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Comparison of the inhalation toxicity of kretek (clove cigarette) smoke with that of American cigarette smoke. II. Fourteen days, exposure.

The comparative repeat dose toxicity of American cigarettes and kreteks (Indonesian cigarettes containing approximately 60% tobacco and 40% shredded clove buds) was assessed by exposure of groups of five male and five female rats to equivalent (approximately 2 mg/l in terms of total particulate matter) concentrations of smoke from each type of cigarette over 15 consecutive days. The smoke was delivered "nose only" using an HRC Rodent Smoking Machine (Mark IV). For each type of cigarette, three doses were used. These were achieved by regulating the daily total duration of exposure to smoke. The different doses used were 2 x, 4 x and 6 x, 15-min exposures, presented daily over a period of approximately 6 h. Inter-group comparisons were made between American and kretek groups which received the same daily durations of smoke exposure. Higher doses of smoke resulted in reduced bodyweight gains and food consumption in male groups; the response of female groups was not as clear. At the highest dose, male rats exposed to kretek smoke gained significantly more weight by comparison with males exposed to American smoke. Higher doses of smoke tended to increase water consumption in both sexes of groups exposed to American smoke; kretek smoke produced no obvious effect. Smoke exposures produced the expected responses in certain haematological and blood biochemical parameters attributed to exposure to CO and the irritants present in cigarette smoke. Such responses were, however, confined largely to the groups exposed to American smoke. Macroscopic pathological findings attributed to smoke inhalation were confined to the lungs, and consisted of minimal to moderate discolouration and incomplete collapse of the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗

Smoking cessation by socioeconomic status and marital status: the contribution of smoking behavior and family background.

We studied socioeconomic status and marital status as predictors of smoking cessation, adjusting for previous smoking behavior and family background by using a large Finnish prospective twin dataset unselected for smoking behavior. The data were collected by postal surveys in 1981 and 1990, and the sample comprised 3,069 current smokers, of whom 20% had quit smoking by 1990. Logistic regression analyses of all twin individuals and conditional logistic regression analysis of discordant pairs were used to predict smoking cessation. High education predicted smoking cessation among both men (OR=2.32, 95% CI=1.31-4.10) and women (OR=3.98, 95% CI=1.85-8.51) as did high social class among women. Additionally, starting at a late age, smoking a small number of cigarettes per day, and a low level of nicotine per cigarette predicted cessation. Socioeconomic differences in cessation diminished only slightly when we adjusted for smoking behavior factors. Among the twin pairs who were discordant in terms of smoking cessation, the twin who continued smoking also smoked more on average at baseline (men: OR=.94, 95% CI=.89-.99; women: OR=.82, 95% CI=.71-.94). The male twins who continued smoking had a smaller probability of getting married during the follow-up than had the cotwin who had quit smoking (OR=3.91, 95% CI=1.02-15.02). Indicators of socioeconomic status were important predictors of smoking cessation even when we adjusted for previous smoking behavior. For men, marriage was associated with an increased probability of cessation

Adolescent↗

Parental smoking and passive smoking in infants: fathers matter too.

This study examines mothers' and fathers' smoking patterns in different kinds of smoking households, and assesses their relative contribution to infants' exposure to environmental tobacco smoke. It uses data from a cross-sectional survey of 314 smoking households (infants: mean age 10 weeks) in Coventry and Birmingham, England, examining reported tobacco consumption and objective measures of exposure: the study infant's urinary cotinine:creatinine ratios and their mother's salivary cotinine. The study shows that both mothers' and fathers' tobacco smoke make substantial contributions to infant exposure to tobacco smoke. Households were more likely to contain a smoking father than mother, with over two-thirds of households including a smoking father. In households where both parents smoke, fathers' tobacco consumption was found to be significantly higher than in households where only the father smokes. This suggests that the interaction between parents needs to be considered rather than focusing on mothers' or fathers' smoking behaviour in isolation. The implications for health promotion programmes are discussed, particularly the need to place more emphasis on tackling fathers' smoking. Currently, fathers' smoking receives far less research or health promotion attention than mothers' smoking. Protecting infants from fathers' as well as mothers' smoking is key to reducing environmental tobacco exposure in early infancy, when the risk of Sudden Infant Death is highest.

