The factors that have the greatest influence on initiation of smoking by primary-school-aged children. A Literature Analysis This is a report on a literature analysis focusing on the factors that influence the initiation of smoking by children such as the family network, mental health, social environment, perceptions and beliefs, and lifestyle. An in-depth account of the methodology is provided along with the full results of each level analysis, and where appropriate visualizations have been provided. Claire Cockburn & The Library Network 5th September 2014 Copyright © NHS Greater Glasgow and Clyde, 2014

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Contents Table of Thematic Visualisations ........................................................................................ 3 Background ...................................................................................................................... 4 The Project Team ............................................................................................................. 4 Methodology ..................................................................................................................... 5

Tools Used .................................................................................................................... 5 Literature Search .............................................................................................................. 6

Master Search Strategy .................................................................................................. 6 Other Searches .............................................................................................................. 7 Refworks: Deduplication and Selection ............................................................................ 7

Inclusion and Exclusion Analysis ........................................................................................ 8 Results .......................................................................................................................... 8

Data Extraction ................................................................................................................. 8 Study Locations ............................................................................................................. 9 Study Characteristics...................................................................................................... 9 Types of Study ............................................................................................................ 11

Literature Analysis ........................................................................................................... 12 Framework .................................................................................................................. 12 Results ........................................................................................................................ 13 1. Mental Health ...................................................................................................... 13 2. The family network .............................................................................................. 15

Family: relationships and communication ....................................................................... 15

Family: modelling behaviour ........................................................................................ 16

Family: structure / circumstances .................................................................................. 17

3. Social environment ............................................................................................... 18 4. Perceptions & Beliefs ............................................................................................ 21 5. Individual circumstances and lifestyle .................................................................... 23

Individual circumstances .............................................................................................. 23

Lifestyle .................................................................................................................... 24

6. Other .................................................................................................................. 25 References ..................................................................................................................... 26

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Table of Thematic Visualisations Note that not all the visualisations listed are presented in this report as some of them are interactive and so best viewed online; the online versions also contain links to allow you to embed the visualisations into websites. The data sets for the visualisations are linked to too, so that the reader can create their own visualisations as well. Name Data Set Visualisation Thumbnail Smoking Themes 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/all-smoking-themes

Word Tree http://www-958.ibm.com/v/406241

Smoking Themes 2

As above Word Cloud http://www-958.ibm.com/v/406244

Smoking Themes 3

As above Tag Cloud http://www-958.ibm.com/v/406243

Smoking & Mental Health 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/smoking-and-mental-health

Word Tree http://www-958.ibm.com/v/406172

Smoking & Mental Health 2

As above Word Cloud http://www-958.ibm.com/v/406174

Smoking & Family 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/smoking-and-famility

Word Tree http://www-958.ibm.com/v/406237

Smoking & Family 2

As above Word Cloud http://www-958.ibm.com/v/406238

Smoking & Social 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/smoking-and-social-factors

Word Tree http://www-958.ibm.com/v/406228

Smoking & Social 2

As above Word Cloud http://www-958.ibm.com/v/406229

Smoking & Perceptions 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/smoking-and-perceptions

Word Tree http://www-958.ibm.com/v/406232

Smoking & Perceptions 2

As above Word Cloud http://www-958.ibm.com/v/406234

Smoking & Lifestyle 1

http://www-958.ibm.com/software/analytics/manyeyes/datasets/smoking-and-lifestyle

Word Tree http://www-958.ibm.com/v/406482

Smoking & Lifestyle 2

As above Word Cloud http://www-958.ibm.com/v/406483

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Background The prevalence of smoking amongst teenagers has serious implications for public health, particularly as we know a large proportion of young people who smoke continue to do so into adulthood. The Scottish Government has set out the aspiration for a tobacco-free generation by 2034. If this vision is to be achieved, we must create an environment where future generations of young people choose not to smoke. There is no single reason why a young person starts to smoke. Evidence suggests that there are three levels of influence;

• Individual (i.e. self -esteem, education, personality, gender, beliefs) • Personal environment (i.e. friends, family, school, resources, social activities) • Social/cultural environmental (i.e. social attitudes and norms, media, social

disadvantage, availability, price) We want to explore the factors that influence the initiation of smoking by children (pre-teenage years). We want to understand how children negotiate decisions about tobacco and other and other types of health-damaging behaviours. Our research questions are: What factors have the greatest influence on initiation of smoking by primary-school-aged children? Sub questions:

1. What evidence is there to demonstrate which individual, personal environment and social environment aspects shape children’s attitudes towards smoking behaviours?

2. What aspects have an influence (either positively or negatively) on the likelihood of smoking initiation by children?

3. What aspects influence the likelihood of children demonstrating risk-taking behaviour in relation to their health and well-being?

4. What evidence is there to support the correlation between early smoking and poverty, social exclusion, and other risk factors?

