A comparison of individual versus community influences on youth smoking behaviours: a cross-sectional observational study

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Abstract

Objectives

To compare individual with community risk factors for adolescent smoking.

Design

A cross-sectional observational study with multivariate analysis.

Setting

National telephone survey.

Participants

3646 US adolescents aged 13–18 years in 2007 recruited through a random digit-dial survey.

Outcome measures

Ever tried smoking and, among experimental smokers, smoking intensity (based on smoking in past 30 days).

Results

One-third of participants (35.6%, N=1297) had tried smoking. After controlling for individual risk factors, neither tobacco outlet density nor proximity were associated with tried smoking or smoking intensity. Associations with trying smoking included age (adjusted OR (AOR)=1.23, 95% CI 1.16 to 1.31), lower socioeconomic status (AOR=0.82, 95% CI 0.74 to 0.91), sibling smoking (AOR=2.13, 95% CI 1.75 to 2.59), friend smoking (AOR=2.60, 95% CI 2.19 to 3.10 for some and AOR=7.01, 95% CI 5.05 to 9.74 for most), movie smoking exposure (AOR=2.66, 95% CI 1.95 to 3.63), team sports participation (AOR=0.69, 95% CI 0.54 to 0.89) and sensation seeking (AOR=7.72, 95% CI 5.26 to 11.34). Among experimental smokers, age (AOR=1.32, 95% CI 1.21 to 1.44), minority status (AOR=0.48, 95% CI 0.30 to 0.79 for Black; AOR=0.46, 95% CI 0.31 to 0.69 for Hispanic; AOR=0.53, 95% CI 0.43 to 0.85 for mixed race/other), friend smoking (AOR=3.37, 95% CI 2.37 to 4.81 for some; AOR=20.27, 95% CI 13.22 to 31.08 for most), team sports participation (AOR=0.38, 95% CI 0.26 to 0.55) and sensation seeking (AOR=6.57, 95% CI 3.71 to 11.64) were associated with smoking intensity.

Conclusions

The study suggests that interventions and policies to prevent and reduce youth smoking should focus on individual risk factors for smoking, including supporting participation in team sports, minimising exposure to movie smoking, addressing the social influence of friend smoking and addressing experience seeking among high sensation-seekers.

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Most cited references 47

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Why children start smoking cigarettes: predictors of onset.

K M Conrad, B R Flay, D. Hill (1992)

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self-esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well-accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support. It is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi-wave studies and careful measurement of changes in smoking behavior.

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Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools?

Lisa Henriksen, Ellen C Feighery, Nina C Schleicher … (2008)

To examine the quantity (density) and location (proximity) of tobacco outlets and retail cigarette advertising in high school neighborhoods and their association with school smoking prevalence. Data from the 135 high schools that participated in the 2005-2006 California Student Tobacco Survey were combined with retailer licensing data about the location of tobacco outlets within walking distance (1/2 mi or 805 m) of the schools and with observations about the quantity of cigarette advertising in a random sample of those stores (n=384). Multiple regressions, adjusting for school and neighborhood demographics, tested the associations of high school smoking prevalence with the density of tobacco outlets and retail cigarette advertising and with the proximity of tobacco outlets to schools. The prevalence of current smoking was 3.2 percentage points higher at schools in neighborhoods with the highest tobacco outlet density (>5 outlets) than in neighborhoods without any tobacco outlets. The density of retail cigarette advertising in school neighborhoods was similarly associated with high school smoking prevalence. However, neither the presence of a tobacco outlet within 1000 ft of a high school nor the distance to the nearest tobacco outlet from school was associated with smoking prevalence. Policy efforts to reduce adolescent smoking should aim to reduce the density of tobacco outlets and retail cigarette advertising in school neighborhoods. This may be achieved through local zoning ordinances, including limiting the proximity of tobacco outlets to schools.

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Physical activity and sedentary behavior patterns are associated with selected adolescent health risk behaviors.

Hillary Nelson, Penny Gordon-Larsen (2006)

Little is known about how physical activity (PA), sedentary behavior, and various adolescent health risk behaviors are associated. The objective of this study was to examine relationships between PA and sedentary behavior patterns and an array of risk behaviors, including leading causes of adolescent morbidity/mortality. Nationally representative self-reported data were collected (National Longitudinal Study of Adolescent Health; wave I: 1994-1995; II: 1996; N = 11957). Previously developed and validated cluster analyses identified 7 homogeneous groups of adolescents sharing PA and sedentary behaviors. Poisson regression predicted the relative risk of health risk behaviors, other weekly activities, and self-esteem across the 7 PA/sedentary behavior clusters controlling for demographics and socioeconomic status. Main outcome measures were adolescent risk behaviors (eg, truancy, cigarette smoking, sexual intercourse, delinquency), other weekly activities (eg, work, academic performance, sleep), self-esteem. Relative to high television (TV) and video viewers, adolescents in clusters characterized by skating and video gaming, high overall sports and sports participation with parents, using neighborhood recreation center, strict parental control of TV, reporting few activities overall, and being active in school were less likely to participate in a range of risky behaviors, ranging from an adjusted risk ratio (ARR) of 0.42 (outcome: illegal drug use, cluster: strict parental control of TV) to 0.88 (outcome: violence, cluster: sports with parents). Active teens were less likely to have low self-esteem (eg, adolescents engaging in sports with parents, ARR: 0.73) and more likely to have higher grades (eg, active in school, ARR: 1.20). Participation in a range of PA-related behaviors, particularly those characterized by high parental sports/exercise involvement, was associated with favorable adolescent risk profiles. Adolescents with high TV/video viewership were less likely to have positive risk behavior outcomes. Enhancing opportunities for PA and sport may have a beneficial effect on leading adolescent risk behaviors.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (publisher-id): bmjopen

Journal ID (hwp): bmjopen

Title: BMJ Open

Publisher: BMJ Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date (Print): 2012

Publication date Collection: 2012

Publication date (Electronic): 1 September 2012

Volume: 2

Issue: 5

Electronic Location Identifier: e000767

Affiliations

[1 ]Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA

[2 ]Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA

[3 ]Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA

[4 ]The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA

[5 ]Community & Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA

Author notes

[Correspondence to ] Dr Anna M Adachi-Mejia; anna.adachi-mejia@ 123456dartmouth.edu

Article

Publisher ID: bmjopen-2011-000767

DOI: 10.1136/bmjopen-2011-000767

PMC ID: 3437428

PubMed ID: 22942229

SO-VID: e77f5783-1110-4c85-9f91-b720f8b75be3

Copyright © © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

A comparison of individual versus community influences on youth smoking behaviours: a cross-sectional observational study

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Abstract

Objectives

Design

Setting

Participants

Outcome measures

Results

Conclusions

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China Tropical Medicine

Most cited references 47

Why children start smoking cigarettes: predictors of onset.

Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools?

Physical activity and sedentary behavior patterns are associated with selected adolescent health risk behaviors.

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