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PubMed1999

Tobacco smoking among Portuguese high-school students.

The aim of this study was to evaluate the prevalence, behavioural patterns, and determinants of smoking among a large sample of high-school students from Porto, the second largest city in Portugal, information on sociodemographic characteristics and personal history of tobacco, alcohol, coffee, and illicit drug use was obtained from 2974 students, aged 12-19 years (48.7% female, 51.3% male), using an anonymous self-administered questionnaire. Crude and adjusted odds ratios (OR) were calculated by logistic regression analysis to estimate the association between smoking and the characteristics evaluated. Overall, 35.8% students had never smoked, 39.4% had tried it ("experimental" smokers) but were not smokers, 3.3% were former smokers, 6.6% occasional smokers, and 14.9% regular smokers. The mean age for starting smoking was 13.4 +/- 2.1 years for males and 13.4 +/- 1.6 years for females. The prevalence of current smoking was higher among males than females, but the difference was not significant. Male students were significantly more likely to smoke more cigarettes per day than were females. The prevalence of smoking was significantly associated with the following variables: being aged > 12 years; having parents who had attended school for < 4 years; having a mother (OR = 1.88), siblings (OR = 1.96) or friends (OR = 1.75) who smoked; low academic performance (OR = 1.74 for one or two failures and OR = 2.27 for more than two failures at school); and consumption of coffee (OR = 2.90), alcohol (OR = 3.53), or illicit drugs (OR = 6.69). The prevalence of smoking among adolescents increased with age. There is therefore a need for school-based tobacco prevention programmes which also deal with family influences on smoking.

Adolescent↗

PubMed1999

[Smoking among high school students in a rural community of Chiloé].

BACKGROUND: People start smoking at early ages in Chile. AIM: To assess the prevalence and features of smoking habits among high school students in Quinchao, a southern rural community in Chile. MATERIAL AND METHODS: A self administered inquiry about smoking habits was answered by 144 male and 168 female students aged 13 to 22 years old, living in Quinchao. RESULTS: Eighty percent of students has smoked at least once. The prevalence of smokers was 64% for males and 58% for females. The latter started their smoking habit at a mean age of 13.6 years compared with males that started smoking at 14.1 years as a mean. The prevalence of smoking increased with age and among students with smoking relatives. The prevalence of daily smokers was 12% in the total sample, 19% among students older than 17 years old and 21% among students with poor academic performance. Seventy two percent of smokers and 50% of daily smokers were worried about the effects of smoking on health. CONCLUSIONS: The prevalence of smoking in this rural community is similar to that of big cities.

Adolescent↗

PubMed1999

Medical student selection: which matriculation scores and personality factors are important?

Sixty-five from a total of 160 medical students were administered the California Psychological Inventory (CPI) to identify which of all 18 scales can be used as a predictor for academic performance. The entrance examination scores of six subjects were also combined with the CPI variables for the purpose of the study. Students' performances were determined by Grade Point Average (GPA) collected between 1993-1997 (year 1 to year 5). Data was analyzed by descriptive and stepwise method of multiple linear regression analysis. The results showed that mathematics, biology and English language were positively correlated with all year GPAs-r2 value was 10-18 per cent. Scales of "dominance", "flexibility" and "socialization" were positively correlated to the GPA, while "sociability" and "sense of well-being" were negatively correlated. R2 value was increased to 16-59 per cent as prediction of GPA when the CPI variables were combined with scores of entrance examination. A comparison of this finding with other studies was conducted.

Achievement↗

PubMed2000

The health profile of incarcerated male youths.

OBJECTIVE: To identify the health needs of adolescent males incarcerated in a juvenile justice facility and to compare their health profiles with those of male adolescents in the community. METHODS: Cross-sectional surveys were conducted of incarcerated (N = 202) and school (N = 379) samples of male youths. Questionnaires were self-administered and completed before admission health screens (incarcerated youth) or in classrooms (school sample). Health status was assessed by the Child Health and Illness Profile, Adolescent Edition, using scale and item means and by categorizing each youth's pattern of health into 1 of 13 mutually exclusive health profile types. RESULTS: Compared with school counterparts, incarcerated male youths had significantly worse health status as demonstrated by poorer health and functioning scores in perceived well being, self-esteem, physical discomfort, acute, chronic, and psychosocial disorders, family involvement, physical activity, interpersonal problem-solving, risk behaviors, and academic performance. Three profile types-High Risks, High Risks/Low Resilience, and Worst Health-accounted for patterns of health for 69.8% of incarcerated youth versus 37.3% of an age-matched school sample. Just 6.4% of incarcerated males were in the Excellent/Good Health profile types, which contrasted with 34.2% of the age-matched school sample. CONCLUSIONS: The health profiles of incarcerated male youths were worse than those of male youths in school. Our results indicate that rehabilitation programs will need to address incarcerated youth's basic health needs as well as modifying their risk and antisocial behaviors.

