], male gender [AOR=1.31, 95% CI=1.11 to 1.53], smoking parents [AOR=1.58, 95% CI=1.36 to 1.84], smoking friends [AOR=2.16, 95% CI=1.85 to 2.53], and knowledge of secondhand smoke dangers [AOR=2.84, 95% CI=2.15 to 3.75]. Adolescents' exposure to secondhand smoke in public spaces is higher in prevalence and has more associated factors compared to exposure at home. Exposure reductions require comprehensive actions from authorities by strictly implementing and expanding non-smoking areas covered by existing regulations. Also, family and school management should be involved in prevention efforts. [ABSTRACT FROM AUTHOR]

In recent years, the prevalence of tobacco and electronic cigarette (e-cigarette) use among adolescents has raised significant public health concerns worldwide. This study aimed to investigate respiratory symptoms among Polish adolescents. We conducted an online survey among Polish school students from all provinces, collecting data over two months in spring 2021. Students voluntarily complete the anonymous survey, answering questions about respiratory symptoms, smoking habits (both traditional and electronic cigarettes), and demographic information. The analysis focused on four subgroups, namely non-tobacco users, traditional cigarette smokers, e-cigarette users, and dual users, totaling 10,388 pupils aged 12–18 years, predominantly attending secondary technical and comprehensive schools. A total of 10,388 pupils participated in the study, 55.6% (5778) of whom were girls and 44.4% (4610) boys. Adolescents who admitted using both e-cigarettes and traditional cigarettes experienced more frequent episodes of cough during the day (39.70%) and at night (18.40%) compared to their peers in other groups. Chest discomfort, including pain and pressure, was also reported more often by adolescents who used e-cigarettes and traditional cigarettes concurrently (27.60%) compared to their peers in other groups. Chest pressure was experienced less commonly by non-smoking adolescents (14.40%) than by smokers (18.90%). Higher severity of cough during the day and at night was observed in the group of adolescents using traditional cigarettes and e-cigarettes concurrently compared to the other groups. The adolescents in the dual-user group experienced more severe dyspnea and wheezing compared to the other groups included in the comparison. The results of this study confirm the correlation between the occurrence of respiratory symptoms in adolescents who smoke cigarettes, adolescents who use e-cigarettes, and adolescents who are dual users. The respiratory symptoms occur most frequently and are the most severe in the group of adolescents who use e-cigarettes and traditional cigarettes [ABSTRACT FROM AUTHOR]

Aim: This study classified 99 countries into four income groups and then analysed the impact of secondhand smoke (SHS) exposure at home, in public places and at school, on current cigarette smoking prevalence. Methods: We utilised data from the WHO Global Youth Tobacco Survey and a meta‐analysis was conducted to evaluate the prevalence and weighted odds ratios (wORs) of adolescent smoking behaviour and SHS exposure locations. Results: Both smoking behaviours increased with higher national income levels. Smoking behaviours in high and upper‐middle‐income countries (HICs and UMICs) exhibited an association with SHS exposure in public places (HIC: wOR, 3.50 [95% CI, 2.85–4.31]; UMIC: wOR, 2.90 [2.60–3.23]) compared to home. Low‐ and lower‐middle‐income countries (LICs and LMICs) showed an association with SHS exposure in the home (LIC: wOR, 5.33 [3.59–7.93]; LMIC: wOR, 2.71 [2.33–3.17]) than public places. The association between current cigarette smoking and SHS exposure at home increased with lower income levels, while anticipated future use of any form of tobacco with SHS exposure in public places rose in lower income countries. Conclusions: Targeted interventions based on income levels are essential, emphasising home strategies in lower income countries and public place efforts in higher income countries. [ABSTRACT FROM AUTHOR]