The Project Team This analysis was performed as a partnership between the Smokefree Project Office and the NHSGGC Library Network, the team were as follows: Client / Researcher: Claire Cockburn, Smokefree Project Officer Team Lead: Michelle Kirkwood, Knowledge Services Manager Team Member: Seona Hamilton, Subject Librarian Team Member: Tracey McKee, Subject Librarian Team Member: Chloe Stewart, Subject Librarian Team Member: Edith Rae, Assistant Librarian Team Member: Scott Adam, Assistant Librarian Team Member: Steven Watson, Assistant Librarian Team Member: Alison McAughtrie, Assistant Librarian Team Member: Jenny McGhie, Assistant Librarian

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Literature Searching

Selection of Articles

Import into Literature Analysis Tool

Inclusion and Exclusion Crtieria Analysis

Data Extraction

Thematic Analysis

Reports

Visualisation

Methodology

A literature analysis uses a selection of techniques and skills to create a knowledge base which reflects and summarises the main ideas and conclusions from the evidence. This is not intended to be a traditional systematic review of the literature e.g. Cochrane Systematic Review. There is no discussion of the knowledge base and we do not draw any recommendations from the evidence. There are 3 levels of analysis: Inclusion & Exclusion Criteria; Quality Appraisal, and Thematic Analysis. For this project Quality Appraisal was excluded as it was not required, a basic data extraction was also performed. Whilst every endeavour is taken to be transparent and truthful throughout the entire process bias will persist due to subjective interpretation of requirements; filtering evidence through an analysis team; and both the client and library lead applying their own knowledge and experience to the results. Any decisions made as a result of a literature analysis should consider this.

Tools Used • Subscription bibliographic and evidence based databases

as provided by The Knowledge Network www.knowledge.scot.nhs.uk

• Weekly catchups (excluding leave of Client/Team Lead) were conducted using Webex www.healthsector.webex.com

• References collated and managed in Refworks www.refworks.com

• All literature searches and document delivery requests were made using QUEST www.quest.scot.nhs.uk

• All analysis was performed using the NHS Scotland Literature Analysis Tool www.lat.scot.nhs.uk

• Word 2007 and Many Eyes http://www-958.ibm.com/software/analytics/manyeyes/ were used to create this report and visualisations.

Figure 1: Process

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Literature Search After the Client set the search questions the Team Members that are Subject Librarians led the work on co-ordinating the literature searches across the rest of the team members. A master search was created using MEDLINE, this search strategy was amended for each database used. Also searches were performed by professional literature searching staff - as this was a collaborative exercise any questions regarding strategy and changes to that strategy were collectively agreed upon and actioned. All search histories and notes of results were collated, a summary of which is provided below.

Master Search Strategy Medline (Search Performed in April 2014) -------------------------------------------------------------------------------- 1 Smoking/ 2 ((smoking or cigarette* or tobacco) adj3 (initiat* or start* or commenc* or begin* or use* or using or prevent*)).tw. 3 Child/ (1346847) 4 (primary school* or elementary school*).tw. 5 ((age or aged or year* old*) adj2 ("4" or four or "5" or five or "6" or six or "7" or seven or "8" or eight or "9" or nine or "10" or ten)).tw. 6 (pre-adolescen* or pre-teen*).tw. 7 Health Behavior/ 8 decision making/ or choice behavior/ or judgment/ 9 risk/ or risk assessment/ or risk factors/ 10 Risk-Taking/ 11 (risk* adj2 behavi*).tw. 12 risk* decision*.tw. 13 health compromising behavi*.tw. 14 risk reduction behavior/ 15 health damaging behavi*.tw. 16 1 or 2 17 3 or 4 or 5 or 6 18 7 or 8 19 9 and 18 20 10 or 11 or 12 or 13 or 14 or 15 or 19 21 16 and 17 22 limit 21 to (english language and yr="2009 -Current") 23 substance-related disorders/ or alcohol-related disorders/ or alcohol-induced disorders/ or alcoholic intoxication/ or alcoholism/ or amphetamine-related disorders/ or cocaine-related disorders/ or drug overdose/ or inhalant abuse/ or marijuana abuse/ or opioid-related disorders/ or heroin dependence/ or morphine dependence/ or phencyclidine abuse/ or substance abuse, intravenous/ or "tobacco use disorder"/ 24 designer drugs/ or street drugs/ or crack cocaine/ 25 drinking behavior/ or alcohol drinking/ or binge drinking/ or drug-seeking behavior/ 26 ((drug* or alcohol*) adj2 (addict* or depend* or misus* or abus* or problem*)).mp 27 23 or 24 or 25 or 26 28 17 and 20 and 27 29 limit 28 to (english language and yr="2009 - 2014")

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Other Searches All searches were limited to the last five years and English Language Only Table 1: Search Sources Specific Source

No of Results Found

No of Results Selected

ERIC 701 26 ASSIA 627 124 Social Care Online 355 20 Embase 2916 165 Medline and Medline in Process 2508 102 PsycInfo 1328 216 Cinahl 1644 176 Cochrane Library (CDSR, CENTRAL)

208

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Websites specified in search guidance and resource list and links from these, Google Scholar

500 20

Total 856

Refworks: Deduplication and Selection All selected references were imported into a shared refworks database and deduplicated. The researcher then selected the most appropriate articles for the topic leaving 310 references for analysis. Members of the project team tidied the final selection ensuring the full text links worked and any articles with no full text available were ordered from the British Library Document Delivery Service.

