Association of School Social Networks’ Influence and Mass Media Factors With Cigarette Smoking Among Asthmatic Students

Asthma is a common chronic disease among adolescent students, and was one of the 5 most common reasons for pediatric treat-and-release for emergency department visits among 5- to 14-year-old children in 2010.1 In 2013, 26.3% of high school and 23.5% of middle school students in Maryland reported ever having been told by a doctor or nurse that they had asthma.2 Avoidance of smoking and exposure to secondhand smoke has been recommended for people with asthma,3 because persons with asthma who smoke experience higher rates of hospitalization and reduced quality of life when compared with non-smokers with asthma.4 Previous studies have found that adolescents with current asthma smoke as many or more cigarettes than adolescents without asthma.5-8 For example, adolescents reporting having had an asthma episode or attack are more likely than other adolescents to report lifetime daily cigarette use and current frequent cigarette use.5 In addition, a recent study has shown that high school students with asthma have a higher prevalence of hookah smoking than other students.9 Despite the large number of studies identifying relationships between peers, school programs, family members, and media for adolescent smokers,10-13 our understanding of the role of these factors for asthmatic adolescent smokers remains limited. Previous studies of asthmatic adolescent smoking have examined environmental smoking exposure, alcohol, communication with parents, as well as intrapersonal factors such as autonomy, depression, smoking prevalence, asthma management.6,14,15 Sex has an impact on adolescents’ school social networks including peer selection, patterning of peer ties, and peer influence making.16 Research is needed to explore whether and to what extent exposure to smoking in mass media has a similar influence on adolescent tobacco use and variations by sex.17 This study aims to determine whether exposure to mass media and school social networks’ influence are associated with current smoking status among asthmatic adolescent students by sex and if these associations vary by sex.