Background and Objectives: In 2022, the Centers for Disease Control and Prevention (CDC) discovered that 2.55 million middle and high school students were using electronic cigarettes (e-cigarettes) in the US alone. E-cigarettes allow people to inhale a nicotine solution (e-liquid) into their bodies. While e-cigarettes are often advertised as a way to help people quit traditional tobacco products, the World Health Organization (WHO) has stated that there is no proof of e-cigarettes being effective at reducing an individual's tobacco use. The objective of this study is to determine why adolescents start smoking e-cigarettes. Materials and Methods: For the following study, the National Youth Tobacco Survey (NYTS) 2021 was used. This is a nationally representative cross-sectional survey that includes middle and high school students. The data were analyzed using SAS v.9.4. The odds ratio for smoking e-cigarettes was evaluated for both sex and race via a logistic regression. Results: It was discovered that the percentage of only e-cigarette smokers (12.10%) was 5.5 times the percentage of only traditional smokers (2.19%). Additionally, the median age at which adolescents started smoking e-cigarettes was fifteen years with an IQR (Inter Quartile Range) of two. We used a logistic regression to show that biological sex and race were significant predictors of e-cigarette usage. Conclusions: In general, we saw that adolescents were mostly starting to smoke e-cigarettes because their friends were doing it, out of curiosity, they were depressed or anxious, and/or to get a "high", implying that adolescents mostly started smoking in order to fit in and/or to numb themselves. Interestingly, reasons like cost, using them to quit smoking, seeing them in the media, and ease of attainment were ranked the lowest when it came to smoking e-cigarettes. However, their lower costs naturally lead to increased accessibility compared to traditional cigarettes, making them easier to reach the hands of teenagers. Overall, in this paper, we aim to identify if adolescents are choosing e-cigarettes as their first foray into tobacco products and why. [ABSTRACT FROM AUTHOR]

Introduction: Smoking behavior among adolescents is a public health problem. The use of e-cigarettes is desirable to teenagers in Indonesia, with as many users aged 10-19 years. To change behavior, health education is needed. One of the strategies is online health education. This research aims to determine the effectiveness of web-based education on e-smoking behavior. Materials and methods: Research using the Mix Method. The research was carried out experimentally and then qualitatively using a case study approach. In experimental research, samples were taken using simple random sampling with a total of 310, divided into 2, namely experimental and control groups. Providing webbased education is carried out for one month. Qualitative research with a case study approach conducted in-depth interviews with 12 students who use electronic cigarettes. Qualitative analysis by creating codes, Simplification, and presentation of data, and Clarification of data Conclusion. Results: The results of this study are that the average age of respondents is 19 years, and 7.7% of students smoke conventional types of cigarettes, electric and use both, smoking more than 100 days. After being given web-based education, with a statistically exact p-value=1 (>0.05) test score; there was no difference in pre- and post-treatment smoke behavior. The results of in-depth interviews showed that students’ knowledge about dangerous e-cigarettes can interfere with health and cause addiction. Conclusion: Web-based education carried out for one month did not influence smoking behavior, but that the perception of e-cigarettes was that e-cigarettes contain tar and are harmful to health. [ABSTRACT FROM AUTHOR]

Preventing young people's cigarette smoking is a major public health priority, and smoking is especially prevalent in vocational schools. Well-enforced comprehensive school tobacco policies accompanied by preventive efforts show potential to reduce smoking, but the implementation process is crucial to achieve the intended effect. We investigate whether and how implementation fidelity of a multi-component smoking prevention intervention impacted student smoking outcomes after 4–5 months among students in Danish vocational education and training (national age range 15–65 years, mean 25.6) and preparatory basic education (national age range 15–25 years, mean 17.6) institutions using questionnaire data from a cluster-RCT. The intervention included a smoke-free school hours policy, educational curriculum, and class competition. We calculated an overall implementation fidelity measure combining staff-reported school-level delivery (fidelity) and student-reported receipt (participation, responsiveness), and used multilevel regression models to analyze associations with smoking outcomes (smoking daily, regularly, and during school hours). We supplemented the analysis with restricted cubic spline regression. Additionally, we stratified the analyses by school types and analyzed associations between implementation fidelity of the separate intervention components and smoking outcomes. High implementation was associated with lower odds of regular smoking (OR: 0.37, 95% CI: 0.18–0.78) and smoking during school hours, but not daily smoking, and these associations varied between the school settings. When analyzed separately, implementation fidelity of the components did not affect the outcomes significantly. Our findings underline the need to support the implementation process of school tobacco policy interventions to ensure the intended effects of reducing students' smoking. [ABSTRACT FROM AUTHOR]

