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At least 217 records · Page 12Linked to original sources
PubMed2001

Passive smoking in the home: plasma cotinine concentrations in non-smokers with smoking partners.

BACKGROUND: Risks of lung cancer and of heart disease attributable to passive smoking have been evaluated mainly in non-smokers married to smokers, but there has been little quantitative assessment of the extent of exposure in marriage partners as indicated by markers of inhaled smoke dose. OBJECTIVE: To relate plasma cotinine concentrations in non-smoking English adults to the smoking behaviour of their partners and to demographic and other factors. DATA: Population survey. Data from two years (1994 and 1996) of the Health Survey for England. MAIN OUTCOME MEASURES: Plasma cotinine concentrations in non-smoking adults married to or cohabiting with a partner. RESULTS: There was a strong dose-response relation between cotinine concentrations in non-smoking adults and the smoking behaviour of their partners, rising from a geometric mean of 0.31 ng/ml in those with non-smoking partners to 1.99 ng/ml in those whose partners smoked 30 or more cigarettes per day. In addition, exposure was greater in men, in the autumn and winter, and in those living in more disadvantaged circumstances, and there was an increasing gradient of exposure from the south to the north of the country. On average, cotinine concentrations in non-smokers with a smoking partner were 0.6-0.7% of those in cigarette smokers. CONCLUSIONS: If cotinine is taken as a measure of risk relevant dose, the implied increase in risk of lung cancer in non-smokers with smoking partners is consistent with the risk observed in epidemiological studies. Smoking by partners in the home is a major source of non-smoking adults' exposure to passive smoking.

Adult↗
PubMed2002

Is smoking a communicable disease? Effect of exposure to ever smokers in school tutor groups on the risk of incident smoking in the first year of secondary school.

OBJECTIVE: To estimate the effect of joining a first year secondary school tutor group with a high prevalence of ever smoking on the risk of incident smoking in schoolchildren. DESIGN: Cross-sectional questionnaire survey. SETTING: 10 randomly selected secondary schools in Nottinghamshire, UK. PARTICIPANTS: Pupils in years (grades) 7-11 (aged 11-16 years). MAIN OUTCOME MEASURE: Incident smoking in the first year of secondary education, defined as pupils who reported smoking their first cigarette during year 7. RESULTS: Of 6522 pupils (75% of those eligible) who completed the questionnaire, 17% were current smokers and 49% had ever smoked, of whom 23% had started smoking in year 7. Incident smoking in year 7 was more common in girls, in children with parents or siblings who smoke, and in more deprived children, and was independently increased in relation to the proportion of ever smokers in the year 7 tutor group joined by the child (adjusted odds ratio of incident smoking for a child joining a year 7 tutor group in the highest relative to the lowest quartile of ever smoking prevalence 1.45, 95% confidence interval (CI) 1.11 to 1.89). Exposure to ever smokers in year 7 tutor groups also accounted for most of the increased risk of incident smoking associated with socioeconomic deprivation. CONCLUSIONS: The risk of incident smoking in children entering secondary education is independently increased by exposure to other ever smokers in school tutor groups. Incident smoking in adolescents is thus to some extent a communicable disorder, and may be partly preventable by policies that reduce exposure to smoking at school.

Adolescent↗
PubMed2004

Exposure to environmental tobacco smoke (ETS) and determinants of support for complete smoking bans in psychiatric settings.

OBJECTIVE: To measure environmental tobacco smoke (ETS) exposure in psychiatric settings and to assess determinants of support for complete smoking bans. DESIGN: Cross sectional study SETTING: Dutch psychiatric hospitals, outpatient care institutions, and sheltered home facilities. SUBJECTS: A random sample of 540 treatment staff, 306 attendants/nurses, and 93 patients. MAIN OUTCOME MEASURES: Self reported ETS exposure, current smoking policy, compliance with smoking policy, beliefs about smoking bans. RESULTS: 87% of respondents were exposed to tobacco smoke in psychiatric institutions; 29% said that on an average day they were exposed to "a lot of smoke". Although ETS originates mainly from smoking patients, both non-compliance from patients and employees with existing bans resulted in non-smokers being exposed to ETS. Due to non-compliance, ETS exposure was quite high when there is a general smoking ban (designated areas option). Only with a complete ban was compliance good and employees sufficiently protected from ETS exposure. Psychiatrists, psychologists, physicians, attendants, and nurses were most concerned about resistance from patients, partly because of the fear of infringing on patients' freedom to smoke. CONCLUSIONS: Complete smoking bans are the only way to fully protect those working in psychiatry from ETS exposure, mainly because general smoking bans are not sufficiently complied with. Communication strategies to improve compliance with complete bans are crucial to protect those working in psychiatry from ETS. Compliance could be improved by addressing the belief that the ban will effectively result in less ETS exposure and the issue of patients' freedom to smoke versus employees' right to work in a smoke-free environment.