Adolescent↗

PubMed1999

Treatment of attention-deficit/hyperactivity disorder.

OBJECTIVES: To determine (a) the long-term and short-term effectiveness and safety of pharmacological and nonpharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) in children and adults and (b) whether combined interventions are more effective than individual interventions. SEARCH STRATEGY: MEDLINE (from 1966), CINAHL (from 1982), HEALTHStar (from 1975), PsycINFO (from 1984), EMBASE (from 1984), and the Cochrane Library searches were completed in November 1997. Reference lists of eligible studies and files of members of the research team and partner organizations were also searched. SELECTION CRITERIA: Studies were selected if they focused on the treatment of ADHD in humans and were published in any language as a full report in peer-reviewed journals. Studies including conditions other than ADHD were reported if separate subgroup analyses for patients with ADHD were provided. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data for 41 variables on general characteristics, along with detailed information on interventions, outcomes, and tests. Differences were resolved by consensus or by a third researcher. Studies were not combined quantitatively because the quality of reporting was low and heterogeneity existed across outcome measures and tests. MAIN RESULTS: Seventy-eight studies (77 randomized controlled trials) met the inclusion criteria. Twenty-three studies compared drugs and showed few, if any, differences among methylphenidate (MPH), dextroamphetamine (DEX), and pemoline; studies comparing stimulants with tricyclic antidepressants (2) were inconclusive. Six studies compared drugs with nondrug interventions and showed consistently that stimulants, particularly MPH, may be more effective than nonpharmacological interventions. Twenty studies compared combination therapies with a stimulant or a nondrug intervention alone; no additional beneficial effects for combination therapies were shown. Nine studies compared tricyclic antidepressants with placebo and showed that desipramine may be more effective than placebo; no consistent effect was shown for imipramine. Fourteen studies (13 in school children and 1 in adults) evaluated long-term therapy (> or = 12 weeks) and showed a trend to general improvement regardless of treatment, but the length of followup was inadequate. MPH may reduce behavioral disturbance in children with ADHD while it is taken. Academic performance does not appear to be improved with stimulants. Twelve studies evaluated treatment in adults with ADHD. For MPH vs. placebo, the results were contradictory. Antidepressants may be effective in adults, but no beneficial effect was seen with pemoline, nicotine, or phenylalanine compared with placebo. Thirty-two reports (29 studies) evaluated adverse effects of drug therapy; many of the side effects associated with stimulant use appear to be relatively mild and of short duration and to respond to dosing or timing adjustments. Data are inadequate on the long-term effects and severity of adverse effects of most interventions. CONCLUSIONS: This report describes rigorous systematic reviews on the treatment of ADHD, ready for incorporation into evidence-based clinical practice guidelines or performance measures. The report also provides a detailed description of the many limitations of the evidence available and provides recommendations to fill existing knowledge gaps. Studies on ADHD have low reporting quality, methodological flaws, and heterogeneity across outcome measures and tests. A detailed description is included of the many limitations of the available evidence plus recommendations to fill existing knowledge gaps. Fulfilling such knowledge gaps will not be easy and will require genuine collaboration among decisionmakers.

Adrenergic Uptake Inhibitors↗

PubMedDate not supplied

Diagnosis and treatment of attention deficit hyperactivity disorder (ADHD).