Background and Aims Design Setting Participants Measurements Findings Conclusions Disposable e‐cigarette use has increased among United States (US) high school students in recent years. However, there is limited research on the profile of these users, how often they use these products, and whether they displace cigarette smoking. This study aimed to measure how disposable e‐cigarette use among US youth varies according to demographic characteristics and whether there is any association between e‐cigarette use and reduced use of traditional cigarettes.We used cross‐sectional data from the 2022 National Youth Tobacco Survey and conducted a multinomial logistic regression to examine factors associated with the types of e‐cigarette devices used in the prior 30 days, adjusting for sex, sexual identity, grade level and race/ethnicity. We also used a finite mixture model to account for unobserved differences among users and identify e‐cigarette use patterns in different subgroups of users.United States.High school students in grades 9–12 (n = 14 389).Survey participants self‐reported the type of e‐cigarette device used, the frequency of e‐cigarettes used and cigarettes smoked over the past 30 days.Disposable e‐cigarettes were the most popular e‐cigarette type. Sex, sexual orientation, grade level and race/ethnicity were associated with disposable e‐cigarette use. The odds of disposable e‐cigarette use were lower in male students than in female students (odds ratio [OR] = 0.78, 95% confidence interval [CI] = [0.64–0.96]), and higher in students who identified as gay or lesbian (OR = 1.70, 95% CI = [1.11–2.61]) or bisexual (OR = 1.52, 95% CI = [1.16–1.99]) than in heterosexual students. The odds of disposable use were higher among students in higher grades (10th, 11th and 12th) than in 9th graders (OR = 1.71, 2.24 and 2.52, respectively). Disposable e‐cigarette users had a lower frequency of traditional cigarette use than other e‐cigarette users, both in the low‐frequency class (incidence rate ratio [IRR] = 0.33, 95% CI = [0.12–0.92]) and the high‐frequency class (IRR = 0.27, 95% CI = [0.08–0.92]).Disposable e‐cigarette use appears to be higher among United States high school students who are female, older and/or identify as gay, lesbian or bisexual. Disposable e‐cigarettes appear to be associated with reduced traditional cigarette use. [ABSTRACT FROM AUTHOR]

Gastro-oesophageal reflux disease (GORD) is recognized by symptoms of heartburn and acid regurgitation. These gastro-oesophageal reflux symptoms (GORS) are common in adults, but data from adolescents are sparse. This study aimed to assess the prevalence and risk factors of GORS among adolescents in a large and unselected population. This study was based on the Trøndelag Health Study (HUNT), a longitudinal series of population-based health surveys conducted in Nord-Trøndelag County, Norway. This study included data from Young-HUNT4 performed in 2017–2019, where all inhabitants aged 13–19 years were invited and 8066 (76.0%) participated. The presence of GORS (any or frequent) during the past 12 months and tobacco smoking status were reported through self-administrated questionnaires, whereas body mass index (BMI) was objectively measured. Among 7620 participating adolescents reporting on the presence of GORS, the prevalence of any GORS and frequent GORS was 33.2% (95% confidence interval [CI] 32.2 − 34.3%) and 3.6% (95% CI 3.2 − 4.0%), respectively. The risk of frequent GORS was lower among boys compared to girls (OR 0.61; 95% CI 0.46 − 0.79), higher in current smokers compared to never smokers (OR 1.80; 95% CI 1.10 − 2.93) and higher among obese compared to underweight/normal weight adolescents (OR 2.50; 95% CI 1.70 − 3.66). A considerable proportion of adolescents had GORS in this population-based study, particularly girls, tobacco smokers, and individuals with obesity, but frequent GORS was relatively uncommon. Measures to avoid tobacco smoking and obesity in adolescents may prevent GORS. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco smoking is one of the 10th leading health indicators proposed by the World Health Organisation (WHO) Healthy People 2020, with major concerns regarding increased mortality rates. Tobacco smoke contains 2.94 mg of nicotine, 802 mg of tar, 145 mg of carbon monoxide, and greater quantities of chrysene. Hookah tobacco poses a serious health threat because of the commonly held belief among college students that this tobacco product is not addictive. Assessing practices represents an important starting point in curbing the spread of tobacco use. It is crucial to understand the use, patterns, and dependence on tobacco to develop appropriate prevention and cessation strategies. Aim: To assess tobacco smoking-related knowledge, attitudes, and practices among students of dental Institutions in Lucknow city, Uttar Pradesh, India. Materials and Methods: A descriptive cross-sectional study was conducted among five dental colleges in Lucknow city from July 2023 to November 2023. A total of 1050 undergraduate dental students were included in the study, and a self-structured, close-ended questionnaire was used to collect information on the knowledge, attitudes, and practices of hookah tobacco. The reliability of the questionnaire was evaluated using Cronbach’s coefficient alpha to measure internal consistency, which was found to be 0.9. Discrete (categorical) data were summarised in numbers (n) and percentages (%). Categorical groups were compared by Chi-square (χ2 ) test. Results: Out of the total 1050 students, 392 (37.3%) were aged between 18-21 years, 630 (60.0%) were aged between 22-25 years, and 28 (2.7%) were aged between 26-30 years. Furthermore, among the students, 355 (33.8%) were females and 695 (66.2%) were males. Among the total of 1050 dental students, the prevalence of hookah smoking was 59.1%. The presence or prevalence of hookah smoking was higher in males (29.4%) at 480 (45.7%) than in females 141 (13.4%), and the difference was statistically significant (χ2 =83.75, p<0.001). Conclusion: The study found that the frequency of hookah smoking continues to increase with the increasing age of the participants. The study also revealed the alarming situation of a high prevalence of hookah smoking among dental college students. [ABSTRACT FROM AUTHOR]