Adult↗
PubMed1996

Smoking in the workplace: do smoking patterns and attitudes reflect the legislative environment?

OBJECTIVE: With regard to the workplace, to examine restrictions on smoking, smoking at work, attitudes toward and reactions to restrictions, and workplace programmes in the context of the legislative environment. DESIGN: Population-based telephone interview survey of adult residents of the jurisdictions of Metropolitan Toronto, Ontario, Canada. SUBJECTS: Workers within the City of Toronto (n = 374) were compared with other workers (n = 536), because their legislative environments with regard to workplace smoking were markedly different, with workplaces in the City of Toronto being covered by a much more stringent bylaw. RESULTS: In comparison with other workers, City of Toronto workers reported workplace restrictions to be more common and widespread. These workers were also less likely to smoke at work, and more likely to smoke less at work and to have cut down on smoking at work. Quit-smoking rates, however, were similar. There was evidence of some compensatory smoking outside work, but additional compensation in association with more stringent restrictions was not found. City workers and other workers were similar in their support for smoke-free workplaces, in their attitudes to the role of governments in regulating workplace smoking, and in their perceptions of conflict between smokers and non-smokers. Reports of quit-smoking programmes and educational interventions in the workplace were similarly uncommon, although both groups of workers indicated strong support for the role of business and industry in helping people quit. CONCLUSIONS: Restrictions on smoking and smoking patterns reflected the legislative environment; a more stringent environment was associated with more restrictions and less smoking at work.

Canada↗
PubMed1995

Trends in cigarette smoking and physicians' advice to quit smoking among people with diabetes in the U.S.

OBJECTIVE: This study describes changes in the distribution of cigarette smoking and in physicians' advice to quit smoking among the U.S. population with and without diabetes from the mid-1970s to 1990. RESEARCH DESIGN AND METHODS: Data on self-reported smoking status, physicians' advice to quit smoking, history of diabetes, and demographic characteristics were obtained from the 1974, 1985, and 1990 National Health Interview Surveys. We examined the age-adjusted prevalence of smoking and physicians' advice to quit smoking by race, sex, and educational level among individuals with diabetes and those without diabetes. RESULTS: The prevalence of smoking decreased 9.8 percentage points from 1974 to 1990 among individuals with diabetes (from 35.6 to 25.8%, P < 0.01) and 11.7 percentage points among those without diabetes (from 37.3 to 25.6%, P < 0.01). For all years, younger individuals, men, and people with less than a high school education were more likely to smoke, regardless of diabetes status. Among individuals who had ever smoked, those with diabetes were more likely to have received advice to quit than those without diabetes; from 1974 to 1990, the percentage advised to quit smoking by a physician increased from 35.1 to 58.4% for smokers with diabetes and from 26.8 to 46.0% for smokers without diabetes. CONCLUSIONS: Despite decreases in smoking prevalence over time, people with diabetes are still as likely to smoke as those without diabetes. More than 40% of smokers with diabetes currently report never having received advice from a physician to quit smoking. Health care providers should increase their efforts to reduce smoking among people with diabetes.

Adolescent↗
PubMed2006

The importance of smoking definitions for the study of adolescent smoking behavior.

PURPOSE: Smoking is the leading cause of death and smoking initiation rarely occurs after adolescence. Thus research on adolescent smoking is crucial. A consistent definition of smoking is important because inconsistent definitions make comparisons across studies an arduous task. Thus, the aim of the study was to suggest future research directions for smoking definitions after examining pitfalls in the literature. METHODS: In this study the literature on adolescent smoking in the U.S. and South Korea was examined, and three types of smoking definitions were identified. Limitations in the studies are identified and future research directions are suggested. RESULTS: In the U.S. literature, smoking definitions can be categorized into three groups: definitions based on stage models, smoking trajectories, and definitions derived from specific data. In the South Korean literature, various levels of smoking have not been differentiated. CONCLUSIONS: While the literature does not provide a definitive answer regarding the definition of smoking, it suggests three issues to consider for future research. First, multiple measures of smoking are more desirable than a one-time measure. Second, theory- or trajectory-based smoking definitions are more desirable than definitions derived from available data. Finally, regularity and amount of cigarette use should be incorporated in defining smoking behavior.