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Inclusion and Exclusion Analysis The development of the criteria was led by the researcher in collaboration with all team members; amendments were made to ensure clarity and consistency in their application. When performing the analysis the team members had the option of selecting ‘Maybe’ – all items in the Maybe list were then presented to the team at a weekly Webex catchup with the final decision on whether to include or exclude the reference made by the researcher. A note was made against all references providing a rationale. Table 2: Criteria Inclusion Criteria

0-12 Years If the majority of the participants in a study are within the age range 0-12 yrs include. If there are only a few mark as maybe to discuss with Claire.

Early Initiation of Risk Taking Behaviour

Not all articles are about smoking, if the article is about the early initiation of any other risk taking behaviour include it also, and in all other criteria where it says 'smoking' substitute 'risk taking behaviour' and apply the criteria. If in doubt choose maybe.

Early Initiation of Smoking

If the articles highlights any aspects which relate specifically to young/early initiation of smoking (under 12s) include.

Research Include any type of research qualitative or quantitative. Exclusion Criteria

Age 15 and above If the majority (over 50%) of the participants in the study are over 15 exclude.

Age over 12 If the study is EXCLUSIVELY with children over 12 years old exclude.

Cessation studies Exclude any reference which discusses stopping smoking or cessation work but not prevention work.

Culture & Lifestyle Exclude or flag as 'maybe' any articles which are about cultural or lifestyle factors which may not apply to Scotland.

Health issues Where references discuss issues which arise due to onset of smoking (ie health concerns/issues) as opposed to why you people start smoking.

Longitudinal Studies Exclude any article about changes to smoking rates over time which does not also include discussion on the reasons why change happened.

Prevalence Rates Exclude any article which provides statistics on rates of smoking but without any discussion on why.

Prevention Programmes Exclude any article purely about describing the programme without any indication of evaluation or impact.

Reviews and Editorials Exclude reviews, editorials or other type of opinions pieces.

Results 210 articles were excluded from the project during this analysis. The main rationale for exclusion was the age of the participants in the study. It was imperative that the studies included children and not teenagers. Other reasons for exclusion were that the articles were either news articles, or not based on primary research; the cultural differences between the study population and the Scottish population; one article was excluded as the full text of the article was not in the English Language. The remaining 95 articles went forward to the thematic analysis phase, though note that only references that had direct relevance to the thematic framework used for the analysis were included in the final literature analysis results.

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Data Extraction

Study Locations For the purpose of this visualisation the data from Guernsey has been included in the UK set and the data from Hong Kong in the China set. Note that not every reference provided the detail of location therefore only the references that did provide that information have been included. Although every attempt was made not to count the data from the same research more than once (where a single set of research data was reported in multiple articles) there is no guarantee that all data is unique. This visualisation was performed using Many Eyes, view the online version at http://www-958.ibm.com/v/396824

Visualisation 1: Location of Studies

Study Characteristics Only articles which provided the data required are provided in this table.

Table 3: Sample Characteristics

Reference No of Children Location Gender Age* 4877 8256 Australia 11-14 (m=12) 4912 6837 Australia 11-13 5000 318 Belgium M=10.4 4943 1025 Canada 11-15 (m= 12.9) 4780 1135 Canada 51% female / 49% male 10-11 4791 12894 Canada 51% female / 49% male 11-14 5018 2767 Canada 50% female / 50% male 10-15 (m=12.6) 4898 4073 China 44% female / 56% male 9-12 4895 910 Czech

Republic 6-11

4897, 4896 1082 Czech Republic

50% female / 50% male 10

5070 766 Czech Republic

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4982 2459 Germany 51% female / 49% male 7-17 (m=10) 4960 333 Germany 53% female / 47% male 6 4903 3444 Germany M=10.37 4781 377 Guernsey 10-11

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5048 2171 Hong Kong 7-9 4866 161 Italy 49% female/ 51% male 11-12 4891, 4889, 5006

