Parents' educational level and second-hand tobacco smoke exposure at home in a sample of Portuguese children.

Second-hand tobacco smoke (SHS) exposure is a major and entirely avoidable health risk for children's health, well-being and development. The main objective of the current study was to investigate the association between parents' educational level and children's SHS home exposure. A self-administered questionnaire was conducted within a sample of 949 students in 4th grade (mean age 9.56±0.75, 53.4% male). The sample was randomly selected from all schools located at Lisbon District, Portugal. The current study confirmed that Portuguese children are exposed to unacceptable high levels of SHS at home, mainly by their parents' smoke. Prevalence of smokers was higher amongst parents with low educational level. Children of parents with low educational level were more likely to suffer SHS exposure at home. These results confirmed the social inequalities associated with smoking, support the relevance of more research on this subject and stress the need for more interventions to control this problem. Some interventions should be specifically aimed at less educated parents, particularly at less educated mothers.

Children's exposure to second hand smoke at home: a cross-sectional study in Portugal.

Second-hand tobacco smoke (SHS) is a major indoor pollutant that causes serious health problems for all exposed, especially children. Children are often exposed to SHS at home, due to parental or other households' or guests' smoking. This study describes Portuguese children's exposure to SHS at home (total and by Portuguese main regions). In 2010/2011, a questionnaire was applied to a sample of Portuguese children in the 4th grade (N=3187, mean age 9.05±0.7 years, 51.1% male). Descriptive analysis, chi-square tests and crude odds ratios were performed. Of the participants, 62.9% of those with smoking parents and 19.2% of those with non-smoking parents were exposed to SHS at their home. Parental smoking varied significantly among regions and was significantly associated with children's exposure to SHS at home. Children's exposure to SHS at home was high, especially if their parents smoke. Children living in Lisbon Region presented the highest SHS exposure rate. The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness. Our findings highlight the need to effectively prevent children's SHS exposure at their home and to develop tailored tobacco control measures by region.

Portuguese children's exposure to second-hand tobacco smoke in the family car / Exposición de los niños y niñas portugueses al humo ambiental de tabaco en el coche familiar

Objectives: To assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents. Methods: In 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N=3187, mean age 9.5±0.7, 51.1% boys). Prevalence rates and chi-square tests were computed. Results: Of the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Children's exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed. Conclusions: Children's exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard (AU)

Objetivos: Describir la prevalencia de la exposición de niños y niñas al humo ambiental del tabaco en el coche familiar; comparar la exposición de niños y niñas con padres fumadores y no fumadores. Métodos: En 2011, se aplicó un cuestionario auto-administrado a una muestra de niños y niñas portugueses de 4° curso (N=3187, edad promedio 9,5±0,7, 51,1% varones). Se calcularon ratios de prevalencia y pruebas de chi-cuadrado. Resultados: El 52,0% informaron tener al menos un padre/madre fumador. En la muestra total, la exposición fue del 28,9% (CI95%: 27,3-30,5). Esta exposición fue del 46,9% (CI95%:44,4-49,4) entre los niños y niñas con padres fumadores y del 8,6% (CI95%:7,1-10,1) entre los con padres no fumadores (p<0,001), por lo tanto, fue más de cinco veces mayor entre los niños y niñas con padres fumadores. Conclusiones: La exposición es alta, especialmente si uno o ambos padres fuman. Esto indica la necesidad de medidas de control efectivo del consumo de tabaco para prevenir este severo riesgo para la salud (AU)

Portuguese children's exposure to second-hand tobacco smoke in the family car.

OBJECTIVES: To assess the prevalence of children's exposure to second-hand smoke in the family car; to compare exposure among children with smoking and non-smoking parents. METHODS: In 2011, a self-administered questionnaire was applied to a 4th grade Portuguese children national sample (N=3187, mean age 9.5 ± 0.7, 51.1% boys). Prevalence rates and chi-square tests were computed. RESULTS: Of the participants, 52.0% reported having, at least, one smoking parent. Overall exposure in the car was 28.9% (95% CI 27.3-30.5). Children's exposure among those reporting smoking parents was 46.9% (95% CI 44.4-49.4); and 8.6% (95% CI 7.1-10.1) among those reporting non-smoking parents (p<.001). Therefore, children with smoking parents were 5.44 times more likely to be exposed. CONCLUSIONS: Children's exposure to second-hand smoke in the family car is frequent, especially if one or both parents smoke. This highlights the need for effective tobacco control measures to prevent this severe health hazard.