Cotinine↗

Parental tobacco smoking behaviour and their children's smoking and cessation in adulthood.

AIMS: To examine the extent to which childhood exposure to parental tobacco smoking, smoking cessation and parental disapproval of smoking predicts daily smoking and attempts to quit in adulthood. DESIGN: A longitudinal prospective design was used to examine the possible association between parental smoking variables in childhood and adolescence and subsequent smoking and cessation by age 26 years. PARTICIPANTS: Interview data were collected as part of a longitudinal study of some 950 individuals followed from birth to age 26 years. Outcome measures were daily smoking and self-reported attempts to quit smoking. FINDINGS: Less daily smoking among the participants at age 26 was related more strongly to parental smoking cessation in the adolescent years than the childhood years. By contrast, inconsistent advice about smoking in childhood and adolescence predicted later daily smoking. Cessation attempts to age 26 were unrelated to earlier parental quitting but were related to consistent advice in adolescence from both parents about smoking. CONCLUSIONS: Encouraging parents to voice consistent messages about their disapproval of smoking has a significant role to play in discouraging smoking in their adult children and promoting attempt to quit where their children are smokers.

Adolescent↗

Attitudes to smoking and smoking habits among hospital staff.

BACKGROUND: Health professionals should take an active role against smoking, so it is relevant to have information on their smoking habits and their attitudes towards smoking, especially with a view to identifying and offering help to those smokers who wish to stop. Staff in Llandough Hospital were surveyed to determine their smoking habits and attitudes, and the findings were compared with those of a similar survey at Llandough in 1987. METHODS: In October 1991 a questionnaire was sent to each member of staff employed half time or more requesting data on age, sex, department, smoking habit, attitudes to smoking in various areas of the hospital, and attitudes to access to smoking rest rooms for patients, staff, and visitors. Smokers were asked whether they would like to join a "quit smoking" group. Non-responders were sent a reminder four weeks later and all replies returned by 31 December 1991 were analysed. RESULTS: The response rate was 82%; of the respondents, 65% were non-smokers, 15% ex-smokers, and 20% current smokers. The prevalence of current smokers was 5% among doctors, 20% among nurses, 18% among administrative and clerical staff, and 40-42% among domestics, catering, and portering staff. Thirty eight per cent of responders wished smoking to be completely forbidden in all areas of the hospital and 90% in certain areas such as wards, offices, cafeteria, and laboratories. Nearly half wanted smoking to be allowed in rest rooms and over 60% wanted a 24 hour facility for smoking for staff, 56% for patients, and 44% for visitors. Only 39% of smokers wished to join a "quit smoking" support group. In comparison with the 1987 survey, the response rate in this study was higher (82% v 70%), the proportion of non-smokers had increased (65% v 59%), and more smokers wanted help (39% v 26%). Fewer wanted 24 hour access to smoking areas for staff and for visitors. CONCLUSION: This hospital should capitalise on these changes of attitude among staff and proceed more rapidly with the implementation of policies to further reduce smoking among staff, visitors, and patients. As a first step a smoking cessation counsellor has been appointed.

Adult↗

Risk assessment of active smoking: smoking-attributable mortality and years of potential life lost in Taiwan, 1980 and 1992.