1476 Netherlands 9-12 (m=10.11)

4952 3783 Netherlands 11-15 5038,4901 477 Netherlands 7-9 4790 3205 Netherlands 51% female / 49% male M=11.64 4938 206 Netherlands 44% female / 56% male 8-11 5039 433 Netherlands 48% female / 52% male 10-13 5014 778 Netherlands 51% female / 49% male 9-12 (m=10.7) 4832 3173 Netherlands 53% female / 47% male 10-13 5005 1289 Netherlands 8-12 (m=10.1) 4839 206 Netherlands M=5.14 4937 30 Netherlands M=11.37 4838 100 Netherlands 4-8 4962 515 New Zealand 50% female / 47% male 11-13 (m=11.5) 4959 1478 Poland M=10.1 4814 2686 Taiwan 10 4899 2350 Taiwan 8-12 4900 1585 Taiwan M=8.9 4795 35 UK 57% female / 47% male 8 4934 52 UK 58% female / 42 % male 11-18 4971 247 UK 9 4853 3903 UK 50% female / 50% male 10-15 4941 13763 UK 50% female / 50% male 11-15 4886 212 US 11-14 5054 137 US 8-11 4783 2322 US 10-11 4850 255 US 51% female / 49% male m = 10.9 4926 754 US 50% female / 50% male 5- 18 4924 679 US 51% female / 49% male 7-13 (m=9.4) 4986 8984 US 12-17 4818 4088 US 12-17 5046 8795 US 11-17 (45%

under 12) 5063 386 US 24% female / 76% male 3-5 5060 1118 US 52% female / 48% male M=11.89 4788 4691 US 50% female / 50% male 47.8%= 10 4826 1843 US 50% female / 50% male M=10.9 4828 79 US 54% female / 46 % male 9-12 4998 6094 US 50% female / 50% male 6-15 4930 201 US 55% female / 45% male 8-13 (m=10) 4931 387 US 8-13 (m=10) 4893 1733 US 44% female / 56% male 9-13 4876 1843 US 50% female / 50% male 10-11 4784 1168 US 50% female / 50% male 10-12 4861 271 US 7-12 4945 257 US 44% female / 56% male 9-12 (m=11) 4841 234 US 45% female / 55% male 9-13 (m=11) 5033 496 US 50% female / 50% male 8-11 5036 187 US 8-11 4846 7648 US 12-18 4873 247 US 61% female / 39% male 11-15(m=12.49) 5020 964 US 52% female / 48% male 11-13 (m=11.6) 5010 4524 US 51% female / 49% male 10-14

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4999 1036 US 50% female / 50% male 10-13 (m=11.7) 5062 290 US 55% female / 45% male 10 5065 383 US 47% female / 53% male M=11.47 4974 452 US 8-10 4837 6522 US 10-14 4904 588 US M=11.7 4957 503 US M =6.2 *For longitudinal studies the start age is given

Types of Study Note that only study types that could be identified from the articles have been included. Table 4: Study Type Study Type No References Longitudinal Study 32 4783,4926,4986,4818,4814,5063,4795,482

8,4780,4930,4893,4790,4896,4945,4841,5039,4999,4832,5062,5005,4941,5065,4837,4957, 4971, 5020, 4921, 4897, 4803,4974, 4894, 5010

Randomised Controlled Trial 9 4924,5038,4784,4960, 4938, 4993,4901, 4891, 4903

Questionnaire /Survey 31 4986,4818,4889,5046,4952,4877,4814,4788,4791,4893,4876,5000,4945,4841,5039,5014,5033,5036,4873,4853,4832,4962,4898,4900,4866,5070,4805, 5048, 5029, 4781, 4993

Observational Study 3 4839,4838, 4937 Interviews 8 4889,4828,4930,4931,4893,4999,5062,

4934 Cohort Study 3 5060, 5028,4912 Secondary Data Analysis (of a previous Survey)

4 5018,4899,4846, 4886

Interview and Survey 2 5006, 5047 Prospective Study 1 4894 Other/Mixed Methods 2 4851, 4904

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Literature Analysis

Framework The team (using the Literature Analysis Tool) analysed the content of the selected articles using the following framework, based upon the initial questions and further developed as the analysis progressed, and with the addition of some sub-themes:

• What aspects have an influence on the likelihood of smoking initiation by children? o Positive o Negative

• What aspects influence the likelihood of children demonstrating risk taking behaviour in relation to their health and well-being?

• What shapes children’s smoking behaviours? o Individual factors e.g. gender, age, religion o Personal environment e.g. family, friends, school o Social environment e.g. media, community, costs etc.

• What evidence is there to support the correlation between early smoking and poverty or social exclusion, and other risk factors?

Post this initial analysis the evidence base clearly showed that the true themes of what shapes children’s smoking behaviour were as follows:

• Mental Health • The Family Network • Social Environment • Perceptions & Beliefs • Individual circumstances and lifestyle

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Results

1. Mental Health The mental health of the child is critical in influencing whether or not the child initiates smoking. Stress, depression, personality traits and behaviours can all affect the mental health and wellbeing of the child which, in turn, can affect smoking initiation. Children with mental health issues or concerns are more likely to initiate smoking at a young age, whilst those with a higher sense of wellbeing or emotional intelligence are less likely to smoke.