Introduction We quantified the linear trend in combustible tobacco smoking among adolescents in the United States from 2014 to 2020, and then compared these trends across racial and ethnic categories. We also tested the effect of e-cigarette use on these trends for all-youth and across racial and ethnic categories. Aims and Methods We pooled and analyzed seven years of National Youth Tobacco Survey data for n  = 124 151 middle and high school students from 2014 to 2020. Weighted logistic regression analyses calculated the annual change in combustible tobacco smoking (ie cigarettes, cigars, and hookah) from 2014 to 2020. Stratified analyses examined linear trends for non-Hispanic White (NHW), NH-Black (NHB), Hispanic/Latino, and NH-Other (NHO) youth. All-models controlled for sex, grade level, and past 30-day e-cigarette use. Results Combustible tobacco smoking from 2014 to 2020 dropped by more than 50% for NHW youth, more than 40% for Latino and NHO youth, compared to just 16% among NHB youth. From 2014 to 2020, the odds of combustible tobacco smoking declined by 21.5% per year for NHWs, which was significantly greater than Hispanic/Latinos (17% per year; p  = .025), NHOs (15.4% per year; p  = .01), and NHBs (5.1% per year; p  < .001), adjusting for sex, grade, and e-cigarette use. Trends and disparities in trends by race and ethnicity were observed independent of e-cigarette use. Conclusions Combustible tobacco smoking declined for all-youth but at significantly different rates across races and ethnicities. Notably, declines in combustible tobacco smoking are lagging among NHB youth. Interventions are critically needed to address this disparity. Implications A direct, evidence-based intervention to reduce combustible tobacco smoking among NHB youth is critically needed. Such tobacco control initiatives should follow the Best Practices for Comprehensive Tobacco Control Framework, incorporating sustainable funding for school-based intervention, public health education, and adult cessation. [ABSTRACT FROM AUTHOR]

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Introduction: Ferritin has been implicated in body physiology and pathology. Smoking cigarettes (Cg) alters ferritin metabolism. Waterpipe (Wp) smoking has recently reemerged as a global epidemic and is linked to the most devastating diseases. However, the effect of smoking Wp on ferritin is not known. Therefore, the current study compared plasma ferritin in adolescents smoking Cg, Wp, both (CgWp) versus never smoked. Material and methods: Self-reported smoking status and plasma ferritin levels were obtained from 849 boys (n = 470) and girls (n = 379) in the 7th-10th grade (age range = 13-17 years). Results: The ANCOVA revealed a main effect for gender (p < 0.000) and smoking status (p < 0.02) without an interaction effect (p > 0.9). Post-hoc analysis showed greater plasma ferritin in the adolescents smoking Wp (p < 0.03) and CgWp (p < 0.004) versus never smoked. Gender-stratified ANCOVA showed a main effect for smoking status in the boys (p < 0.02) and girls (p < 0.03). Additional comparisons among the boys showed greater plasma ferritin in the Wp (p < 0.006) and CgWp (p < 0.008) smoking groups versus never smoking, without differences (p > 0.5) between Wp and CgWp smoking. Another subgroup comparison showed greater plasma ferritin in the girls smoking Cg (p < 0.02) and CgWp (p < 0.02) versus never smoking, without a difference (p > 0.3) between Cg and CgWp smoking. Conclusions: The results indicate that ferritin is elevated in adolescent smokers, particularly the boys smoking Wp and CgWp and in the girls smoking Cg and CgWp. [ABSTRACT FROM AUTHOR]

