Cigarette Smoking Habits Among Schoolchildren

doi:10.1378/chest.110.4.921

Chest

Volume 110, Issue 4, October 1996, Pages 921-926

https://doi.org/10.1378/chest.110.4.921 Get rights and content

Study objective

Cigarette smoking is a major preventable cause of morbidity and mortality worldwide. Most adult smokers start smoking regularly some time before 18 years of age. The aim of this study was to determine the age at which children begin cigarette smoking, to study the environmental factors that influence children to smoke, and to understand the reasons why children smoke. The results of this study may help lead to the development of more effective smoking prevention programs.

Methods

We carried out a cross-sectional survey of all students in grades 6 to 11 (ages: 11 to 17 years) in two high schools in the Jerusalem area, using an anonymous self-completion questionnaire. The students were asked questions regarding the age at which they began smoking, initiation, their smoking habits, their reasons for smoking, and their views on children who smoke. In addition, they were asked about the smoking status of their parents, siblings, and friends. Finally they were asked about the health hazards of smoking.

Results

Of the 847 students who answered the questionnaire, 35% stated that they had smoked at least once and 14% stated that they were currently smoking. The percentage of students who were currently smoking increased gradually with age to 36%. There was a sharp increase in experimental smoking after seventh grade (ages 12 to 13 years). Having a friend who smoked substantially increased the likelihood of smoking, whereas parental smoking or having a sibling who smoked did not increase the likelihood of smoking. The most common reason for starting to smoke was “to try something new” (55%). There was a significant difference between the views of students with different smoking statuses regarding children who smoke: nonsmoking children associated more negative characteristics to smoking. All of the children studied were well aware of the health hazards of cigarette smoking

Conclusions

Smoking is highly prevalent among schoolchildren in Jerusalem. The increase in the rate of smoking at the age of 12 years indicates that smoking prevention programs need to be started at an earlier age. Peer pressure is a very strong stimulus for smoking in children. Since children are aware of the health hazards of smoking, prevention policy should be aimed more at associating smoking with negative images and addressing peer pressure.

Section snippets

Materials and Methods

In this cross-sectional study, a self-completion questionnaire was given to all students in grades 6 to 11 (ages 11 to 17 years) in 2 nonreligious high schools in the Jerusalem area. The students of these schools represent the majority of the Israeli population, which is (basically) nonreligious, lives in an urban area, and was born in Israel. The study group comprised all students who attended class at the time of the survey. After the students were informed about the anonymity of the survey,

Results

Of the 936 students attending the 2 schools, 847 (90%) answered the questionnaire (47% male). Thirty-five percent indicated that they had smoked at least once: 21% (n=175) were experimental smokers and 14% (n=118) were current smokers. The similarity between the number of self-reported current smokers and the number of smokers in the class reported by the students (n=116) suggests a high degree of honesty in answering the questionnaire. The current smokers stated that they smoked 40 ±73

Discussion

The high prevalence of smoking among schoolchildren in Israel found in our study is similar to that found in the United States and Western Europe (Table 4). In addition, the dramatic increase in the prevalence of smoking after the age of 12 to 13 years is also similar to other reports from the Western world.28, 29, 30 This demonstrates that smoking habits are similar in the Western society. This may dismiss our initial hypothesis that living in an area with high political tension causes an

Acknowledgments

The authors wish to thank J. Kuik, statistician, Department of Biostatistics and Epidemiology, Free University, Amsterdam, the Netherlands, for his assistance with statistical analysis.