Visualisation 2: Smoking and Mental Health

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION Ref ID

Stress resulting from parental or family problems, romantic break-ups, personal problems, chaotic family life, and other sources. 4943, 4893

High score on personality test indicating hopelessness or sensation seeking 4952, 4876, 4945

Children whose mothers display depressive symptoms are more likely to start drinking alcohol and engage in episodes of heavy drinking at an early age

4926

Children who display signs of anxiousness, depression or of being withdrawn are more likely to engage in risky behaviours. 4998

Boys with higher levels of generalised anxiety are at higher risk of trying marijuana at an earlier age and rapid development to problem use after first use

4957

Display of externalising behaviours which includes a lack of emotional control, interpersonal aggressiveness and lack of adherence to societal norms

4803, 5038, 5062

Personality traits of urgency, lack of planning and lack of perseverance were more likely to be shown in children who had experimented with smoking or some other form of risky behaviour

4826, 4876,4945

Childhood problem behaviours such as externalizing (e.g. aggressiveness and lack of control) and internalizing (e.g. shy, anxious) have been linked to risky health behaviour in later adolescence

4960

Low levels of confidence and self-esteem associated with smoking 4982,4795,4780

Parental alcohol problems are associated with negative "self-schemas", which can increase the likelihood of youth alcohol abuse. 4828

GBG classroom intervention strategy promoting pro-social behaviour and 4901

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aiming to reduce hyperactive, impulsive and disruptive behaviour through clear setting of rules and systematic rewards.

Having a cognitive susceptibility to smoking. 5060, 4930

Concluded that "susceptibility" was the strongest predictor of smoking experimentation - susceptibility defined as the lack of a firm commitment not to smoke in the future

4791,5020

Maltreated children are more likely to exhibit risk-taking behaviour because of impairments in their decision-making abilities. 5054

Individual distal variables (such as low self esteem) increased rate of behavioural risk factors 4780

Social distal variables (parental/peer smoking and drinking) increased rate of behavioural risk factors 4780

Non-genetic risk factors (perceived positive outcome expectations, number of smokers in the household, risk taking tendencies) have a greater influence than genetic factors (71% vs 59%).

5060

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Targeting depressive feelings, focusing on self-efficacy and tailoring interventions to meet the needs of children with asthma who are also feeling depressed may help with smoking prevention.

5005

Good self control reduces impact of peer influence on smoking initiation. 5062

School based life skills programme looking at issues such as coping with emotions, stress, and peer pressure. Increases refusal skills, decreases pro-smoking influences.

4903

High levels of emotional intelligence reduces the intention to smoke 4850

Subjective wellbeing - being happy, being able to communicate well with parents and friends. 4853

Children with positive sociostructural influences - engagement with community, enjoy school - are at lower risk of taking up smoking 4893,4846

Promoting mental health and positive social behaviours in schools using MMH intervention reduces aggressive behaviour and likelihood of substance abuse

4993

“Undertaking smoking prevention among children at the age of 10 might be useful because results suggest the first mechanism (association of asthma with self-efficacy through depressive feelings) already exists in the younger sample” p. 509

5005

An interactive training model can be effective, focusing on social influences, teaching of refusal skills, recognising and resisting peer pressure, identifying and avoiding drug taking environments, dealing with stress, making healthy life choices

5065

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2. The family network The family network of the child is important in a number of ways; it provides a basis for the child to model their behaviour, it forms their central early relationships and it dictates their personal circumstances as they are developing.

Visualisation 3: Smoking and Family

Family: relationships and communication Ref ID

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION

Frequently talking about smoking with parents but not perceiving this as positive 4889

Weak parental anti-smoking messages / Children who were unclear about parent’s attitudes to smoking or who thought parent’s wouldn’t mind were more likely to have experimented with smoking

4962,4898

Low levels of parental support associated with smoking 4982,4893,4962

Home-based smoking prevention programme shown to have no impact on smoking initiation 4891

Family conflict increased risk of early alcohol consumption 4912

Parents esp. mothers unaware of children's activities 5046,4877

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Close parental supervision/perception of maternal awareness of child behaviour 4818, 5046 4866

Increases in sustained positive parenting, such as parental involvement/knowledge, monitoring, and expectation 4962,4866

Respectful parent-child relationships reduce likelihood of risk-taking behaviours including substance misuse 5029

Clear, strong anti-smoking message from parent(s) / Children who had parents who considered smoking wrong and parents who they could discuss problems with are less likely to start smoking

4962, 4851

Quality of parent-child communication is more important than the content of communication about risk-taking behaviours in reducing them among children

4866,5029

Children take notice of parental views on smoking even as they age (unlike 4962, 4851, 4904

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other risk taking behaviours)

Greater parental involvement in anti-smoking programmes and/or practices meant children could recall these and were at lower risk of smoking.