The article "Journey towards a smoke-free nation" published in the Annals of the Academy of Medicine, Singapore, details Singapore's efforts to reduce smoking rates and become a smoke-free society. Initiatives such as the National Smoking Control Programme, public health campaigns, and smoking cessation services have contributed to a decline in smoking prevalence. Factors influencing smoking cessation, including ethnicity, education level, marital status, and doctors' advice, are discussed, highlighting the need for tailored interventions. Challenges posed by the rise of e-cigarettes and the economic impact of smoking are also addressed, emphasizing the importance of continued research and policy development in tobacco control. [Extracted from the article]

There is a lack of robust research investigating the association between neurocognitive impairments and chronic tobacco smoking in adolescents/young adults. Therefore, a systematic review and meta-analysis were conducted to examine this association by pooling cross-sectional studies published from 1980 to 2023. The systematic review assessed the neurocognitive performances between chronic tobacco smokers and nonsmokers in each study. The meta-analysis included six studies that compared chronic tobacco smokers against non-smokers using neuropsychological tests covering three neurocognitive domains. The results showed a cross-sectional association between impairpments in motor impulsivity across two aspects: reaction delay and incongruent errors, with the effect size being (SDM = 0.615, p = 0.000) and (SDM = 0.593, p = 0.000) respectively. However, no significant associations were found for intelligence (SDM = 0.221, p = 0.425) or working memory (SDM = 0.150, p = 0.581). This study highlights the need for further research to explore a greater number of neurocognitive domains in the context of chronic smoking in adolescents/young adults, particularly motor impulsivity, intelligence and working memory, as well as the socioeconomic factors involved. There is also a need to further study the effects of emerging alternative nicotine administration methods in this age group. [ABSTRACT FROM AUTHOR]

Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual's positive and negative cognitions related to a behavior, and subsequent initiation of that behavior. Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents. Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11–2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10–5.68) or negative (OR = 1.93, 95% CI 1.03–3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03–4.17) compared to those with lower levels of negative implicit cognitions. Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the effectiveness of a school‐based multiple health behaviour change e‐health intervention for modifying risk factors for chronic disease (secondary outcomes). Study design: Cluster randomised controlled trial. Setting, participants: Students (at baseline [2019]: year 7, 11–14 years old) at 71 Australian public, independent, and Catholic schools. Intervention: Health4Life: an e‐health school‐based multiple health behaviour change intervention for reducing increases in the six major behavioural risk factors for chronic disease: physical inactivity, poor diet, excessive recreational screen time, poor sleep, and use of alcohol and tobacco. It comprises six online video modules during health education class and a smartphone app. Main outcome measures: Comparison of Health4Life and usual health education with respect to their impact on changes in twelve secondary outcomes related to the six behavioural risk factors, assessed in surveys at baseline, immediately after the intervention, and 12 and 24 months after the intervention: binge drinking, discretionary food consumption risk, inadequate fruit and vegetable intake, difficulty falling asleep, and light physical activity frequency (categorical); tobacco smoking frequency, alcohol drinking frequency, alcohol‐related harm, daytime sleepiness, and time spent watching television and using electronic devices (continuous). Results: A total of 6640 year 7 students completed the baseline survey (Health4Life: 3610; control: 3030); 6454 (97.2%) completed at least one follow‐up survey, 5698 (85.8%) two or more follow‐up surveys. Health4Life was not statistically more effective than usual school health education for influencing changes in any of the twelve outcomes over 24 months; for example: fruit intake inadequate: odds ratio [OR], 1.08 (95% confidence interval [CI], 0.57–2.05); vegetable intake inadequate: OR, 0.97 (95% CI, 0.64–1.47); increased light physical activity: OR, 1.00 (95% CI, 0.72–1.38); tobacco use frequency: relative difference, 0.03 (95% CI, –0.58 to 0.64) days per 30 days; alcohol use frequency: relative difference, –0.34 (95% CI, –1.16 to 0.49) days per 30 days; device use time: relative difference, –0.07 (95% CI, –0.29 to 0.16) hours per day. Conclusions: Health4Life was not more effective than usual school year 7 health education for modifying adolescent risk factors for chronic disease. Future e‐health multiple health behaviour change intervention research should examine the timing and length of the intervention, as well as increasing the number of engagement strategies (eg, goal setting) during the intervention. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12619000431123 (prospective). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the prevalence rate and assess knowledge and attitudes among secondary students in Sulaimani city. Methods: A cross-sectional study was conducted among school students, from eight randomly selected secondary schools in Sulaimani city, Iraq. 1200 students participated in this study during six months from October 2022 to April 2023. The respondents were explained about each section of the questionnaire form. It describes behaviors, knowledge, beliefs, opinions, and other variables related to tobacco use. Results: The prevalence rate of current tobacco use (all types) is 21.8%, from this rate; 13.2% were cigarette smoking, 11.9% waterpipe, 24.7% used electronic smoke such as vape and pods and 50.2% of students used all types of tobacco product. The prevalence rates of tobacco use in males (31.3%) and females (12.1%). The rates were higher among students whose mother and father, schoolmates, relatives, and friends were smokers than those whose parents, schoolmates, relatives, and friends were non-smokers. A higher rate of smokers have not thought about the harmful of other people's cigarettes on them, 16.7%, 25%, 9.9%, and 4.8% of smokers have not thought definitely, probably not, probably yes, and definitely yes. Regarding the attitude of the smokers, it showed statistically that there were significant associations for example only 6.6% of smokers were with the banning of smoking in public places while 21.7% of them were with not banning smoking in public places. Conclusions: Despite the prevalence rate of smoking in Sulaimani City being relatively lower than in other cities in Iraq the rate is still high. The rate was higher in males than females. In addition, there were factors connected with smoking initiation which are parents, schoolmates, relatives, and friends smoking. A higher rate of smokers did not think about the harmful of other people's cigarettes to them and a lower rate of smokers were with the banning smoking in public places. [ABSTRACT FROM AUTHOR]

Background: Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia. Methods: Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence. Conclusion: This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population. [ABSTRACT FROM AUTHOR]

Prior research has predominantly focused on the overall effects of the tobacco tax increase and the COVID-19 pandemic on adolescent smoking behavior. However, there is a need to examine both the immediate and sustained associations of these two factors on subgroups of adolescents, employing an interrupted time-series model. We aimed to investigate the immediate and sustained association of tobacco tax increase and the COVID-19 pandemic on adolescent smoking prevalence. This study utilized data from the Korea Youth Risk Behavior Web-Based Survey to analyze the prevalence of current smoking among all participants (CSP) and the prevalence of daily smoking among current smokers (DSP) of Korean adolescents (n = 1,159,995; mean, age 14.99; male 51.5%) over 18 years from 2005 to 2022. The study examined 18-year trends in CSP and DSP among Korean adolescents, emphasizing the influences of the 2015 tobacco tax increase and the COVID-19 pandemic, using β coefficients and their differences (βdiff) from an interrupted time-series ARIMA model. While CSP exhibited a decreasing trend, DSP exhibited an increasing trend. Tobacco tax increase was associated with both the short and long terms in smoking prevalence, however, the short-term association on prevalence (CSP, − 3.076 [95% CI, − 3.707 to − 2.445]; DSP, − 4.112 [95% CI, − 6.488 to − 1.735]) was stronger. The pandemic was associated with an immediate increase in DSP (9.345 [95% CI, 5.285–13.406]). These effects were strongest among adolescents from low economic status and those exposed to familial secondhand smoking. Supportive programs for adolescents in low-income families will help overcome the effects associated with the pandemic. As a tobacco tax increase was associated with a reduction in smoking prevalence, this could be one method to overcome the effects of the pandemic. [ABSTRACT FROM AUTHOR]