Adolescent↗
PubMedDate not supplied

Creating a smoke-free hospital: attitudes and smoking behaviors of nurses and physicians.

PURPOSE: To assess smoking prevalence and attitudes of physicians and nurses before a smoking ban. The relationship between pre-ban attitudes and post-ban smoking behavior was also studied. DESIGN: This is a prospective descriptive study of a cohort of nurses and physicians who were surveyed six months before and six months after a ban on smoking was implemented. SETTING: A large, 1,000-bed teaching hospital in the Northeast of the United States. SUBJECTS: All full-time members of the medical (n = 1,496) and nursing staff (n = 1,500) were surveyed. The overall response rate for the cohort was 41% for physicians and 39% for nurses. MEASURES: Surveys included standardized questions on current smoking behavior, and sociodemographic variables. Attitudes toward quitting and the smoking policy and attitudes about implementation and enforcement of the smoking ban were included. RESULTS: Both physicians and nurses were supportive of a smoke-free policy, but the two groups differed significantly on attitudes related to implementation and enforcement, with nurses being more accommodating toward smoking and less likely to enforce a ban on smoking. Physicians were more likely than nurses to quit smoking after implementation of the ban. Pre-ban attitudes were not predictive of post-ban changes in smoking behavior. CONCLUSIONS: Physicians and nurses agreed with establishing a smoke-free environment but disagreed over the efforts needed to maintain the smoke-free environment. Quitting behavior was not influenced by pre-ban attitudes.

Adult↗
PubMed2000

Factors influencing discussion of smoking between general practitioners and patients who smoke: a qualitative study.

BACKGROUND: Anti-smoking advice from general practitioners (GPs) is effective and recent evidence-based guidelines urge GPs to advise all patients against smoking at every opportunity. GPs do not exploit many opportunities to discuss smoking with patients and the reasons for this are unclear. AIM: To elicit, relate, and interpret GPs' accounts of why they discuss smoking with some patients and not others. METHOD: Thirty-nine Leicestershire GPs were purposively selected so as to have a range of attitudes towards discussing smoking with patients. Each GP had one surgery session video-recorded and afterwards participated in a qualitative, semi-structured interview. Prior to each interview, GPs were shown a video-recording of one of their consultations with a smoker to enhance their recall of events. RESULTS: Being aware of patients' smoking status did not necessarily result in GPs discussing smoking with patients. GPs were keen to preserve good doctor-patient relationships and avoid negative responses from patients once the topic of smoking had been raised, and this was felt to be best achieved by restricting most discussions about smoking to situations where patients presented with smoking-related problems and in circumstances where the doctors perceived the doctor-patient relationship was strong. Doctors also thought it important to address patients' agendas relating to the current consultation before discussing smoking. CONCLUSIONS: General practitioners have strong reasons for preferring to discuss smoking when patients present with smoking-related problems. Those wishing to increase the amount of advice-giving by GPs might be more successful if they encouraged GPs to make greater use of problem-orientated opportunities to discuss smoking.

Attitude of Health Personnel↗
PubMed1982

Study of smoking habits in hospital and attitudes of medical staff towards smoking.

Most hospital policies place little or no restriction on patients' smoking in hospital. In this study patients were surveyed to determine if they smoked and if their doctors advised or ordered them to stop smoking in hospital. As well, the smoking habits and attitudes towards smoking of the medical staff and other hospital workers were explored. Of 741 patients 37% were smokers, and those who responded fully to a questionnaire 86% continued to smoke in hospital. Patients who were advised or ordered not to smoke (59%) were no more likely to stop smoking than those who were not so advised or ordered. Physicians were less likely to smoke than other hospital staff, and those who did smoke were much more likely not to smoke while in the hospital. Physicians appear to have a reasonable appreciation of the health hazards of smoking, and almost two thirds are in favour of stricter restrictions on patients' smoking in hospital. The ineffectiveness of their efforts is primarily due to hospital policies that are not in keeping with physicians' standards of practice and with established knowledge of the deleterious effects of smoking on health.