4962, 4904

Emotional closeness to the parent of the opposite gender predicted alcohol use 4912

Greater occurrence of alcoholism in the family can predict future alcoholism but this can be moderated by positive parenting practices and reducing anti-social or aggressive behaviours in children before alcohol problems arise

4974

Non-alcohol consumption by mothers, siblings and peers, parental disapproval and emotional closeness to mothers reduced risk of early alcohol use

4912

Girls from immigrant cultures where female interaction with others is traditionally curtailed may be at lower risk of smoking 4921

Family: modelling behaviour

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION

Having close friends and/or parents who smoke around them

4818,4889,5046,4795,4895,5014,4999,4898,4900, 4889, 5038,5014, 4790, 5062, 4895, 5047

Smoking among children was higher when smoking was allowed in their home. 5000

Living with a smoker was associated with experimentation for those who had never smoked at baseline 5020

School-based smoking prevention programme found to be less effective on children from smoking families 4895

Parental smoking increases both positive attitudes to smoking and actual smoking initiation before age of 11 4889,5014

For children who had tried smoking the most significant source of cigarettes was their own home. 4897

Smoking behaviour of the family influences whether the child will pick smoking or non-smoking friends 4897

Observed 'play smoking' indicated that children of parents who smoked were more likely to pretend-smoke. They also were observed instigating play smoking in their peers.

4839, 4838

Link between the smoking behaviour of children and household smokers who smoke while watching television 5000

Children of smokers show higher levels of attention to smoking cues in movies. This suggests that their parents activity initiates automatic 4937

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cognitive processes that stimulate interest in smoking long before other socio-environmental factors arise

Alcohol: anticipated that future drinking behaviours would be similar to parents'; receptive to parents' advice; children from deprived areas more likely to be exposed to problematic drinking at home and on the street thus potentially 'normalising' it

4851

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Mothers in particular have a strong influence on prevention or delay of smoking initiation by instituting a household ban, or discussing the dangers - even if they themselves smoke.

5033

Parents play an important role in creating a smoke free environment that will shape pre-adolescents perceptions of later smoking. 5033

Family: structure / circumstances

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION

Family problem drug or alcohol use 4886 5063

Large family size is linked to engaging in risky behaviours. 4893

Ethnic variants may be explained by peer/family factors identified. 5046

In single parent households it seems that regardless of gender, smoking behaviour is impacted upon by the parent the child is living with 4941

In two parent households it seems that there is an “intergenerational transmission of smoking behaviour” p. 734, particularly between parents and children of the same gender

4941

Parents smoking in their late twenties 4803

Prenatal smoking did show a trend toward significance in relation to growth in tobacco use 5038

Early alcohol use correlated with poor parental supervision/rules, poor paternal relationship, and being from a one-parent family 4877,5018,4999

Found that parental smoking had no effect on early-onset tobacco use 4901

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Exposure to parents' smoking gives children an understanding of its addictive and dangerous properties 4851

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3. Social environment The social environment plays a major role in childhood smoking initiation. Children who see smoking around them regularly and/or accept it as normal behaviour are at an increased risk of initiating smoking themselves. This ‘normalisation’ can come from parents, peers, school and other places. The social environment also impacts on the child’s feeling of wellbeing, attitudes, likelihood of experimentation and refusal skills.

Visualisation 4: Smoking and Social

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION Ref ID

Adults and authority figures turning a blind eye /providing cigarettes and/or community acceptance of smoking from an early age 4934, 4962

The acceptance of smoking as an expression of working-class values in industrial communities that are becoming increasingly marginalised can mean that smoking becomes a natural part of the progression to adulthood for some children.

4934

Children who said that their school had not given out anti smoking material during the previous semester were more likely to have experimented with smoking

4898

Children from immigrant or minority cultures move towards the smoking behaviour of the dominant culture 4873, 4921

Children who overestimated the level of peer smoking were more likely to later initiate smoking than those who correctly identified the level of peer smoking (14.3% Vs 2.3%)

5048

Having at least one smoking and/or substance-abusing friend significantly increases risk of smoking experimentation

5046, 5020, 4952, 4921

Parental or peer smoking or drinking, or other social distal variables, increased the rate of behavioural risk factors such as smoking 4780

'Never smokers' who perceived more pro-tobacco pressure were more likely to have initiated smoking at follow up. 4790

Unsupervised time with peers does not have a DIRECT influence on smoking, however may have an INDIRECT influence - esp. with delinquent peers children are more likely to experiment and engage in talks and discussions about cigarette smoking.