Anti-smoking programs have been advocated by the government and other private organizations for decades in Taiwan, especially in the past ten years. We conducted an analysis to assess the effectiveness of anti-smoking programs by examining the changes in active smoking attributable mortality (ASAM) and active smoking attributable years of potential life lost (ASAYPLL) between 1980 and 1992. This analysis also evaluated the present health impact due to active smoking. Total estimated ASAM was 12,765 for 1980 and 14,764 for 1992, representing 34.9% and 31.8% of all deaths from smoking-related causes for each year, respectively. Our results suggested a progress of anti-smoking efforts contributed by the government and other private anti-smoking organizations. By comparing the figures between 1980 and 1992, a reduction in all dimensions has been observed. The overall smoking prevalence rate decreased from 31.7% to 29.5% and the ASAM rate declined from 121.8/10(5) to 91.5/10(5). Additionally, the ASAYPLL rate declined from 513.4/10(5) to 406.9/10(5). Furthermore, the ratio of ASAM from cardiovascular diseases (CVD) to all ASAM decreased from 56.3% in 1980 to 46.7% in 1992, while the ratio of ASAM from cancer to all ASAM increased from 22.9% in 1980 to 34.9% in 1992. Our analysis also found that active smoking seemed to be a more important risk factor for smoking-related causes of death in people aged 41-65 than in people of other age group. Although the anti-smoking programs seemed effective over the past 13 years, active smoking still contributed to an estimated number of 14,764 deaths and 63,743 economically productive years lost in 1992. More efforts should be devoted to further reduce the high smoking prevalence in men and particularly to hamper the increasing smoking trend in adolescents and young women. This remains a challenge for the government of Taiwan.

Adolescent↗

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors.

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Adult↗

[Dental students' smoking behavior and their attitude towards smoking].

This study investigated dental students' smoking behavior and their attitudes, in order to provide programs to patients for giving up smoking. A questionnaire survey was conducted on dental students from November 2003 to February 2004. The subjects were 69 third-grade and 80 fifth-grade students of Tokyo Medical and Dental University. The following results were obtained. (1) The smoking rate of dental students was 19.4% (Male: 31.3%, Female: 5.8%). (2) About forty-three percent of the students had started smoking before entering the university. However, most of the students who smoked had started after entering the university. The smoking rate and number of cigarettes smoked of fifth-grade students were significantly higher than those of third-grade students. (3) Dental students recognized the health risks of smoking more than the general public, especially concerning periodontal disease. (4) Only 5.4% of students answered that they would actively provide advice and instructions about the health hazards of tobacco to patients who smoked. (5) The rate of students who answered that they had enough knowledge to conduct smoking cessation programs for patients was 21.5%. (6) Students who smoked showed positive attitudes towards dentists' smoking behaviors and had passive attitudes towards smoking cessation programs conducted by dentists. These results show it is necessary to conduct smoking cessation programs soon after entering university and to provide more lectures on tobacco and health issues as well as practical training programs about giving up smoking in the dental education curriculum.

Attitude of Health Personnel↗

[A survey of smoking behavior among junior high school students and smoking prevention education developed using the survey results].

In June 1996 and 1997, a self-administered anonymous questionnaire survey of smoking behavior was conducted on students (118 boys and 135 girls) of two junior high schools in Kami-gun, Kochi Prefecture. Following the surveys, smoking prevention education classes were held using the survey results as material for education. The survey results were as follows; 1. The percentage of ever-smokers was higher in boys than in girls, 37.9% and 22.8% respectively. The percentage of those who smoked at least one cigarette during the past one month was 2.9%, and the rate increased with school grade. 2. Most commonly, first experience of smoking was between the 4th to 6th grades in elementary school, and the main motive for first smoking was curiosity. 3. The association between smoking and lung cancer was the most widely known, and that between smoking and intrauterine growth retardation was relatively well-known among students. More than 90% of students clearly understood the harmfulness of passive smoking. 4. The results of logistic regression analyses revealed that friends' and parents' smoking were significant correlates of smoking experience in boys. Among girls no significant relationship was found. The content of smoking prevention education class consisted of quizzes about smoking, an explanation of the survey results, an exhibition of a cross-sectional model of the lung, an experiment of smoking using a small doll, an analysis of expired air carbon monoxide concentration, and an explanation of the harmfulness of smoking. The reports of the students after the class showed that not only the explanation of the harmfulness of smoking, but also the experiment or explanation of the survey results appeared to be effective educational content.

Adolescent↗

Associations between smoking, passive smoking, GSTM-1, NAT2, and rectal cancer.