Attitude of Health Personnel↗
PubMed1997

Do work-place smoking bans cause smokers to smoke "harder"? Results from a naturalistic observational study.

The purpose of this study was to investigate whether smokers outside buildings with work-place smoking bans smoke "harder" than those smoking in social settings. An unobtrusive random observational study of smokers followed by structured interview was used, with 143 smokers taking smoking breaks outside their office buildings and 113 smokers in social settings. The main outcome measurements were number of puffs per cigarette and cigarette smoking duration. The mean number of puffs per cigarette for the office building group was 18.7% greater than that for the social settings group (10.7 +/- 3.2 vs. 8.7 +/- 2.7, t = 5.58, df = 253, p < 0.001); 74.8% of smokers outside offices took more than the mean number of puffs for the group compared to 42.5% of smokers in social settings (chi 2 df 1 = 26.31, p < 0.0001). Mean cigarette smoking duration was 30.4% shorter for the work-place group than the social settings group (3.9 +/- 1.2 minutes vs. 5.6 +/- 2.6 minutes). Of smokers outside offices, 55.2% had a cigarette smoking duration between 3 and 4.59 minutes, while 53.1% of smokers in social settings took > or = 5 minutes to smoke the observed cigarette (chi 2 df 2 = 31.55, p < 0.0001). Smokers who scored at the 75th percentile on the Fagerstrom Tolerance Scale took a mean 9.5 +/- 2.6 puffs per cigarette compared to 9.3 +/- 2.7 puffs by those who scored in the 25th percentile on the scale (t = 0.34, df = 145, p = 0.73). Regardless of degree of nicotine dependency, smokers leaving work-stations to smoke outside buildings smoked their cigarettes nearly 19% "harder" than cigarettes smoked in social settings. The individual and public health benefits of reduced smoking frequency engendered by work-place smoking bans may be lessened by policies which allow smokers to take smoking breaks.

Adult↗
PubMed1986

Alterations in prostacyclin and thromboxane formation by chronic cigarette smoke exposure: temporal relationships and whole smoke vs. gas phase.

Chronic cigarette smoke exposure in vivo causes decreased conversion of [14C]arachidonic acid (AA) to prostacyclin (PGI2) by isolated aortic tissue and increased conversion to thromboxane (TXA2) by isolated platelets from rats. Alterations in the PGI2/TXA2 balance may be part of the mechanism through which smoking increases the risk of cardiovascular disease. To study the influence of smoke exposure duration on this response, male rats were exposed daily to 10 puffs of freshly generated cigarette smoke. Animals were killed after 1, 4, 14, 28 and 57 days of smoke exposure and 3, 7, 14 and 28 days after cessation of the 57-day of smoke-exposure regimen. Elevated carboxyhemoglobin levels during the smoke-exposure sessions verified smoke (gas phase) inhalation. Statistically significant alterations in prostacyclin synthesis preceded those of thromboxane. A decrease of 20-25% (P less than 0.05) in PGI2 production from [14C]AA in isolated aortic tissue was found beginning 28 days after smoke was initiated and quickly rebounded when smoke exposure was terminated. Increased production of TXA2 from [14C]AA by isolated platelets became statistically significant (P less than 0.05) on the 57th day and returned to normal 7-14 days after cessation of smoke exposure. To determine the effect of gas phase constituents on the PGI2/TXA2 balance a second series of experiments divided male and female Sprague-Dawley rats into sham, whole smoke and gas phase groups. Gas phase was produced by passing whole smoke through a Cambridge filter to remove particulate matter. Per cent COHb averaged 1.4 for sham, 7.8 for whole smoke and 9.4 for gas phase groups.(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1999

Age at starting smoking and number of cigarettes smoked in Catalonia, Spain.