Social influence, intention to smoke, and adolescent smoking behaviour longitudinal relations.

OBJECTIVES: There is a debate on the determinants of smoking behaviour, their relative impact, and how impacts are exerted. This longitudinal study is on the relations among social influence, intention to smoke, and smoking behaviour, controlling for attitude and self-efficacy. DESIGN AND METHODS: A model combining parents and peers with subjective and descriptive norms, resulting in four factors, was used to assess social influence. Data were collected at the beginning of the 7th(-T1), 8th(-T2), and 9th(-T3) school years, concerning 578 students (M(age) = 13.04 at T1). Structural Equation Modelling was used to test longitudinal effects. RESULTS: Variances explained by the model were high: R(2) (intention-T2) = .65, R(2) (behaviour-T2) = .67, and R(2) (behaviour-T3) = .76. Longitudinal analyses confirmed the effects of social influence on intention and behaviour. These effects on behaviour were direct and indirect (peers' and parents' descriptive norms in both cases). Descriptive norms had a stronger effect on behaviour than subjective norms. Peers' effect on behaviour was stronger than parents', but peers' effect was exerted only through descriptive norms while parents' effect was exerted through both norms. The intention effect on behaviour was not as detached as expected and its role of full mediator between other variables' effects on behaviour was not confirmed, since descriptive norms and self-efficacy had also a mediation role. CONCLUSIONS: Results show direct and indirect effects of social influence on behaviour. Descriptive norms are an important variable to operationalize social influence. Peers and parents exert influence on adolescents' intention and behaviour through different processes. The impact of intention on behaviour is not as important as expected.

Avaliação longitudinal de programa de prevenção do tabagismo para adolescentes / Evaluación longitudinal del programa de prevención del tabaquismo para adolescentes / Longitudinal evaluation of a smoking prevention program for adolescents

OBJETIVO: Avaliar programa de prevenção do tabagismo para adolescentes. MÉTODOS: O programa foi realizado entre 1999 e 2002 em escolas do Distrito de Lisboa, Portugal e integrou atividades na escola, na família e na comunidade. Estudo quasi-experimental, longitudinal, baseado em ensaio de intervenção comunitária, com condição de controlo (CC) e de intervenção (CI) definidas aleatoriamente. Foram aplicados quatro questionários, no início do 7º(T1), 8º(T2) e 9º(T3) e no fim do 9º(T4) anos de escolaridade a 1.205 adolescentes, com idade média de 13 anos, dos quais 57 por cento eram meninas e 55 por cento pertenciam à condição de intervenção. A exposição às atividades de prevenção, os determinantes psicossociais do comportamento e o comportamento tabágico foram as variáveis consideradas na avaliação do programa. Utilizou-se análise de variância e regressão logística para testar as diferenças nas duas condições do estudo. RESULTADOS: A CI obteve melhores resultados nos determinantes psicossociais do tabagismo e no comportamento. Ao final do projeto, 41,8 por cento dos participantes da CI e 53,3 por cento da CC iniciaram o consumo de tabaco (OR = 0,62; IC95 por cento 0,49;0,80), e passaram a ser fumantes regulares 8,0 por cento e 12,4 por cento, respectivamente (OR = 0,59; IC95 por cento 0,40;0,87). CONCLUSÕES: O programa diminuiu a iniciação e o tabagismo regular. Os resultados surgiram no segundo ano e melhoraram no terceiro. A efetividade de programas de prevenção do tabagismo depende de implementação continuada ao longo da adolescência e de integração de medidas dirigidas directamente aos adolescentes e indirectamente, por via do seu contexto social (escola, família e comunidade).

