Smoking among Norwegian schoolchildren 1975–1980: II. The influence of the social environment

In 1975 all primary schools in Norway were asked to carry out local studies of the smoking habits of all pupils in grades 6–9 (age 12–15). A sample of 6968 questionnaires from the pupils (those born on the sixth irrespective of month) forms the empirical basis of the present study. Among ninth graders (age 15) coming from homes where both parents smoked and the children were permitted to smoke, 67% of the boys and 78% of the girls smoked daily. Among children from homes where both parents were non-smokers and did not permit their children to smoke, only 9% of the boys and 11 % of the girls smoked daily. The probability of being a daily smoker can to a great extent be regarded as the additive effect of milieu predictors. When both parents smoke, older sisters and brothers smoke, best friend smokes, and the pupils are permitted to smoke, practically all 15 year olds were daily smokers. On the contrary, an environment of non-smokers and with no permission to smoke reduces the probability of being a daily smoker to almost zero.     

A Qualitative Exploration of the Theory of Triadic Influence in a Nigerian Setting: The Case of Cigarette Smoking

The theory of triadic influence (TTI) was employed as a framework to explore the risk influences for cigarette smoking among an inclusive sample of young smokers. This qualitative study involved a purposive sample of 18 young smokers aged 18–24 years. Data were collected using individual interviews and analysed using thematic analysis. Following the TTI, factors found to influence young people’s initiation and perpetuation of smoking included at the intrapersonal level, sensation seeking, hedonic attitudes and poor coping skills; young smokers engage in cigarettes smoking to cope with social and psychological challenges like stress, worries, to aid digestion and for relaxation. At the interpersonal level, smokers were influenced by their peers and significant others like parents, brothers, teachers and mentors. Immediate risk influences for smoking included experimentation with cigarettes and the use of other substances like marijuana and alcohol. Intervention programmes targeted at building life skills and the ability to resist the pressure from peers and significant others to smoke are needed.     

Perceived health: a test of incremental validity in relation to smoking outcome expectancies, motivation to smoke and desire to quit smoking

This study examined the role of perceived health in predicting theoretically-relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

Perceived Health: A Test of Incremental Validity in Relation to Smoking Outcome Expectancies,Motivation to Smoke and Desire to Quit Smoking

This study examined the role of perceived health in predicting theoretically‐relevant aspects of smoking behavior among 161 young adult regular smokers (67 females; mean age = 21.9 years (SD = 7.2), cigarettes per day (M) = 12.2 (SD = 5.7)) recruited from the general community. Consistent with prediction, results indicated that relative to anxiety sensitivity, gender, number of cigarettes smoked per day and nicotine dependence, perceived physical health uniquely and significantly predicted expectancies for negative affect reduction and expectancies that smoking would lead to negative personal consequences. Additionally, perceived health incrementally predicted motivation to smoke to reduce negative affect. In contrast to expectation, perceived health was unrelated to motivation to quit smoking. Results are discussed in relation to the role of perceived health as a cognitive vulnerability factor for specific types of smoking patterns.     

Comparison of three antismoking interventions among pregnant women in an urban setting: a randomized trial

This study examined smoking cessation and cigarette reduction of indigent inner city pregnant women (n = 193) who completed one of three interventions: a special video program based on their perceptions of the effects of smoking during pregnancy, the American Lung Association's "Freedom From Smoking For You and Your Baby" program, or the usual physician's advice. Six percent of the women quit smoking, and 43% reduced the number of cigarettes they smoked. There were no significant differences among the three groups for either the number who quit smoking or who reduced the number of cigarettes smoked.     

Smoking patterns and dependence: contrasting chippers and heavy smokers

The authors used ecological momentary assessment to contrast smoking patterns among chippers (CHs; n = 26)--smokers who smoke despite an apparent absence of tobacco dependence--with those seen in heavy smokers (HSs; n = 28). Smoking and nonsmoking settings (activity, mood, etc.) were assessed by means of electronic diary. CHs were not social smokers; like HSs, they smoked half their cigarettes while alone. When smoking, CHs' urge levels equaled those of HSs; between cigarettes, CHs had few urges, whereas HSs reported moderate urges. CHs' smoking was particularly associated with indulgent activities: relaxation, socializing, eating, and drinking alcohol. Outside of these indulgent settings, CHs' (but not HSs') smoking was associated with negative affect. In idiographic analyses, CHs' smoking was under much stronger stimulus control than was that of HSs. The authors propose that the disappearance of stimulus control over use is a characteristic of dependence.     