OBJECTIVE: The objective of this NIH Consensus Statement is to inform the biomedical research and clinical practice communities of the results of the NIH Consensus Development Conference on Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). The statement provides state-of-the-art information regarding effective treatments for ADHD and presents the conclusions and recommendations of the consensus panel regarding these issues. In addition, the statement identifies those areas of study that deserve further investigation. Upon completion of this educational activity, the reader should possess a clear working clinical knowledge of the state of the art regarding this topic. The target audience of clinicians for this statement includes, but is not limited to, psychiatrists, family practitioners, pediatricians, internists, neurologists psychologists, and behavioral medicine specialists. PARTICIPANTS: Participants were a non-Federal, nonadvocate, 13-member panel representing the fields of psychology, psychiatry, neurology, pediatrics, epidemiology, biostatistics, education and the public. In addition, 31 experts from these same fields presented data to the panel and a conference audience of 1215. EVIDENCE: The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS: The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions. CONCLUSIONS: Attention deficit hyperactivity disorder or ADHD is a commonly diagnosed behavioral disorder of childhood that represents a costly major public health problem. Children with ADHD have pronounced impairments and can experience long-term adverse effects on academic performance, vocational success, and social-emotional development which have a profound impact on individuals, families, schools, and society. Despite progress in the assessment, diagnosis, and treatment of ADHD, this disorder and its treatment have remained controversial, especially the use of psychostimulants for both short and long-term treatment. Although an independent diagnostic test for ADHD does not exist, there is evidence supporting the validity of the disorder. Further research is needed on the dimensional aspects of ADHD, as well as the comorbid (coexisting) conditions present in both childhood and adult forms. Studies, (primarily short term, approximately three months) including randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms. Because of the lack of consistent improvement beyond the core symptoms and the paucity of long-term studies (beyond 14 months), there is a need for longer term studies with drugs and behavioral modalities and their combination. Although trials are underway, conclusive recommendations concerning treatment for the long term cannot be made presently. There are wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus regarding which ADHD patients should be treated with psychostimulants. (ABSTRACT

Adult↗

PubMed2000

Evaluation and treatment of sleep disorders in adolescents.

Sleep disorders are quite common in adolescents and sleep disturbances occur most often during the mid-adolescent years. These disorders result in considerable negative consequences in terms of increased accidents, decreased academic performance, and increased behavioral difficulties. Over the past 25 years, the evaluation, diagnosis, and treatment of sleep-related breathing disorders has undergone dramatic changes. The diagnosis and treatment of pediatric sleep disorders are now the focus of more complex and collaborative research efforts. This article discusses the differences between childhood and adolescent sleep cycles, delayed sleep phase syndrome, sleep-related breathing disorders, narcolepsy, parasomnias, and behavior-related sleep problems.

Adolescent↗

PubMed2000

Family influence on current smoking habits among secondary school children in Kota Bharu, Kelantan.

OBJECTIVES: To measure the prevalence of cigarette smoking among male secondary school children and assess their family influence especially that of their fathers' smoking habits on their current smoking habits. METHODOLOGY: A cross-sectional study was carried out in Kota Bharu, Kelantan in April 1997 where 460 male form four students, aged 15-16 years were randomly selected from six secondary schools. Data on smoking habits, sociodemographic profile and family characteristics particularly parents and siblings' smoking habits, perceived parental supervision and communication were collected through self-administered questionnaires. RESULTS: The prevalence of cigarette smoking among male secondary school children was 33.2%. Crude analysis shows family factors, fathers' and siblings' smoking habits, and lack of parental supervision were significantly associated with the students' current smoking habit. Among students who smoked compared to non-smokers, father's smoking habit gives a crude Odds Ratio = 1.8, 95% C.I. 1.08 - 3.16. Further analysis shows that the effect of their father's smoking habit on the student's current smoking habit is still significant after controlling for other familial and non-familial factors including parental supervision, academic performance, reported influence of cigarette advertisement, having friends who smoked and the student's poor knowledge of the ill-effects of smoking and other factors (Odds Ratio = 1.9, 95% C.I 1.05 - 3.32). In conclusion, family factors especially the father's smoking habit is an important factor that influences a student's current smoking habit and the presence of negative role models within the home need to be seriously considered in any cigarette smoking prevention programs among secondary school adolescents.

Adolescent↗

PubMed2000

Evaluation and management of intractable epilepsy.