Background: Smoking remains a major risk factor for the development and progression of chronic obstructive pulmonary disease (COPD). Due to the adolescent smoking associated with worse health state, the age, at which an individual started smoking, might play a key role in shaping the trajectory of COPD development and the severity. Methods: We conducted an observational study from September 2016 through January 2023 of eligible patients hospitalized with COPD. Patients who started smoking during the alveolar development stage (ADS, smoking initiation ≤ 24 years old) were defined as early smoking patients, and patients who started smoking after ADS (smoking initiation > 24 years old) were defined as late smoking patients. We collected demographic and clinical data characterizing the patients and documented their condition from hospital discharge to follow-up. The primary endpoints were short-term (within one year), 3-year, and long-term (beyond 3 years) all-cause mortality after discharge. Results: Among 697 COPD patients, early smoking patients had a lower smoking cessation rate (P < 0.001) and a higher smoking index (P < 0.001) than late smoking patients. Although adjusted smoking index, early smoking patients still had poorer lung function (P = 0.023), thicker left ventricular diameters (P = 0.003), higher frequency of triple therapy use during stable stage (P = 0.049), and more acute exacerbations in the past year before enrollment (P < 0.05). Survival analysis showed that they had a higher risk of death after discharge within three years (P = 0.004) and beyond three years (P < 0.001). Furthermore, even in early smoking COPD patients who quit smoking after adjusting the smoking index had poorer lung function (P < 0.05) and thicker left ventricular diameters (P = 0.003), and survival analysis also showed that they had a higher long-term mortality rate (P = 0.010) and shorter survival time (P = 0.0128). Conclusion: Early smoking COPD patients exhibited multiple adverse clinical outcomes, including heavy cigarette addiction, compromised pulmonary function, augmented left ventricular diameter, and elevated mortality risk. Additional, smoking cessation could not bring enough improvement of health state in early smoking COPD patients as late smoking COPD patients. Consequently, early intervention and specialized cessation approaches for younger smokers are of paramount importance in this context. [ABSTRACT FROM AUTHOR]

The issue of smoking is becoming progressively genuine, both for dynamic smokers and individuals around them who don’t smoke (detached smokers). The cause of smoking among youngsters is expanding, due to the expanding concentration of publicizing, particularly portraying smoking as cool, and cheap cost of cigarettes. Cross-sector participation in dealing with KTR in schools is vital since execution is way better with cross-sector commitment and participation. The resultant information is considered to be exceptionally compelling and critical in changing students’ states of mind and practices regarding the threats of smoking, that is to say that, there is a relationship between information and early adolescents’ activities concerning KTR approaches in junior high schools. The method used in the study is in-depth interviews. Results show that companions have the most significant influence on pre-adult smoking behavior compared to mass media and peers. A few of the deterrents that exist within the bureaucratic structure, division of specialists, and extraordinary controls in a few schools in Bener Meriah have not been completely shaped, agreeing to Qanun number 1 of 2018 with respect to non-smoking zones in schools that still need to be moved forward. The study recommends more studies to be conducted on high-school students or young people who don’t go to school since their level of autonomy and social designs are distinctive from those that are in universities and colleges. [ABSTRACT FROM AUTHOR]

Cigarette smoking, as a significant public health problem worldwide, deserves more attention. This research intended to assess the prevalence rate of smoking among college students self-identified as lesbian or gay, examine whether depression mediated the association between social support and smoking, and explore whether disclosure moderated the indirect effect of the mediation model. All data were collected by online questionnaires, yielding a total of 1,109 homosexual college students involved in the analysis. A moderated mediation analysis was adopted to uncover the connection between social support, depression, and cigarette smoking, with disclosure as the moderator. The prevalence of smoking was 7.4%, and lesbian females (12.5%) were more likely to report smoking than gay males (5.2%). Depression fully mediated the effects of social support on cigarette smoking (coefficient ab = −0.0097, 95% Boot CI: −0.0174 to −0.0029), accounting for 97.0% of the total effect. Further moderated mediation analyses revealed the indirect effect of depression was statistically significant in both disclosed (effect = 0.0737, 95% Boot CI: 0.0005 to 0.1502) and non-disclosed groups (effect = −0.0109, 95% Boot CI: −0.0183 to −0.0039). The prevalence of smoking among homosexual college students in China should not be neglected, especially among lesbian students. Interventions, such as encouraging greater disclosure and expanding social support, may help break the link between depression and smoking. [ABSTRACT FROM AUTHOR]

Methods: Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use. Results: Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95% CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002) Conclusion: Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking. [ABSTRACT FROM AUTHOR]