Cigarette smoking has been identified as a risk factor for colon cancer, however, much less is known about the association between cigarette smoking and rectal cancer. The purpose of this article is to evaluate the associations between rectal cancer and active and passive cigarette smoking and other forms of tobacco use. We also evaluate how genetic variants of GSTM-1 and NAT2 alter these associations. A population-based case-control study of 952 incident rectal cancer cases and 1205 controls was conducted. Detailed tobacco use information was collected as part of an interviewer-administered questionnaire. DNA was extracted from blood to examine genetic variants of GSTM-1 and NAT2. Cigarette smoking was associated with an increased risk of rectal cancer in men [odds ratio (OR)=1.5, 95% confidence interval (CI), 1.1-2.1 for current smokers; OR=1.7, 95% CI, 1.3-2.3 for smoking >20 pack-years of cigarettes relative to never-smokers]. After adjusting for active smoking, exposure to cigarette smoke of others also was associated with increased risk among men (OR=1.5, 95% CI, 1.1-2.0). Neither GSTM-1 genotype nor NAT2-imputed phenotype was independently associated with rectal cancer. However, the risk associated with smoking cigarettes among those who were GSTM-1 null relative to those who never smoked and had the GSTM-1 present genotype was OR=2.0 (95% CI, 1.2-3.3). This interaction was of borderline significance (P=0.08). Men who had the combined GSTM-1 present genotype and who were rapid acetylators had no increased risk from cigarette smoking. There were no significant associations between cigarette smoking and rectal cancer among women. This study shows that men who smoke cigarettes, especially those who smoke >20 pack-years, are at increased risk of rectal cancer. This association may be influenced by GSTM-1 genotype. Furthermore, exposure to cigarette smoke of others may increase risk of rectal cancer among men who do not smoke.

Adult↗

[Hospital no-smoking policy could increase smoking cessation rate among preoperative patients].

BACKGROUND: Although it is well known that a no-smoking policy can reduce smoking rate among hospital employees, the effect of this policy on patients' smoking behavior has not been examined. METHODS: Starting on the world no-tobacco day in 2001, the Sakai Municipal Hospital changed partial no-smoking policy into complete no-smoking policy. In this study, we examined the effect of this policy change on patients' smoking status during preoperative period. At preoperative visit, we asked a patient a change of smoking status during preoperative period. The change of patients' smoking status was compared between before and after coming into effect of no-smoking policy. RESULTS: Smoking rates at first visit to out-patient clinic of each surgical department before and after coming into effect of no-smoking policy were 35.6%(36/101) and 41.8%(28/67), respectively (P=0.317). Among these smokers, smoking cessation rates at preoperative visit before and after coming into effect of no-smoking policy were 44.4%(16/36) and 75.0%(21/28), respectively (P=0.014). CONCLUSIONS: The hospital no-smoking policy has a strong effect on improvement of patients' smoking behavior during preoperative period.

Health Promotion↗

[Smoking among pregnant women and the significance of sociodemographic factors on smoking cessation].

In order to describe smoking habits among pregnant women and predictors of smoking cessation all pregnant women attending routine antenatal care from 1989 to 1991 at the Department of Obstetrics, Aarhus University Hospital, were asked to fill in questionnaires. Information about smoking habits from 8806 women revealed that 44% smoked prior to pregnancy. One fifth of the smokers stopped smoking early in pregnancy, leaving 33% women smoking during pregnancy. The strongest predictor of smoking cessation was the number of cigarettes smoked prior to pregnancy, where those that smoked the least were most likely to give up smoking. Caffeine intake, parity, years of education, and partner's smoking habits were also associated with smoking cessation whereas social status, alcohol intake, marital status, and age of the women had no influence on smoking cessation. Thus, a strategy for a smoking cessation campaign among pregnant women could be directed towards women who smoke heavily prior to pregnancy and women with a high daily intake of caffeine.

Adult↗

Physician advice for smoking cessation.