Seizures remain uncontrolled in 15-20% of all childhood epilepsies despite conventional therapy. This review will focus on the etiologies, effects and treatment strategies in this group of patients. Risk factors for intractable seizures include early age of onset, remote symptomatic seizures, certain seizure types and epileptic syndromes. Adverse effects of chronic epilepsy on academic performance and future employment have been documented. The mechanisms underlying cognitive and behaviour decline are outlined. Errors in diagnosis and therapy often result in pseudo-intractability. Common errors are emphasised. Medical treatment strategies should be based on a complete etiological, syndromic and seizure--type diagnosis sometimes with the help of simultaneous video-EEG and MRI. A detailed past drug use review helps in planning future therapy. New antiepileptic drugs introduced in the last two decades include clobazam, vigabatrin, lamotrigine, gabapentin and topiramate. Strategies of when and how to use these are highlighted. The ketogenic diet has been rejuvenated in severe epilepsy especially in younger, more handicapped patients. Surgical treatment for epilepsy has emerged as a powerful treatment option in selected patients. The patient selection process, types of surgeries and the long-term results are highlighted. Many of these new therapies are now available in India and may offer relief to many of these unfortunate patients.

Age of Onset↗

PubMed2000

Adolescent cigarette smoking in U.S. racial/ethnic subgroups: findings from the National Education Longitudinal Study.

Using nationally representative data for 16,454 8th graders and 13,840 10th graders, we explore racial/ethnic differences in "daily cigarette initiation," beginning to smoke on a daily basis between baseline interviews and reinterviews conducted two years later. In both samples, the initiation rate among whites is more than double the rate among blacks and higher than rates among Asian/Pacific Islanders and Hispanics. Risk factors at the individual, family, and peer-group levels of analysis do not explain most racial/ethnic differences. We develop alternative hypotheses by extending theories of cigarette use to the school level, and we test them using multilevel models: Consistent with social learning theory, cigarette risk among blacks and Hispanics decreases as the percentage of racial/ethnic minority students in the school increases. Consistent with strain theory, cigarette risk increases with the academic competitiveness of the school--especially among females--after controlling for the adolescent's academic performance.

Adolescent↗

PubMedDate not supplied

The impact of home computer use on children's activities and development.

The increasing amount of time children are spending on computers at home and school has raised questions about how the use of computer technology may make a difference in their lives--from helping with homework to causing depression to encouraging violent behavior. This article provides an overview of the limited research on the effects of home computer use on children's physical, cognitive, and social development. Initial research suggests, for example, that access to computers increases the total amount of time children spend in front of a television or computer screen at the expense of other activities, thereby putting them at risk for obesity. At the same time, cognitive research suggests that playing computer games can be an important building block to computer literacy because it enhances children's ability to read and visualize images in three-dimensional space and track multiple images simultaneously. The limited evidence available also indicates that home computer use is linked to slightly better academic performance. The research findings are more mixed, however, regarding the effects on children's social development. Although little evidence indicates that the moderate use of computers to play games has a negative impact on children's friendships and family relationships, recent survey data show that increased use of the Internet may be linked to increases in loneliness and depression. Of most concern are the findings that playing violent computer games may increase aggressiveness and desensitize a child to suffering, and that the use of computers may blur a child's ability to distinguish real life from simulation. The authors conclude that more systematic research is needed in these areas to help parents and policymakers maximize the positive effects and to minimize the negative effects of home computers in children's lives.

Adolescent↗

PubMedDate not supplied

[Microdeletion 22q11: apropos of case of schizophrenia in an adolescent].

