Perceived Accessibility of Cigarettes Among Youth A Prospective Cohort Study

Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
American journal of preventive medicine (Impact Factor: 4.53). 02/2009; 36(3):239-42. DOI: 10.1016/j.amepre.2008.11.006
Source: PubMed


The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study.
Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed or disagreed with the statement It would be easy for me to get a cigarette.
At baseline, the average age was 12 years; 85% had never before smoked; more than 21% perceived that cigarettes were easy to obtain. Perceived accessibility increased over the 4 years among the cohort. Youth with friends who smoked or whose parents allowed the watching of R-rated movies were more likely to perceive easy accessibility of cigarettes. Among nonsmokers, there was a dose-response relationship between perceived accessibility and exposure to smoking in the family environment. Nonsmokers who knew commercial sources of cigarettes also had higher perceived accessibility.
Several potentially preventable exposures to tobacco in the family and social environment contribute to confidence among some youth that cigarettes are easy to obtain. Further studies are needed to determine if modifying these factors (e.g., through programs to reduce the exposure of youth to tobacco products in the home) might reduce perceived accessibility.

7 Reads
  • Source
    • "Perceived availability was defined as very easy and fairly easy versus other responses (fairly difficult; very difficult; impossible; don’t know) [23,28]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Translational Medicine focuses on “bench to bedside”, converting experimental results into clinical use. The “bedside to bench” transition remains challenging, requiring clinicians to define true clinical need for laboratory study. In this study, we show how observational data (an eleven-year data survey program on adolescent smoking behaviours), can identify knowledge gaps and research questions leading directly to clinical implementation and improved health care. We studied gender-specific trends (2000–2010) in Italian students to evaluate the specific impact of various anti-smoking programs, including evaluation of perceptions of access to cigarettes and health risk. Methods The study used, ESPAD-Italia® (European School Survey Project on Alcohol and other Drugs), is a nationally representative sample of high-school students. The permutation test for joinpoint regression was used to calculate the annual percent change in smoking. Changes in smoking habits by age, perceived availability and risk over a 11-year period were tested using a gender-specific logistic model and a multinomial model. Results Gender-stratified analysis showed 1) decrease of lifetime prevalence, then stabilization (both genders); 2) decrease in last month and occasional use (both genders); 3) reduction of moderate use (females); 4) no significant change in moderate use (males) and in heavy use (both genders). Perceived availability positively associates with prevalence, while perceived risk negatively associates, but interact with different effects depending on smoking patterns. In addition, government implementation of public policies concerning access to tobacco products in this age group during this period presented a unique background to examine their specific impact on behaviours. Conclusion Large observational databases are a rich resource in support of translational research. From these observations, key clinically relevant issues can be identified and form the basis for further clinical studies. The ability to identify patterns of behaviour and gaps in available data translates into new experiments, but also impacts development of public policy and reveals patterns of clinical reality. The observed global decrease in use is countered by stabilization in number of heavy smokers. Increased cigarette cost has not reduced use. While perceived risk of smoking may prevent initial experimentation, how government policies impact the perception of risk is not easily quantifiable.
    Full-text · Article · May 2012 · Journal of Translational Medicine
  • Source
    • "Parental smoking might constitute an important factor in peer processes involved in initial experiences with smoking [12] [13]. Research has revealed that individuals often steal their first cigarettes from parents or received them from friends who themselves mostly took the cigarettes from their parents [11] [14] [15] [16] [17]. Consequently, it is plausible that children of smoking parents are a catalyst for smoking uptake among their peers, especially as they appear to start smoking on average one year earlier than their peers [15]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether perceived parental smoking is related to pretend smoking in young children and whether children influence each other in pretend smoking. Children who reported to have at least one smoking parent were coupled with children who had non-smoking parents. Both children were then asked to pretend that they were adults having a barbeque party. During their role playing, the children were observed in order to assess their pretend smoking behaviours and to examine whether children of smoking parents were more likely to initiate pretend smoking. Children were tested at their schools; the sample consisted of 206 children between 4 and 7 years of age (mean age=5.14, SD=0.87), of which 54.4% were girls. The main outcome was whether a child pretended to be smoking and whether the child initiated or followed the other child in this behaviour. During their play, 63.6% (n=131) of the children pretended to smoke. Children of smoking parents were more likely to initiate pretend smoking than to follow. Through their own smoking, parents appear to be able to influence the way in which their children interact with peers regarding pretend smoking. More specifically, children of smoking parents might instigate smoking among their peers.
    Full-text · Article · Feb 2011 · Tobacco control
  • Source
    • "There must be thousands of studies that demonstrate that social factors such as socioeconomic status, smoking by family and friends, cigarette advertising, the availability of cigarettes, smoking depictions in movies, and attitudes and beliefs are predictive of which youth will try smoking [43-46]. However, if such factors sustain tobacco use until tobacco addiction develops, they should predict which smokers will advance to addiction in prospective studies. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In their commentary, Dar and Frenk call into question the validity of all published data that describe the onset of nicotine addiction. They argue that the data that describe the early onset of nicotine addiction is so different from the conventional wisdom that it is irrelevant. In this rebuttal, the author argues that the conventional wisdom cannot withstand an application of the scientific method that requires that theories be tested and discarded when they are contradicted by data. The author examines the origins of the threshold theory that has represented the conventional wisdom concerning the onset of nicotine addiction for 4 decades. The major tenets of the threshold theory are presented as hypotheses followed by an examination of the relevant literature. Every tenet of the threshold theory is contradicted by all available relevant data and yet it remains the conventional wisdom. The author provides an evidence-based account of the natural history of nicotine addiction, including its onset and development as revealed by case histories, focus groups, and surveys involving tens of thousands of smokers. These peer-reviewed and replicated studies are the work of independent researchers from around the world using a variety of measures, and they provide a consistent and coherent clinical picture. The author argues that the scientific method demands that the fanciful conventional wisdom be discarded and replaced with the evidence-based description of nicotine addiction that is backed by data. The author charges that in their attempt to defend the conventional wisdom in the face of overwhelming data to the contrary, Dar and Frenk attempt to destroy the credibility of all who have produced these data. Dar and Frenk accuse other researchers of committing methodological errors and showing bias in the analysis of data when in fact Dar and Frenk commit several errors and reveal their bias by using a few outlying data points to misrepresent an entire body of research, and by grossly and consistently mischaracterizing the claims of those whose research they attack.
    Full-text · Article · Nov 2010 · Harm Reduction Journal
Show more