BACKGROUND: Few studies have investigated the association between age at starting smoking and the average number of cigarettes smoked per day in adulthood. To provide further evidence on this issue, we analyzed data from the Catalan Health Interview Survey (CHIS). METHODS: The CHIS was conducted in 1994 on a randomly selected sample (N = 15,000) of the population of Catalonia, Spain. A total of 4,897 current or exsmokers (3,276 males and 1,621 females) were included for analysis. Age-standardized proportions of subjects smoking <15, 15-24, and >/=25 cigarettes/day, age-standardized mean number of cigarettes smoked per day, and multivariate odds ratios (OR) of being a heavy smoker (>/=25 cigarettes/day) according to age at starting smoking (<15, 15-17, 18-19, >/=20 years) were computed. RESULTS: Men who started smoking before the age of 15 smoked on average 5.5 cigarettes more than those who started at age 19 or over. Women who started smoking early in life smoked, on average, 6.8 cigarettes/day more than women who started later. The proportion of smokers of <15 cigarettes/day was higher among subjects who started smoking later. Both for males and for females, the OR of being a heavy smoker significantly increased with decreasing age at starting smoking (OR = 2.4 for males and 4.5 for females who started at age <15 versus >/=20 years). The level of education did not modify the relationship in males, whereas the association with age at starting was only apparent for more educated women. CONCLUSIONS: This study confirms that age at starting smoking is inversely and strongly associated to the number of cigarettes smoked per day. Thus, actions aimed at the prevention or delay of smoking onset among adolescents would have an important beneficial effect.

Adolescent↗
PubMed1985

A method for enriching the cadmium content of cigarette smoke and effect of exposure to this smoke on coronary vascular reactivity in the rat.

To study the effect of smoke-borne cadmium on the cardiovascular system, a method was developed to vary the cadmium content in the smoke of Kentucky 2R1 reference cigarettes. 2R1 filler tobacco was sprayed with aqueous solutions of CdSO4; cigarettes were prepared from this tobacco and smoked through Cambridge filters. These treatments increased the cadmium content of the cigarette smoke from 0.23 +/- 0.01 micrograms Cd/2R1 cigarette to 0.317 +/- 0.029, 2.38 +/- 0.092, and 4.9 +/- 0.1 micrograms Cd/cigarette for 500 microM, and 50 mM CdSO4, respectively. Male Sprague-Dawley rats were exposed for 5 or 23 weeks to smoke from 2R1 reference cigarettes and cigarettes prepared from 2R1 tobacco that was treated with 500 microM CdSO4. Following 5 weeks of smoke exposure, neither kidney cadmium amount nor coronary vascular reactivity to angiotensin was altered in either smoke-exposed group compared to cage controls or sham-smoked animals. After 23 weeks of exposure, cadmium amounts in kidneys from animals exposed to cadmium-enriched smoke were significantly greater than quantities observed in any other group. Exposure to either type of cigarette smoke increased coronary vascular reactivity above either control group. Exposure to cadmium-enriched cigarette smoke increased coronary vascular reactivity to angiotensin above the amount observed following exposure to 2R1 cigarette smoke. This finding indicates that smoke-borne cadmium may mediate the observed increases in coronary vascular reactivity following exposure to cigarette smoke.

Analysis of Variance↗
PubMed1982

The effects of peer and parental smoking and age on the smoking careers of college women: a sex-related phenomenon.

In the United States, smoking for women has followed a different pattern for women than for men, and the literature suggests that it, as a 'masculine' behavior, may serve as a role-delineating function for women. This research examines the relationship between sex of smoking parents and peers and the smoking behavior of college women. Having a mother who smokes was significantly related to whether or not the daughter smokes, the age of onset, and the frequency of the daughter's smoking; the proportion of female friends who smoke, to the frequency and amount of the woman's smoking and to the degree of difficulty of quitting. Smoking by the father and male friends was not important. Also, the age of the woman was significantly to whether or not she ever smoked and to the age of onset of smoking. This likely reflects her experience of social norms regarding smoking by women and the publication of the first surgeon general's report on smoking and health. These findings support the notion of smoking as a role-related behavior for women. Further research is needed to extend these findings to men and other health behaviors.

Adult↗
PubMed2004

Gender and smoking status-based analysis of views regarding waterpipe and cigarette smoking in Aleppo, Syria.