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Cited by (36)

Sex differences in smoking initiation among children and adolescents
2013, Public Health
Citation Excerpt :
Ten studies examined the context in which smoking initiation occurred, of which eight studies examined the source of the first cigarette, six studies assessed the person with whom the first cigarette was smoked, and five studies identified the place/location in which smoking initiation occurred. From the reviewed studies, the source of the first cigarette was primarily friends.22,26,27,29–32 However, three studies observed gender differences in the source of the first cigarette.
To understand differences in the context of, and reasons for, smoking initiation among boys and girls.
Sex- and gender-based analysis of published literature.
A comprehensive search of the PUBMED database was conducted for studies (published in the English language) between January 1980 and October 2010 that assessed smoking initiation among children and adolescents (aged 8–19 years). Information on demographics and study design were extracted by two authors from each eligible article. A sex- and gender-based analysis was employed.
Of 40 publications initially obtained, studies in adult or college-age populations (n = 9) and studies that did not examine the specific context of smoking initiation (n = 19) were excluded. Thus, this review is based on 12 eligible studies. Eligible studies represented data from 10,831 children and adolescents in nine countries. In most studies, boys had a lower age of smoking initiation than girls, with the exception of two studies from Yemen and China. In some countries, girls reported obtaining and smoking their first cigarette from family members at home. In most studies, the school was the main setting for initiation for boys, whereas the home setting was the main setting for girls.
This study highlights gender and cultural differences in smoking initiation among children and adolescents. Smoking prevention programmes should thus include gender- and culture-specific content related to smoking initiation. Future studies may further examine gender- and culture-specific messaging to inform policies and enhance tailored programmes aimed at preventing smoking initiation.
Cigarette smoking and myocardial infarction in young men and women: A case-control study
2007, International Journal of Cardiology
Citation Excerpt :
Based on the aforementioned findings preventive strategies have emphasised the need for lifestyle interventions, including stopping smoking, at very early age. Studies that were carried out in several countries [23–25] have shown that the appropriate and sufficient information of young people has led to reduction in the consumption of cigarettes and, consequently, to their cardiovascular risk. In this case-control study two main sources of systematic error may exist, selection and recall bias.
The effect of cigarette smoking on the risk of myocardial infarction (MI) has long been investigated. However, its role on the likelihood of having MI at young age has not been well understood and appreciated. We investigated whether smoking habits can discriminate young individuals with MI from age- and sex-matched controls.
We enrolled 100 consecutive patients who had survived their first episode of MI before the age of 36 years and 100 age- and sex-matched controls without a history of cardiovascular disease. Smoking habits, physical activity status, body mass index and blood lipids levels were measured in all participants.
96% of the patients with premature MI and 55% of the controls reported current smoking habits (p < 0.001). Moreover, patients had higher levels of total cholesterol, low density lipoprotein cholesterol, triglycerides and lower levels of high density lipoprotein cholesterol (p < 0.05). Multivariate logistic regression analysis showed that current smoking increased 6-fold the odds of having a MI (95% CI 1.01 to 37), after controlling for age, sex, body mass index, hypertension, diabetes, physical activity, family history of coronary heart disease and total cholesterol levels. Finally, discriminant analysis showed that pack-years of smoking was the strongest discriminator for MI among all the investigated factors (λ-Wilks = 0.85).
Our study suggests that cigarette smoking seems to play the most important role for having a MI in individuals under the age of 36 years.
Factors related to tobacco use among teenagers
2007, Respiratory Medicine
Citation Excerpt :
During the last decades efforts have been made in many countries to reduce smoking in the general public, as well as to prevent young people from starting to smoke.1,6–9 Studies have reported that young people start experimenting with tobacco as early as 10 years of age,1 and become regular smokers at approximately 15.5 Tobacco use by gender varies between countries and has a complex association with cultures.
To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program.
From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years.
Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0–9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2–3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2–0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation.
The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.
Nine-year prospective association between older siblings' smoking and children's daily smoking
2003, Journal of Adolescent Health
To explore the hypothesis that older siblings’ smoking, after controlling for parents’ smoking, influences children’s smoking.
Study participants were 2981 students in the control cohort of a school-based smoking prevention randomized trial for whom parents’ smoking and older siblings’ smoking data were collected at 3rd grade and daily smoking data was assessed 9 years later through a self-report questionnaire at the 12th grade. Data were analyzed using conditional logistic regression and likelihood ratio tests.
For families in which no parent smoked, the 12th grade prevalence of daily smoking was 31% when at least one older sibling smoked compared to 18% when no older sibling smoked. For families in which at least one parent smoked, the 12th grade prevalence of daily smoking was 41% when at least one older sibling smoked compared to 29% when no older sibling smoked. There was a substantial increase in the odds (OR = 1.60, p = .004) of children’s daily smoking at 12th grade when their older siblings smoked, even after adjusting for parents’ smoking.
Older siblings’ smoking is associated with increased risk of children’s smoking after adjusting for parents smoking. Furthermore, there was no evidence to suggest that the influence of older siblings’ smoking was different in families where no parent smoked compared to those where at least one parent smoked. Also, there was no evidence that the influence of older siblings’ smoking was different in boys vs. girls.
Smoking: Not for anyone
2003, Chest
Sources of information on the health effects of environmental tobacco smoke among African-American children and adolescents
2001, Journal of Adolescent Health
Purpose: To determine the common sources of information regarding the effects of smoking on health and their relationship to knowledge, attitudes, and preventative efforts regarding exposure to environmental tobacco smoke (ETS) among urban African-American children and adolescents.
Methods: All students who were enrolled in Grades 5–12 in an urban public school district located in the greater metropolitan area of Detroit, Michigan were surveyed using a structured, written questionnaire that assessed sources of information on the health effects of smoking, as well as knowledge, attitudes, and preventive efforts with respect to exposure to ETS. The primary analytic procedures utilized in the study were correlation analysis and analysis of variance.
Results: The African-American students surveyed in this study received information regarding the health effects of smoking from many sources, most notably television, family, and teachers. Second, students who received information on the effects of smoking on health from family and external sources (teacher, parent’s friend, and religious leader) had higher overall knowledge, attitude, and preventive efforts scores than students who received information from other sources (friends, electronic media, and printed media). Finally, family influence was greater when parents were not smokers, and influenced elementary students more than middle school or high school students.
Conclusions: The active involvement of teachers, religious leaders, parents, and other influential adults should be elicited in tobacco education and prevention efforts to maximize their effectiveness.

