Youths' exposure to environmental tobacco smoke (ETS): associations with health beliefs and social pressure.

Youths' exposure to environmental tobacco smoke (ETS) is a significant public health problem in the United States. This study examined the associations between health beliefs, social pressure, and exposure to ETS among high school youth. Data were collected in 65 schools in 18 California counties during the 1996-1997 school year as part of the Independent Evaluation of the California Tobacco Control, Prevention, and Education Program. The total sample (N = 6902) represents 10th grade California youth attending public schools. The multiple group analysis approach of structural equation modeling (SEM) was employed to test the associations of five constructs of the health belief model (HBM) and one construct of perceived social pressure with ETS exposure among nonsmokers and smokers. Results demonstrated that high perceived susceptibility to disease was significantly associated with lower levels of ETS exposure for both nonsmokers (beta = -0.11, P < .01) and smokers (beta = -0.20, P < .01). High social pressure to smoke was significantly associated with higher exposure to ETS for both nonsmokers (beta = 0.30, P < .01) and smokers (beta = 0.41, P < .01). Perceived barriers predicted lower exposure to ETS for nonsmokers (beta = -0.09, P < .01) but higher exposure for smokers (beta = 0.11, P < .01). Cues to action and self-efficacy were not significantly associated with ETS exposure among nonsmokers or smokers. These findings underscore the need to increase the awareness of harms associated with second hand smoke and alter social pressure, to minimize exposure to ETS.

Independent evaluation of the California Tobacco Control Program: relationships between program exposure and outcomes, 1996-1998.

OBJECTIVES: This study sought to determine the effects of the California Tobacco Control Program on tobacco-related attitudes and behaviors. METHODS: In 1996 and 1998, a telephone survey was conducted among adults in randomly selected households in 18 California counties. Tenth-grade youths in 84 randomly selected high schools completed a written survey. In analyses conducted at the county level, differences in outcomes were regressed on an index of program exposure. RESULTS: Among adults, program exposure was associated with decreased smoking prevalence rates, increased no-smoking policies in homes, and decreased violations of workplace no-smoking policies. Among youths, there was no effect of program exposure on outcomes. CONCLUSIONS: These results suggest that the California Tobacco Control Program may have reduced adult smoking prevalence rates and exposure to environmental tobacco smoke.

Chewing tobacco: who uses and who quits? Findings from NHANES III, 1988-1994. National Health and Nutrition Examination Survey III.

OBJECTIVES: This study identified mutually exclusive groups of men at high and low risk for use of chewing tobacco and for quitting. METHODS: Analyses used a national sample of 1340 non-Hispanic Black, 1358 Mexican American, and 1673 non-Hispanic White men, aged 25 to 64, who participated in the National Health and Nutrition Examination Survey III from 1988 to 1994. Signal detection analysis was used to delineate high- and low-risk subgroups; survival analysis was used to estimate hazard curves for comparing age at onset for chewing tobacco use with that for smoking. RESULTS: Rural, lower-income Black and White men had the highest regular use of chewing tobacco (33.3%), followed by rural, higher-income men regardless of race/ethnicity (14.9%). Southern men who began using chewing tobacco during adulthood had the lowest quit rate (22.5%). In sharp contrast to smoking, chewing tobacco showed a continued onset throughout adulthood. CONCLUSIONS: Because subgroups of men show highly different chewing tobacco use and quit rates and because age at chewing tobacco onset occurs across the life span, prevention and cessation programs should be specific to different risk groups and distinct from smoking programs.