4873

Over one third of children had been offered cigarettes by their friends (boys more often than girls). 4897

Suggestion that delinquent youths may be more likely to have peer groups 4957

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who smoke tobacco and marijuana and drink alcohol and therefore be more likely to try it themselves

Children from low income families may be exposed to more second-hand smoke, but evidence does not suggest they find it any less unpleasant. 4930

Study found that children in receipt of free school meals were more likely to smoke. 4853

Negative attitudes towards smoking and an understanding of its dangers the same in affluent and deprived communities; seen as a greater risk than alcohol

4851

Lower parental education levels correlate with a higher exposure to passive smoking for their children 5070

Individual ultimate variables (e.g. age, sex) and social ultimate variables (e.g. family socioeconomic status) only contributed slightly to rate of behavioural risk factors

4780

Having friends who display disruptive behaviour increases the risk of smoking experimentation. 5039

Hearing or seeing adult smokers (including teachers) on school property 4897 4898 4934

Poor academic performance and/or behaviour at school increases likelihood of risk taking behaviours. 4893, 4999

Feeling unfairly treated at school associated with smoking 4982, 4791, 4893

Bullying. Forced to smoke by peers. 4934

Link between smoking initiation and disruptive behaviour problems. 5038 5039

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Stronger feelings of being connected to school protects against smoking susceptibility. 4791, 4893

School-based behaviour management strategies can reduce the risk of smoking initiation and other risky behaviours. 5039

Pupils in schools that promote anti-smoking are less likely to ever smoke 4899, 4832

Anti-smoking intervention programme in primary school can affect future intention to smoke in secondary school. 4832

Specific anti-smoking intervention in school had greater impact on girls' future intentions to smoke. 4832

School- based smoking prevention programme reduces the intentions and willingness of participants to smoke in the future 4783, 4832, 5065

School- based smoking prevention did not have significant impact on the initiation of smoking behaviour 4783

Children taking part in the Good Behavior Game intervention had a lower probability of onset of tobacco use from age 10-13. 5038, 5039

Click City Tobacco intervention program run in schools significantly decreased student intention to smoke and chew tobacco in the future and also significantly decreased student willingness to smoke if they were given the opportunity to do so. Article notes effect sizes were small. Intervention was most effective for students that were most 'at risk' e.g., high sensation seeking, previous experimentation, family member who smoked.

4784

20

PALS prevention program lowered intention to use tobacco, immediately after program and upon follow up. 5065

PALS or other Schools based Intervention programs may be effective in delaying age of onset of ATOD behaviour but may not be effective in achieving abstinence

5065

Michigan Model for Health (MMH) school intervention curriculum promoting positive health and lifestyle behaviours through lessons on health topics - pupils who participated self-reported that they were less likely to initiate smoking.

4993

Regular exposure to antismoking information and education on refusal skills in school does not predict the likelihood of experimentation with smoking

4898

Behaviour management strategy programmes in school can decrease participation in risky behaviours. 5039

Participation in a life skills programme that is school based can lead to a reduction in childhood problem behaviour which may help reduce risk taking behaviour in adolescence

4960

In households with two parents where the mother is educated to higher level children are significantly less likely to experiment with smoking and are more likely to report that they do not want to smoke in the future

5070

21

4. Perceptions & Beliefs Another important factor in shaping children’s smoking behaviour is their personal perceptions and beliefs about tobacco, and how susceptible they are to the influences around them.

Visualisation 5: Smoking and Perceptions

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION Ref ID

Exposure to smoking in films / Exposure to cigarette advertising increases youths willingness to experiment with smoking

4861, 4999, 4962 4938, 5010

Repeated exposure to smoking in films prompts smoking onset 4938, 5010

Influence of smoking in films increases with age, children aged between 8-10 more resistant than adolescents to smoking cues in films 4938

Smoking in films that are aimed at a younger audience such as cartoons or family films might have less of an effect than smoking which is depicted in films for adolescents or adults.

4938

Access to R-rated films associated with sensation-seeking behaviours and early substance misuse 4837

Watching a short segment from a family film that shows smoking had little impact on beliefs or associations towards smoking 4938

Exposure to cigarette advertising has normative influence and leads children to overestimate smoking prevalence / Positive appraisal of tobacco advertising - e.g. smoking is perceived as cool, stylish etc.

4999, 4962, 4805

Cigarette advertising which is tailored to underage females. 4999

Tobacco marketing affects smoking progression after initiation 5010, 4999

Tobacco marketing aimed at underage groups affects smoking initiation. 4999

Association between susceptibility to tobacco advertising and the likelihood of later uptake of smoking 4962, 5062

Tobacco marketing susceptibility is associated with uptake of smoking 4959, 5062

Limited opportunities of exposure to antismoking campaign messages through magazines, TV, radio etc 4900

Exposure to environmental smoke does not in itself create susceptibility; but increased exposure can lead to greater favourable attitudes to smoking.