BACKGROUND: Health care professionals frequently advise patients to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES: The aims of this review were to assess the effectiveness of advice from physicians in promoting smoking cessation; to compare minimal interventions by physicians with more intensive interventions; to assess the effectiveness of various aids to advice in promoting smoking cessation and to determine the effect of anti-smoking advice on disease specific and all cause mortality. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register and the Cochrane Controlled Trials Register. Date of the most recent searches: October 1998. SELECTION CRITERIA: Randomised trials of smoking cessation advice from a medical practitioner in which abstinence was assessed at least six months after advice was first provided. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the setting in which advice was given, type of advice given (minimal or intensive), and whether aids to advice were used, the outcome measures, method of randomisation and completeness of followup. The main outcome measure was abstinence from smoking after at least six months follow-up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow-up were counted as smokers. Where possible, meta-analysis was performed using a fixed effects model. MAIN RESULTS: We identified thirty-one trials, conducted between 1972 and 1997, including over 26,000 smokers. In some trials, subjects were at risk of specified diseases (chest disease, diabetes, ischaemic heart disease), but most were from unselected populations. The most common setting for delivery of advice was primary care. Other settings included hospital wards and outpatient clinics, and industrial clinics. Pooled data from 16 trials of brief advice versus no advice (or usual care) revealed a small but significant increase in the odds of quitting (odds ratio 1.69, 95% confidence interval 1.45 to 1.98). This equates to an absolute difference in the cessation rate of about 2.5%. There was insufficient evidence, from indirect comparisons, to establish a significant difference in the effectiveness of physician advice according to the intensity of the intervention, the amount of follow-up provided, and whether or not various aids were used at the time of the consultation in addition to providing advice. However, direct comparison of intensive versus minimal advice showed a small advantage of intensive advice (odds ratio 1.44, 95% confidence interval 1.23 to 1.68). In one study which determined the effect of smoking advice on mortality at twenty years, there were no statistically significant differences in death rates in the group receiving advice. REVIEWER'S CONCLUSIONS: Simple advice has a small effect on cessation rates. Additional manoeuvres appear to have only a small effect, though more intensive interventions are marginally more effective than minimal interventions.

Humans↗

Smoking prevalence and attitudes toward smoking among Japanese physicians.

CONTEXT: The World Health Organization has advocated that physicians should not smoke cigarettes and surveys on this issue should be conducted among medical professionals. However, no nationally representative surveys of smoking among physicians in Japan have been reported. OBJECTIVES: To estimate the nationwide prevalence of smoking and determine the attitudes toward smoking among Japanese physicians. DESIGN, SETTING, AND PARTICIPANTS: Descriptive study in which anonymous questionnaires were mailed to 4500 randomly selected physician members of the Japan Medical Association in the year 2000, which represents 63% of all Japanese physicians; 3771 (84%) respondents were included in the analysis. MAIN OUTCOME MEASURES: Smoking prevalence among physicians, history of smoking, and attitudes toward smoking. RESULTS: The prevalence of cigarette smoking among physicians was 27.1% for men and 6.8% for women, about half the age-adjusted prevalences among the general Japanese population. Smoking prevalence was higher among male physicians in Japan than those in the United States (3%-10%) and the United Kingdom (4%-5%). Smoking prevalence differed by age, with the highest prevalence among male past smokers aged 70 years or older (51.8%; 95% confidence interval [CI], 47.4%-56.2%). Among male current smokers, the highest rates were for those aged 40 to 49 years (31%; 95% CI, 27.5%-34.5%); rates for female past smokers were highest among those aged 50 to 59 years (10.7%; 95% CI, 6.6%-14.8%) and for female current smokers were highest among those aged 70 years or older (8.2%; 95% CI, 4.8%-11.6%). Nonsmoking physicians had more unfavorable views toward smoking and were more active in encouraging patients not to smoke than those physicians who smoked. CONCLUSION: Smoking cessation programs should be introduced among Japanese physicians to reduce the number of smoking physicians. Also, a continuing education program should be instituted to motivate physicians about their role in society.

Adult↗

Initiation of cigarette smoking and subsequent smoking behavior among U.S. high school students.