OBJETIVO: Evaluar el programa de prevención del tabaquismo para adolescentes. MÉTODOS: El programa fue realizado entre 1999 y 2002 en escuelas del Distrito de Lisboa, Portugal. El programa integró actividades en la escuela, en la familia y en la comunidad. Estudio quasi-experimental, longitudinal, basado en ensayo de intervención comunitaria, con condición de control (CC) y de intervención (CI) definidas aleatoriamente. Se aplicaron cuatro cuestionarios, en el inicio del 7º(T1), 8º(T2) y 9º(T3) e al final del 9º(T4) años de escolaridad a 1.205 adolescentes, con edad promedio de 13 años, de los cuales 57% eran niñas y 55% pertenecían a la condición de intervención. La exposición a las actividades de prevención, los determinantes psicosociales del comportamiento y el comportamiento tabáquico fueron las variables consideradas en la evaluación del programa. Se utilizó análisis de varianza y regresión logística para evaluar las diferencias en las dos condiciones de estudio. RESULTADOS: La CI obtuvo mejores resultados en los determinantes psicosociales de tabaquismo y en el comportamiento. Al final del proyecto, 41,8% de los participantes de la CI y 53,3% de la CC iniciaron el consumo de tabaco (OR= 0,62; IC95% 0,49;0,80), y pasaron a ser fumadores regulares 8,0% y 12,4%, respectivamente (OR=0,59; IC95% 0,40;0,87). CONCLUSIONES: El programa disminuyó la iniciación y el tabaquismo regular. Los resultados surgieron en el segundo año y mejoraron en el tercer. La efectividad de programas de prevención del tabaquismo depende de implementación continuada a lo largo de la adolescencia y de integración de medidas dirigidas directamente a los adolescentes e indirectamente, por vía de su contexto social (escuela, familia y comunidad).

Avaliação longitudinal de programa de prevenção do tabagismo para adolescentes / Longitudinal evaluation of a smoking prevention program for adolescents

OBJETIVO: Avaliar programa de prevenção do tabagismo para adolescentes. MÉTODOS: O programa foi realizado entre 1999 e 2002 em escolas do Distrito de Lisboa, Portugal e integrou atividades na escola, na família e na comunidade. Estudo quasi-experimental, longitudinal, baseado em ensaio de intervenção comunitária, com condição de controlo (CC) e de intervenção (CI) definidas aleatoriamente. Foram aplicados quatro questionários, no início do 7º(T1), 8º(T2) e 9º(T3) e no fim do 9º(T4) anos de escolaridade a 1.205 adolescentes, com idade média de 13 anos, dos quais 57 por cento eram meninas e 55 por cento pertenciam à condição de intervenção. A exposição às atividades de prevenção, os determinantes psicossociais do comportamento e o comportamento tabágico foram as variáveis consideradas na avaliação do programa. Utilizou-se análise de variância e regressão logística para testar as diferenças nas duas condições do estudo. RESULTADOS: A CI obteve melhores resultados nos determinantes psicossociais do tabagismo e no comportamento. Ao final do projeto, 41,8 por cento dos participantes da CI e 53,3 por cento da CC iniciaram o consumo de tabaco (OR = 0,62; IC95 por cento 0,49;0,80), e passaram a ser fumantes regulares 8,0 por cento e 12,4 por cento, respectivamente (OR = 0,59; IC95 por cento 0,40;0,87). CONCLUSÕES: O programa diminuiu a iniciação e o tabagismo regular. Os resultados surgiram no segundo ano e melhoraram no terceiro. A efetividade de programas de prevenção do tabagismo depende de implementação continuada ao longo da adolescência e de integração de medidas dirigidas directamente aos adolescentes e indirectamente, por via do seu contexto social (escola, família e comunidade).(AU)

Longitudinal evaluation of a smoking prevention program for adolescents.