Conscientiousness, perceived risk, and risk-reduction behaviors: a preliminary study.

Participants (N = 343) from an Oregon community completed surveys at baseline, 3 months, and 12 months to assess personality, the perceived health risk of radon in combination with smoking, and changes in smoking behavior. Conscientiousness predicted instituting a more restrictive household smoking rule (p < .01), and perceived risk predicted reduction in cigarettes smoked per day for men (p < .001). Perceived risk predicted a reduction in the proportion of cigarettes smoked in the home for those who had high (p < .05) but not low or moderate levels of Conscientiousness, a dimension in one personality model. The results demonstrate the importance of Conscientiousness in the prediction of health behavior, particularly behavior that affects others as well as oneself.     

A national survey of older smokers: treatment needs of a growing population

Examined smoking and quitting patterns among 289 smokers ages 50 to 74 years who took part in a nationwide survey of American Association of Retired Persons members. Respondents were predominantly chronic, heavy smokers. They had smoked for an average of 45 years, more than one third smoked 25 or more cigarettes per day, and more than two thirds showed evidence of high nicotine addiction. Nonetheless, most were interested in quitting smoking and reported plans to quit in the next year. Concerns about missing or craving cigarettes; losing a pleasure; and being nervous, tense, or irritable after quitting were the most common barriers to quitting reported. These problems were rated as more serious by heavier, longer term smokers and by smokers with lower quitting self-efficacy. The variables most strongly associated with "contemplating" quitting were beliefs in quitting health benefits, recent attempts to quit or cut down, prior attempts to quit, and high self-efficacy. Limitations of these findings are discussed along with implications for the design of treatments geared to the special needs of older smokers.     

Interest in Participating in Smoking Cessation Treatment Among Latino Primary Care Patients

Smoking is the leading preventable cause of disease and death for U.S. Latinos. This study identified correlates of interest in participating in a smoking cessation program among urban Latinos seen in community clinics. Interviews were completed with 141 current smokers. Participants were predominantly Spanish-speaking (93%) males (66%), who were on average 37.6 years old and smoked 8.7 cigarettes per day. Over two-thirds (63%) of participants were “definitely interested” in participating in a smoking cessation program. Participants who smoked more cigarettes per day and reported greater nicotine dependence, depression, and readiness to quit were more likely to be interested, while those employed fulltime were less likely to report high interest. Treatment preferences were consistent with Clinical Practice Guidelines recommending counseling, social support, and pharmacotherapy. Results support recommendations that healthcare providers intervene with all Latino smokers, including light smokers and those who do not report initial interest in smoking cessation.     

The false consensus effect: predicting adolescents' tobacco use from normative expectations.

A longitudinal sample of 916 adolescents was examined to assess the extent to which the perceived smoking prevalence of adults' or peers' smoking was related to cigarette smoking. Questionnaires were distributed to junior high school students in Grade 7 and again in Grade 9. Prevalence of perceived peers' smoking and prevalence of perceived adults' smoking were significantly related to cigarette smoking both cross-sectionally and longitudinally. Adolescents who believed that half or more than half of all adults or peers smoked cigarettes showed the most smoking involvement, and those who believed that fewer than half of adults or peers smoked were least involved. These findings provide further evidence that adolescent normative expectations about cigarette smoking are an important determinant of smoking initiation.     

Effects of delta 9-THC on marijuana smoking, dose choice, and verbal report of drug liking.