BACKGROUND: Most adult smokers report trying their first cigarette before age 18 years. Understanding the impact of smoking initiation at young ages may help public health policy makers and practitioners improve strategies to prevent or delay adolescent cigarette smoking. METHODS: This paper examined age of initiation of cigarette smoking and subsequent patterns of smoking among U.S. high school students 16 years of age and older (N = 13,858). We used data from the 1991-1997 national Youth Risk Behavior Surveys, conducted by the Centers for Disease Control and Prevention. RESULTS: The majority of students 16 years of age and older (60.4%) reported ever having smoked a whole cigarette, and 11.1% initiated smoking at age 10 years or younger. Age of smoking initiation was significantly related to current frequent smoking, daily smoking, and whether students had ever smoked daily. A younger age of smoking initiation was associated with smoking more cigarettes per day than was initiating at an older age. CONCLUSIONS: Delaying the onset of smoking may affect the likelihood of becoming addicted to nicotine and smoking heavily. For students who are already addicted to nicotine, smoking cessation programs are needed.

Adolescent↗

Parental smoking and sociodemographic factors related to smoking among German medical students.

Smoking among medical students has been found to vary strongly between European countries. Few studies have addressed factors associated with smoking among medical students within countries. In this study, we assessed the association of parental smoking and sociodemographic factors with smoking habits of medical students at the University of Ulm, Germany, Students who entered the 1st, 3rd and 5th year of medical school in fall 1992 were asked to complete a self-administered questionnaire. Questionnaires were returned by 696 (85.2%) of 817 eligible students. Overall, 23.7% of students were current smokers, and 11.9% were former smokers. Smoking habits were related to maternal smoking: Odds ratios for the association of maternal smoking with ever or current smoking of students were 2.11 (95% CI: 1.48-3.03) and 2.01 (95% CI: 1.35-3.01), respectively, after adjustment for potential confounders in multiple logistic regression. In contrast, no association was found between paternal smoking and students' smoking status. Male students were more likely to smoke than female students, and living in a large city during secondary school was also associated with ever smoking. No association was found between students' smoking habits and educational achievement of their mothers and fathers. These results suggest a key role of maternal smoking for smoking among medical students in this society.

Adult↗

Smoking habits and attitudes towards smoking among Estonian physicians.

OBJECTIVES: This study examined the smoking habits and attitudes towards smoking among Estonian physicians. STUDY DESIGN AND METHODS: Cross-sectional data for 2668 physicians were gathered by a self-administered postal survey. RESULTS: The current smoking prevalence was 24.9% for male physicians and 10.8% for female physicians. The percentages of ex-smokers were 32.9 and 16.8%, respectively. Smoking prevalence among physicians was below the levels reported for the highest educational bracket of the total population in Estonia. Non-smoking physicians had more unfavourable views towards smoking than those who smoked. The majority of physicians were aware of the association between smoking and various diseases, with significant differences between smokers and non-smokers. Non-smoking physicians were more active in asking patients about smoking habits than those who smoked. Most Estonian physicians, especially those who smoked, failed to perceive themselves as positive role models. CONCLUSIONS: This study found a lower prevalence of smoking among physicians compared with the general population, and demonstrated the impact of personal smoking on physicians' attitudes towards smoking. The results provide an important challenge to medical education in Estonia.

Adult↗

Television viewing and age at smoking initiation: does a relationship exist between higher levels of television viewing and earlier onset of smoking?

This cross-sectional study of children assessed the association between television viewing and age at smoking initiation, using self-reports administered by research assistants in schools. Participants were 909 students in their first and fourth years of secondary education in a random sample of 15 secondary schools in Flanders, Belgium, who had smoked at least one cigarette. The main outcome measure was age at smoking initiation. The independent variable was weekly television viewing volume. Gender, educational level, parental smoking, and peer smoking were the control variables. The relationship between television viewing and age at smoking initiation was significant. Higher levels of television viewing were related to earlier onset of smoking behavior in adolescents. The relationship of television viewing with age at smoking initiation was stronger than that of peer smoking, parental smoking, and gender. For each hour of television viewing per day, the average smoking initiation age decreased by 60 days. Heavier television viewers start smoking at an earlier age. Two possible explanations for this relationship are suggested. Social learning theory suggests that actors and actresses serve as behavioral role models for heavy viewers. Cultivation theory suggests that exposure to positive messages influences smoking attitudes. Further research should examine whether the relationship is causal and whether television acts as a provider of smoking role models or whether it influences smoking attitudes.

Adolescent↗