Deletion of chromosome 22q11 concerns nearly 1/5.000 births, and is the most frequent interstitial microdeletion. The deletion generates various phenotypes which were initially regarded as distinct syndromes. 1) Di George syndrome was described in 1962 by immunologists, and associates thymic and parathyroid hypoplasia, cardiac malformation, and dysmorphic face; the prognosis is severe, as Di George syndrome is a life-threatening condition. 2) The velocardiofacial syndrome was described in 1978 by stomatologists, and associates palate abnormalities, cardiac malformations, dysmorphic faces, and learning disabilities. 3) The Takao syndrome was described in the late seventies by cardiologists as a clinical condition associating cardiac abnormalities and dysmorphic faces. During the nineties, a common molecular etiology was identified, and a new name proposed: CATCH 22, an acronyme for Cardiac abnormalities, Abnormal face, Thymic hypoplasia, Cleft palate, Hypocalcemia, deleted chromosome 22. Furthermore, new phenotypes have been recently recognized, most of them belonging to the psychiatric spectrum. Descriptive studies of large samples of children with 22q11 deletion, conducted, both in the United States and european countries, have shown the following pattern of associated symptoms:--abnormal face (100%), which expression varies with age, and can be discrete;--cardiac abnormalities (84%), including cardiac malformations of conotroncal types;--mouth abnormalities (49%), including cleft palate (14%), and velar dysfunction (20%);--urinary tract abnormalities (36%), including ureteric reflux, lung dysplasia;--transitory hypocalcemia (60%) mostly during infancy, and due to transitory hypoparathyroid dysfunction;--seizures (21%), which are usually a consequence of hypocalcemia;--immunodeficiency (1%), which worsens the prognosis. Deletion of chromosome 22q11 has been also associated with various psychiatric phenotypes, which can be classified into two groups, developmental abnormalities and psychiatric conditions. The great majority of patients with the deletion exhibit impairment of language and motor development, mild mental retardation, persistent coordination deficits, and poor academic performance. The deletion of chromosome 22q11 is also associated with high frequency of behavioral disorder with attention deficit during childhood, and with high frequency of psychotic disorder (bipolar disorder, and schizophrenia) during adolescence and young adulthood. The link between the 22q11 deletion and schizophrenia has been also supported by recent studies showing that the rate of 22q11 deletion in adults with schizophrenia (2%) is higher than it is in the general population. The rate may even be higher (6%) in subjects with childhood onset schizophrenia. The present work reviews the psychiatric literature associated with 22q11 deletion. We also report a case of 22q11 deletion in a 17-year-old girl that was initially diagnosed as paranoid schizophrenia. We will discuss the diagnostic, prognostic, and therapeutic consequences that such a genetic diagnosis implies. In the case reported here, transitory hypocalcemia induced: 1) dystonic symptoms that was believed to be catatonic symptoms or neuroleptic secondary effects, by clinicians; 2) a poor response to neuroleptic medication.

Adolescent↗

PubMed2001

Exercise is positively related to adolescents' relationships and academics.

Eighty-nine high school seniors were administered a questionnaire that gathered information on their exercise habits (ranging from rarely to daily), relationships with parents and peers, depressive tendencies, sports involvement, drug use, and academic performance. Students with a high level of exercise had better relationships with their parents (including greater intimacy and more frequent touching), were less depressed, spent more time involved in sports, used drugs less frequently, and had higher grade point averages than did students with a low level of exercise.

Achievement↗

PubMed1996

Asian Pacific American Medical Students: Beyond the 'golden stethoscope'

PURPOSE OF THE PAPER: The purpose of this paper is to present a keynote address given in 1995 immediately prior to the formal inauguration of the Asian Pacific American Medical Student Association (APAMSA) in New York. PRINCIPAL FINDINGS: Asian Pacific American (APA) medical students have increased tenfold as a percentage of the entering class from 19751995 to its current level of 18.2%. The recent history of the APA medical student movement is traced from its inception in regional conferences in 1993 to the formation of a national electronic mail bulletin board ("AAMSnet") in 1994, and its culmination in the first national conference and inauguration of the Asian Pacific AMerican Medical Student Association (APAMSA) at New York University in 1995. CONCLUSIONS: Although the "golden stethoscope" image is used to represent the pinnacle for APA students entering the medical profession, beneath the image lie difficult challenges specific to APAs including those of family and culture, academic performance, professional acceptance, and community responsibility. The potential of the APAMSA organization to address local, regional, and national APA health issues is explored.

Journal Article↗

PubMedDate not supplied

Gender, sexual abuse and risk behaviours in adolescents: a cross-sectional survey in schools in Goa.