The effects of delta 9-tetrahydrocannabinol content of marijuana on cigarette smoking, dose choice, and verbal report of drug "liking" by adult males living in a residential laboratory were investigated. Marijuana cigarettes were available during programmed intervals while subjects were engaged in recreational activities. The tetrahydrocannabinol content of the cigarettes remained constant each day, but was changed across days. Subjects provided written ratings of drug liking at the end of each day. In the first study, placebo or active (2.3% delta 9-tetrahydrocannabinol) marijuana cigarettes were available for 1-, 2-, or 3-day intervals at varying times of day. The number of cigarettes smoked was unrelated to tetrahydrocannabinol content, although verbal reports of drug liking were consistently higher when marijuana cigarettes containing tetrahydrocannabinol were smoked. In a second study, a choice procedure, consisting of four 3-day blocks of 2 sample days and 1 choice day, was used. On sampling days, subjects smoked cigarettes varying in tetrahydrocannabinol content (0.0, 2.0, and 3.5%, w/w); on choice days they were allowed to choose between the two previously sampled doses. The number of cigarettes was not consistently related to tetrahydrocannabinol content. Ratings of drug liking were increased when marijuana cigarettes contained tetrahydrocannabinol, but ratings of marijuana containing 2.0% and 3.5% of the compound were similar. In contrast, subjects consistently chose the 3.5% dose over either the 0.0% or 2.0% dose. Dose choice was more sensitive to tetrahydrocannabinol content than either reports of drug liking or numbers of cigarettes smoked.     

Implicit alcohol and smoking associations among young adult heavy drinkers: Associations with smoking status and alcohol-cigarette co-use

Implicit memory associations may play a role in motivation to use alcohol and cigarettes, but the relationship between implicit associations and co-use of alcohol and cigarettes is currently unknown. This study provided an initial examination of alcohol and smoking implicit associations among young adult drinkers who were either nonsmokers or relatively light smokers (i.e., 10 or fewer cigarettes per day) as a function of smoking frequency and daily-level alcohol-cigarette co-use. Drinkers (n?=?129) completed alcohol-arousal and smoking-valence variants of the implicit association test as well as a daily-level assessment of past 90-day alcohol and cigarette use. Smokers were grouped according to whether they reported daily or nondaily smoking frequency. Results showed that although implicit alcohol-arousal associations did not differ between smokers and nonsmokers, stronger implicit alcohol-arousal associations were observed for nondaily smokers relative to daily smokers after controlling for drinking frequency. Further, implicit positive-smoking associations were stronger for smokers relative to nonsmokers. Within the subgroup of nondaily smokers, more frequent co-use of alcohol and cigarettes was associated with stronger implicit positive-smoking associations when controlling for total drinking and smoking frequency. The findings suggest that implicit alcohol and smoking associations may be linked with smoking patterns (daily vs. nondaily) and co-use of alcohol and cigarettes among young adult drinkers who are not heavy smokers, highlighting the need for more research on the role of implicit associations in the co-use of cigarettes and alcohol.     

Nicotine craving and cue exposure therapy by using virtual environments.

Smokers who are exposed to cues associated with smoking show cardiovascular reactivity and an increase in smoking urges as compared to when they are presented with neutral cues. Cue exposure therapy (CET), which refers to the repeated exposure to drug-related cues in order to extinguish this learned association, has increasingly been proposed as a potential treatment of addictive behaviors, including tobacco smoking. The result of our pilot study suggests that a cue elicited using a virtual environment (VE) is more effective than other cue exposure devices. The VE was composed of craving environments (virtual bar) and objects (an alcoholic drink, a packet of cigarettes, a lighter, an ashtray, a glass of beer, and advertising posters) that are likely to trigger craving, a smoking avatar, and an audio environment that included the noisy sound and music of a restaurant. Sixteen late-adolescent males who smoked at least 10 cigarettes a day were recruited to participate in the VE-CET study. The CET virtual bar program consisted of six sessions, and the participants were exposed repeatedly to each session using different questions and procedures. Although the effects of CET did not yield significant reductions in all of the dependent variables, the craving for cigarettes was gradually decreased during the course of the sessions. This tendency was closely related to the reduction in the smoking count between the morning before the experiment and the start of the experiment. Based on these preliminary results, it appears that VE-CET maybe a useful tool to use in treatment programs to help reduce craving in those who are nicotine dependent.     