BACKGROUND: Narghile (waterpipe) smoking is increasing across the Eastern Mediterranean region (EMR), though little is known about the social attitudes and perceptions related to this method of tobacco use, and how those attitudes and perceptions are influenced by gender. METHODS: Data from two cross-sectional surveys conducted in 2003 in Aleppo, Syria, were used to examine these issues. Overall, 855 participants were included (439 men, 416 women; mean age, 24.4+/-7.1 years; response rate, 97%). The current analysis focuses on responses to four similar nine-item questions tapping perceptions related to narghile smoking by women or men, and cigarette smoking by women or men. Scores on the nine items were summed to yield a total score to gauge participants' perceptions about narghile and cigarette. RESULTS: Generally, participants were less positive about women smoking relative to men smoking, and cigarette smoking relative to narghile smoking. Cigarette smoking by women was the behavior least associated with positive perceptions. Individuals who resided in the city, were economically better-off, and were Christian, had higher perception scores (i.e., more positive attitudes) toward all forms of smoking, whereas older and married participants had higher perception scores for narghile only. Smoking status of participants, especially narghile smoking, was also associated with more positive perceptions toward smoking in general. CONCLUSIONS: We conclude that preliminary analysis shows that views on different forms of smoking in Syria differ by gender and smoking status.

Adolescent↗
PubMed2005

Parenting style and smoking-specific parenting practices as predictors of adolescent smoking onset.

OBJECTIVE: To test whether parenting style and smoking-specific parenting practices prospectively predicted adolescent smoking. METHODS: Three hundred eighty-two adolescents (age 10-17 years, initial nonsmokers, 98% non-Hispanic whites) and their parents were interviewed, with smoking also assessed 1-2 years later. RESULTS: Adolescents from disengaged families (low acceptance and low behavioral control) were most likely to initiate smoking. Adolescents' reports of parents' smoking-related discussion was related to lowered smoking risk for adolescents with nonsmoking parents, but unrelated to smoking onset for adolescents with smoking parents. Smoking-specific parenting practices did not account for the effects of general parenting styles. CONCLUSIONS: Both parenting style and smoking-specific parenting practices have unique effects on adolescent smoking, although effects were largely confined to adolescents' reports; and for smoking-specific parenting practices, effects were confined to families with nonsmoking parents. Interventions that focus only on smoking-specific parenting practices may be insufficient to deter adolescent smoking.

Adolescent↗
PubMed1988

The influence of self-esteem, parental smoking, and living in a tobacco production region on adolescent smoking behaviors.

Selected antecedents of smoking initiation among 1,513 eighth grade students in an urban tobacco producing county of North Carolina were studied using the Tobacco Cigarette Smoking Questionnaire and the Rosenberg Self-Esteem Scale. Fifteen percent of students reported currently smoking, and 17.2% indicated an intention to smoke upon graduation from high school. Self-esteem and parental smoking behavior related significantly to adolescents' smoking behavior and future intention to smoke. Significantly more females intended to smoke and had lower self-esteem than males. Family involvement in the tobacco industry related significantly to adolescents' intention to smoke but not their smoking behavior. Overall, low self-esteem and parental smoking models may be important to developing the smoking habit among young adolescents. Prevention of smoking initiation should involve promotion of children's self-esteem and avoidance of parental smoking modeling prior to the eighth grade.

Adolescent↗
PubMedDate not supplied

Smoking among adolescents in China: an analysis based upon the meanings of smoking theory.

PURPOSE: This study utilized the Meanings of Behavior theory to examine whether meanings of smoking differ among adolescents in China who were never smokers, ever smokers, and past-30-day smokers. The Meanings of Behavior theory argues that affect takes precedence over cognitive constructs in motivating behavior This study also examined whether the associations among meanings of smoking and smoking behavior vary by age and gender DESIGN: This study was a cross-sectional study using survey data. SETTING: Middle and high schools in seven cities in China. SUBJECTS: A random sample of 4724 students comprised this study. MEASURE: A self-administered questionnaire asked about smoking behavior and incorporated the meanings of smoking scale. RESULTS: Overall prevalence rates of ever smokers and past-30-day smokers in this sample were 24.3% and 9.0%. Smoking was much more prevalent in boys than in girls. Students in the 11th grade were more likely than those in the 7th grade to have tried smoking at some time and to have smoked within the past 30 days. Odds ratios confirmed that meanings of smoking were significantly associated with smoking behaviors. CONCLUSIONS: Meanings of smoking are associated with smoking behavior among Chinese adolescents in that smoking may connote autonomy, control, or social relatedness. Prevention programs in China require new strategies to incorporate meanings of smoking in order to meet adolescent psychological needs for autonomy, competence, and social connections.

Adolescent↗