BACKGROUND: There is little information on the prevalence and correlates of sexual abuse in adolescents in India. METHODS: A cross-sectional survey of all Class XI students in eight higher secondary schools in Goa (n = 811 ) was conducted in March 2000. A self-report questionnaire, developed and piloted in collaboration with the adolescents, elicited information on education, mental health, risk behaviours and the experience of violence and sexual abuse in the previous year. RESULTS: A third of adolescents had experienced some form of sexual abuse. Sexual abuse experiences were associated with the experience of other forms of physical and verbal violence. Coercive sex had been experienced by approximately 6% of adolescents. These adolescents had significantly poorer academic performance, poorer mental and physical health, greater substance abuse, poorer parental relationships and higher rates of consensual sexual behaviours. Gender differences in the types of abuse and the associations with abuse were found. However, there was no difference between boys and girls in the rates of experience of coercive sexual intercourse. Differences in risks were found for urban and rural school students; while rural boys were more likely to have experienced coercive sexual intercourse than urban boys (10.3% v. 2.5%), urban girls were more likely to have experienced any form of sexual abuse than rural girls (37.2% v. 25.4%). CONCLUSIONS: Abuse and violence in school-based adolescents is a common experience and is associated with poorer health and greater prevalence of risk behaviours. Interventions aimed at improving adolescent reproductive health must incorporate personal safety, prevention of abuse, communication skills and mental health issues.

Adolescent↗

PubMed2001

Adolescent depression and risk factors.

Seventy-nine high school seniors were administered the Center for Epidemiological Studies Depression Scale (CES-D), as well as a questionnaire on parent relationships, peer relationships, positive and negative feelings including suicidal thoughts, and lifestyle variables including academic performance, exercise, and drug use. The group of adolescents who scored above the clinical cutoff for depression on the CES-D (n = 29) had poorer relations with parents. Further, the incidence of paternal depression in that group was greater. The depressed adolescents also had less optimal peer relationships, fewer friends, and were less popular. They experienced less happiness and more frequent suicidal thoughts. They spent less time doing homework, had a lower grade point average, and spent less time exercising. The depressed group also reported more use of marijuana and cocaine. A stepwise regression indicated that physical affection with parents, homework, well-being, exercise, happiness, and parent relations explained 55% of the variance.

Adolescent↗

PubMed1975

Effects of auditory and pictorial-auditory stimulus enrichment on the verbal abstracting abilities of low-SES children.

Sixty-four low-SES Caucasian children, mean age 8.3 years, with high- and lowintellectual ability, were given a verbal similarities task. One-half of the subjects (the control group) received nonenriched items (2 exemplars of each concept on Presentation 1, which were repeated on Presentation 2), and half (the experimental group) received enriched items (2 exemplars of each concept on Presentation 1 and 4 exemplars on Presentation 2). Stimuli were presented in either the auditory or pictorial-auditory mode. The low-ability experimental group achieved abstracting gain scores greater than those of the lol-ability control group and greater than those of the high-ability experimental group. The low-ability experimental group achieved scores equivalent to those of the high-ability group under the pictorial-auditory enriched condition. Implications of these findings were discussed relative to academic performance of EMR children.

Acoustic Stimulation↗

PubMed2002

Smoking in Syria: profile of a developing Arab country.

One of the main obstacles to tobacco control in the Middle East lies in the shortage of reliable, standardised data on the spread and patterns of tobacco use in society. In Syria, a project aiming at drawing an epidemiological map of the tobacco epidemic in this country was started 4 years ago. Overall, nine studies have resulted, with a total of 6780 participants. The crude prevalence of current smoking among adults in Syria, based on combined information from all studies, is 48% and 9% for males and females, respectively. The prevalence of current smoking among high school adolescents is 16% and 7% for boys and girls, respectively, and was strongly associated with parental and sibling smoking. High school students from families with parents and/or siblings who smoked were 4.4 times more likely to be current smokers than those from non-smoking families. The biggest influx of new smokers among males in Syria is occurring in the early twenties, but an earlier pattern can occur among youths with low academic performance or socioeconomic status. Smoking in women, evaluated by data from physicians, tends to start later than in men and continues to increase with age. Women's smoking in Syria is related to their level of social liberalisation. Data show that active smoking is associated with an increased risk of respiratory diseases among smokers, and that exposure to environmental tobacco smoke (ETS) is associated with an increased risk of respiratory symptoms in children. Knowledge about the harmful effects of smoking and the desire to quit are disproportionate to the rate of successful cessation. The evidence collected indicates possible avenues for tobacco control in Syria, including price increases, smoking cessation programmes, restriction of adolescents' access to cigarettes, and intensive prevention work among women.

Adolescent↗