A model of situational preference amongst smokers

Seventy-five medium-light smokers rated their performance for smoking in 25 situations covering a range of high- and low-stress situations. Information on personality, age, sex, length of habit, number of cigarettes smoked, amount inhaled and amount of cigarettes smoked was also obtained. Six main factors were extracted by principal-factor analysis which were related respectively to situations involving preparatory activity, attentional stress, neutral relaxation conditions, unpleasant (anxiety) and pleasant (excited) emotional stress and social vs isolated activity. Smokers who scored high on Neuroticism tended to smoke more when experiencing unpleasant emotions; older smokers smoked predominantly in pleasant relaxing conditions; extraverts and low-activity situational smokers, reported inhaling more. A model of smoker motivation is developed which suggests that both pharmacological and psychological factors contribute to habit maintenance. Three basic motivational types of smokers are identified: high-stress smokers for whom smoking is a secondary activity, and who rely on smoking to form a minor distraction for their current task. Low-activity smokers who wish to act, or change their current affective state in some way and who rely on pharmacological factors. Neutral relaxation smokers for whom smoking is a pleasurable activity in its own right.     

PSYCHOPHYSIOLOGICAL REACTIONS TO CIGARETTE SMOKING

Dosage and time effects of cigarette smoking were studied in nine moderate smokers, who participated in a control condition without smoking, and in two experimental conditions, in which they smoked either two weak or two strong cigarettes (nicotine content 1.3 mg/cig. and 2.3 mg/cig., respectively) at the beginning of a 90-min period. The main effects of smoking were to increase adrenaline output, blood pressure, and heart rate, and to decrease skin temperature and hand steadiness, the changes being consistently more pronounced after the larger dose. Peak effects were recorded at the first trial after smoking, whereupon followed a gradual return toward baseline levels which, however, were not reached within the 90-min period.     

EEG effects of conventional and denicotinized cigarettes in a spaced smoking paradigm

Although there is a documented association between plasma nicotine levels and smoking behavior, recent studies indicate that denicotinized cigarettes reduced craving and symptoms of tobacco withdrawal. Denicotinized cigarettes (that deliver tar but insignificant amounts of nicotine) and conventional cigarettes were compared in a within-subject spaced smoking study. In six sessions, subjects (n=10) smoked denicotinized cigarettes or conventional cigarettes every 30, 60 or 240 min (8, 4 or 1 cigarette(s)). EEG effects of the last cigarette of each session were deduced by comparisons with EEG recordings collected before smoking. Conventional cigarettes increased spectral edge EEG frequency, decreased theta power and increased beta1 power. Denicotinized cigarettes decreased spectral frequency. The EEG effects of both cigarettes depended upon the recentness of smoking. The results indicate that nicotine delivery, recentness and the process of smoking importantly influence the EEG; other, non-nicotine components of tobacco smoke may also exert EEG effects.     

Cigarette smoking and oral contraceptive use influence women's lipid, lipoprotein, and cardiovascular responses during stress

Investigated the effects of behavioral stress and smoking cigarettes on the lipid, lipoprotein, neuroendocrine, and cardiovascular responses of female smokers who either used or did not use oral contraceptives (OC). Thirty-five healthy female smokers (20 of whom used OC) relaxed, smoked, or sham smoked and then prepared, delivered, and reviewed a speech presented in front of a video camera. Results show that behavioral stress increased total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, triglyceride, and free fatty acid levels, with significant increases in cholesterol, LDL-C, and free fatty acids apparent only among women who smoked during the session. In addition, OC users exhibited larger increases in triglyceride and blood pressure responses during stress than did nonusers whether or not they smoked during the protocol. Possible physiological mechanisms for each of the effects, as well as implications of the findings for understanding epidemiological associations among OC use, smoking, and coronary heart disease in women are discussed.     