OBJECTIVE: To evaluate a smoking prevention program for adolescents. METHODS: The program was conducted between 1999 and 2002, in schools of the district of Lisbon, Portugal. The program integrated activities in the school, family and community. This was a longitudinal quasi-experimental study, based on Community Intervention Trial, with randomly defined control conditions (CC) and intervention conditions (IC). A total of four questionnaires were applied in the beginning of the 7th(T1), 8th(T2) and 9th(T3) and in the end of the 9th(T4) school grades, to 1,205 adolescents, aged 13 years on average, of which 57% were girls and 55% were included in the IC. Exposure to prevention activities, psychosocial determinants of smoking and behavior were the variables considered in the evaluation of the program. Variance analysis and logistic regression were used to test the differences between the two study conditions. RESULTS: IC obtained better results in the smoking psychosocial determinants and in behavior. At the end of the project, 41.8% of participants in the IC and 53.3% of those in the CC had tried tobacco (OR = 0.62; CI95% 0.49;0.80), while those who became regular smokers totaled 8.0% and 12.4%, respectively (OR = 0.59; CI95% 0.40;0.87). CONCLUSIONS: The program reduced the initiation of smoking and regular smoking. Results appeared in the second year and improved in the third. Effectiveness of smoking prevention programs depends on a continuous implementation throughout adolescence and on the integration of measures aimed to reach adolescents directly and indirectly through their social context (school, family and community).

The impact of social influence on adolescent intention to smoke: combining types and referents of influence.

OBJECTIVES: Theory and research suggest that the intention to smoke is the main determinant of smoking initiation and emphasizes the role of cognitive and social factors on the prediction of the intention to smoke. However, extended models such as the I-Change and results from published studies reveal inconsistencies regarding the impact of social influence on the intention to smoke. Possible explanations for this may be the definition and measurement of the constructs that have been used. DESIGN AND METHODS: The current study was designed with two main goals: (i) to test a measurement model for social influence, combining different types of social influence (subjective norms, perceived behaviour, and direct pressure) with various referents of influence (parents, siblings, peers, and teachers); (ii) to investigate the impact of social influence on adolescent intention to smoke, controlling for smoking behaviour. LISREL was used to test these models. The sample includes 3,064 Portuguese adolescents, with a mean age of 13.5 years, at the beginning of the seventh school grade. RESULTS: The hypothesized measurement model of social influence was supported by results and explained 29% of the variance of the intention to smoke. A more extended model, including attitude and self-efficacy, explained 55% of the variance of the intention to smoke. Perceived behaviour of peers, parental norms, and perceived behaviour of parents were the social influence factors with impact on adolescent intention to smoke. CONCLUSIONS: Results suggest that different referents exert their influence through distinct types of social influence and recommend further work on the definition and measurement of social influence.

Psychosocial factors related with smoking behaviour in Portuguese adolescents.

Few studies describe the factors associated with smoking behaviour in Portuguese adolescents. Hence, smoking prevention activities are not based on research findings. This study analyses the differences between smokers and nonsmokers and factors associated with smoking behaviour in a sample of Portuguese adolescents. A questionnaire was administrated to seventh grade students of 25 schools from five municipalities near Lisbon (n=3064). The majority of them were never smokers (71.3%), 21.9% smoked less than monthly, 2.1% monthly and 4.7% weekly or more frequently. Smokers were older, had lower school achievement, had more money available to spend, preferred less to be together with nonsmoking people and were more likely to be allowed to smoke at home, to use alcohol and to perform various risky behaviours. Nonsmokers were less convinced of the advantages and more convinced of the disadvantages of smoking, encountered more social norms against smoking, perceived less smoking in others, felt less pressure to smoke from peers, were more confident to refuse cigarettes and had a lower intention to smoke next year. Intention to smoke, self-efficacy expectations to refuse smoking, social influence and alcohol consumption were the most relevant variables associated with smoking behaviour. Consequently, Portuguese smoking prevention programmes should include activities aimed to help adolescents to deal with pressure to smoke from peers and to improve self-efficacy expectations to refuse cigarettes. Our findings also confirm the link between smoking and alcohol use suggesting that the prevention of these two behaviours should be complementary.