View all citing articles on Scopus

: Supported in part by a grant from the Groningen University Foundation (Dr. Meijer).

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Chest

Clinical Investigations: Smoking and Nitric Oxide: ArticlesCigarette Smoking Habits Among Schoolchildren

Study objective

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

Lancet

Prev Med

Prev Med

Prev Med

Addict Behav

J Adolesc Health

Addict Behav

Environmental tobacco smoke and lung cancer risk in nonsmoking women

J Natl Cancer Inst

Parental smoking and risk of childhood brain tumors

Am J Epidemiol

Association between exposure to environmental tobacco smoke and exacerbations of asthma in children

N Engl J Med

The hazards of passive—and active—smoking [editorial]

N Engl J Med

Environmental tobacco smoke: the price of scientific certainty

J Natl Cancer Inst

Nicotine medications for smoking cessation

N Engl J Med

Smoking initiation in the United States: a role for worksite and college smoking bans

J Nati Cancer Inst

Effect of the age at which smoking begins on frequency of smoking in adulthood

N Engl J Med

Long-term follow-up of a pilot project on smoking prevention with adolescents

Prev Med

Prevention of cigarette smoking through mass media intervention and school programs

Am J Public Health

The second Chicago televised smoking cessation program: a 24-month follow-up

Am J Public Health

Evaluation of two school smoking education programmes under normal classroom conditions

BMJ

Even ‘Knowing better’ about smoking, other health risks, may not deter adolescents

JAMA

The influence of three mass media campaigns on variables related to adolescent cigarette smoking: results of a field experiment

Am J Public Health

A comparison of costs and data quality of three health survey methods: mail, telephone and personal home interviews

Am J Epidemiol

Clinical Investigations: Smoking and Nitric Oxide: Articles
Cigarette Smoking Habits Among Schoolchildren