The relationship between depression and smoking in adolescents

The literature suggests that smokers are more likely to be depressed, while people who are depressed are more likely to smoke. The purpose of the present study was to determine the strength of the relationship between smoking, depression, intention to smoke, and several psychosocial and environmental factors. The participants (98 high school and college students aged 16 to 19 years) completed a paper-and-pencil questionnaire consisting of the Multiscore Depression Inventory (MDI) and items regarding smoking behavior as well as psychosocial and environmental factors. Correlation, stepwise regression, and discriminant analyses were then conducted. It was found that participants were more likely to smoke if their parents smoked, if their scores on the MDI indicated instrumental helplessness and social isolation/withdrawal, or if they were older. Participants were more likely to state intention to smoke in the future if they had MDI scores indicating instrumental helplessness, if they were older, if their parents smoked, if their MDI scores indicated social intro-version, or if they resided with a guardian. Participants were also more likely to have smoked for more years if their parents smoked or if their scores on the MDI indicated instrumental helplessness. Further, participants were more likely to have scores on the MDI indicative of higher depression levels if they had low grades or if their parents smoked.     

Demonstration of an Integrated Treatment for Smoking Cessation and Anxiety Symptoms in People With HIV: A Clinical Case Study

Despite high rates of co-occurring tobacco use and anxiety symptoms and disorders among persons with HIV, evidence-based interventions for these individuals are not yet available. The present study sought to evaluate an integrated treatment model addressing smoking cessation and anxiety sypmtoms among HIV-positive smokers. Treatment was an 8-week intervention integrating a standard smoking cessation protocol (i.e., cognitive-behavioral therapy [CBT], nicotine replacement therapy) with CBT for anxiety. Inclusion criteria were 18–65 years of age, ≥ 10 cigarettes/day, State–Trait Anxiety Inventory [STAI-T] score of > 39, and moderate motivation (i.e., ≥ 5 out of 10 on a 10-point Likert scale) to quit smoking. Primary outcomes included scores on the Anxiety Sensitivity Index (ASI) and cigarettes smoked per day. Self-reported abstinence was biochemically verified by carbon monoxide breath analysis. Three male participants (mean age 49.3, SD = 9.1) completed through 2-month follow-up. At baseline all participants reported smoking an average of 20 cigarettes per day. Two participants quit smoking and maintained abstinence by the 2-month follow-up, and demonstrated a reduction in ASI scores. Participant 3 continued to smoke but at a reduced rate. Participants’ response to cognitive and behavioral strategies (e.g., creating balanced thoughts, interoceptive exposures) will be discussed. Clinical lessons learned include use of a flexible approach to cognitive restructuring, use of imaginal and in vivo exposures in session to better prepare patients for homework practice, and flexibility in delivering the treatment in an individual or group format. This clinical presentation provides preliminary support for the feasibility and initial effectiveness of an integrated treatment to reduce anxiety symptoms and aid in smoking cessation in anxious, HIV-positive smokers.     

Smoking among Norwegian schoolchildren 1975–1980: I. Extent of smoking in the age group 12–15 years, 1975

213600 pupils from grades 6–9 (age 12–15) in the primary school in Norway filled in a questionnaire about smoking habits (1975). The headmaster of each individual of the 2824 schools participating in the study filled in reports giving the local frequencies of daily smokers, occasional smokers and nonsmokers for each grade and for boys and girls separately. The school-reports also contained questions about demographical properties of the school. A sample of 6968 questionnaires from the pupils (those who were born on the sixth irrespective of month) were also submitted for statistical analysis. Compared with previous studies, the percentage of smokers among girls proved to have increased considerably. The tendency found in many western industrialized countries, that smoking is increasing among girls more than among boys, or that boys are reducing smoking to a greater extent than are girls, was confirmed also for Norway. In all 19 counties there was a higher percentage of daily smokers among girls than among boys. Higher percentages of occasional smokers or pupils who had tried smoking were found in small schools and scattered settlements. Norway may be divided into geographical areas according to the differences in the smoking habits of girls and boys. In the counties in the south and to the west, girls have not surpassed boys to the same extent as in the rest of the country. From previous political-cultural research it is known that the south and west is characterized by temperance and prohibition movements, higher frequencies of religious attendance, as well as a distintiveness in voting behaviour.