Tobacco Prevention Interventions in Adolescents. Part 2
Several studies have been done to identify determinants of tobacco use in adolescents. A study using population based cohorts of early adolescents, among many predictive determinants, lesser academic achievement and fewer environmental barriers most strongly predicted smoking (Carvajal & Granillo, 2006). Some of the other determinants for smoking initiation are socio-demographic factors like coming from a family of low socioeconomic status and personal factors like low self-image, low self-esteem and inadequate refusal skills (USDHHS, 2001). But it is seen that if the adolescents come from immigrant families they are less likely to smoke inspite of economic hardships. Protective factors for these adolescents are conjured to be lower rates of parental tobacco use and less exposure to peers who smoke (Georgiades, Boyle, Duku, & Racine, 2006). Interpersonal influences such as peer smoking, attitudinal and cultural influences such as academic achievement, initial liking for smoking, to find a meaning (experimenting) with smoking and intrapersonal influences like susceptibility to smoking or difficulty in quitting smoking were found to be important around the world. Other important determinant of smoking initiation in adolescents is whether its related to a particular racial and ethnic subgroup as we can direct are prevention strategies and programs in that particular sub-group. In a study conducted among nationally representative sample of adolescents aged 12-17, the prevalence of smoking ranged from 27.9% among American Indians and Alaskan Natives to 5.2% for Japanese. White and African American boys initiated smoking a few months earlier than white and African American girls (Carabello, Yee, Gfoerer, Pechacekt, & Henson, 2006). In a multivariate study conducted to test a set of hypotheses in determining the antecedents to cigarette smoking among adolescents, it was found that peer influence factor was the strongest predictor for smoking. Furthermore it was seen that the highest vulnerability for smoking was in blacks, intermediate in Hispanics and whites and lowest in Asians (Castro, Maddahian, Newcomb & Bentler, 1987). These determinants are important to acknowledge as they may guide us in developing prevention interventions in this age group of students.
There are a number of smoking prevention strategies targeted towards the youth such as school-based educational interventions, community-based interventions, advertising restrictions on tobacco use, youth access restrictions and public health education. Reviews of these approaches have shown that most of the adolescent/youth community prevention programs had mixed results (Lantz et al., 2000). The programs which emphasized a social model, along with a community-based health program were found to be somewhat effective but again a majority of this school-based and community based programs haven’t been adequately evaluated in the long-term and the impacts if at all seen are all short-term effects. This is corroborated by the first large scale randomized trial which looked at the social influences approach to smoking prevention (Flay, Koepke, Thomson, Santi, Best, & Brown, 1989). In a review of 94 randomized controlled trials, which focused on school-based prevention programs, 13 studies used social influences intervention of which nine found some positive effect of intervention on the prevalence and four failed to detect any influence (Thomas, & Perera, 2006). Similarly among study of 13 studies which compared community interventions to no interventions or controls, two reported lower smoking prevalence. Of three studies comparing community interventions to school based programs only one found differences in reported smoking prevalence (Sowden & Stead, 2003).