5014

22

Perceiving substance use as normal (personal pro-drug norms) 4921

Perception that smoking combats stress and improves mood. Generally a result of observing situations that lead family members to have a cigarette. 4896 5014

Favourable attitude and perception of smoking, developed particularly from observing parental smoking, makes children more susceptible to smoking themselves

5014, 4898

Children perceived that adults smoked due to boredom and to relieve stress and suggested that children might do the same 4971

Belief that smoking enhances attractiveness of an individual / that boys and girls who smoke have more friends 4896, 4898

Low perceived risk of the effect of alcohol on an individual (especially compared to risk for others) can predict alcohol abuse. 4841

Exposure to substance use offers can affect own substance use 4921

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Media literacy education focusing on deconstructing tobacco advertisements led to participants who had smoked in the past having decreased intentions to smoke in the future and participants who had experimented with alcohol in the past to have decreased intentions to drink alcohol in the future

4924

Teaching children analytical skills in regards to media portrayals of smoking could help reducing likelihood of starting smoking 4904

Smoking advertising ban reduces children's perception of smoking as "normal" / Legislation restricting tobacco marketing to adolescents reduces likelihood of smoking

4805, 4999

Perceiving second-hand smoke exposure as unpleasant protects against smoking susceptibility. 4930, 4931

Negative attitudes towards smoking and an understanding of its dangers the same in affluent and deprived communities; seen as a greater risk than alcohol

4851

23

5. Individual circumstances and lifestyle There are a number of individual and lifestyle circumstances which might influence the likelihood of smoking initiation. These include gender, age, income, health and education.

Visualisation 6: Smoking and Lifestyle

Individual circumstances Ref ID

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION

Being male 4814, 5038, 4795

Boys with generalised and social anxiety at greater risk of early first use of tobacco 4957

For girls there was an increase in tobacco use probability with age. 5038

Perceiving themselves as having low susceptibility to smoking-related disease 5036

Children with asthma found to be 2.45 times more likely to have tried smoking 5006

“For children with asthma, there seems to be an indirect pathway from depressive feelings to smoking via lower self efficacy" p. 509 5005

Lack of awareness that smoking is damaging to health and lack of concern about teenage smoking predicted a higher risk of experimentation with smoking

4898

Older age (13-14), family problem drug or alcohol use 4886,5018, 5046,4930,4853, 4790

Early sleep problems increased the probability of onset of drinking alcohol from ages 8-14 in boys 5063

Sleep problems predict onset of cigarette use in boys from ages 7-11. This did not apply to girls. 5063

Personal characteristics brought on by pubertal changes, such as positive and negative urgencies and sensation-seeking. 4876,4945

Genetic factors can have in role in cigarette experimentation in cognitively susceptible youth. 5060

Genes associated with ADHD linked to smoking behaviours 5028, 4901

24

Girls were more likely to perceive that some children may take up smoking as a coping strategy 4971

Neglect and/or maltreatment increases likelihood of substance abuse. 5018

Girls who did not smoke at baseline were more like to have started smoking at follow up if they have at least one parent of non-Dutch origin. 4790

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Higher sensitivity to second-hand smoke exposure predicts lower risk of smoking initiation. 4930,4931

Main reason that children decided not to smoke surrounded a desire to stay healthy and worries about disease. 4896

Risk of experimentation with smoking significantly lower among girls than boys 4898

Children with cancer are more likely to be receptive to anti-smoking prevention messages delivered later in the process of diagnosis and treatment - may be due to hesitancy amongst parents and health care providers to give these messages at diagnosis and initiation of treatment

5033

Race not considered an influence. Results similar to similar studies carried out with different ethnic groups 5020

Individual ultimate variables (e.g. age, sex) and social ultimate variables (e.g. family socioeconomic status) only contributed slightly to rate of behavioural risk factors

4780

Lifestyle

FACTORS WHICH INCREASE THE LIKELIHOOD OF SMOKING INITIATION

High levels of regular pocket money / having more spending money increases susceptibility to smoking. 4791, 4896

Widespread availability of cigarettes from illegal outlets. 4934

Children who watch TV and play video games for longer than the daily recommended limits are more likely to engage in solvent abuse and alcohol consumption at an early age.

4788

Having at least one school detention was significantly associated with experimentation amongst those who had never smoked at baseline 5020

Low income family background increases the likelihood of smoking initiation. 4853

Children from low income families may be exposed to more second-hand smoke, but evidence does not suggest they find it any less unpleasant. 4930

The acceptance of smoking as an expression of working-class values in industrial communities that are becoming increasingly marginalised can mean that smoking becomes a natural part of the progression to adulthood for some children.

4934

Study found that children in receipt of free school meals were more likely to smoke. 4853

Lower parental education levels correlate with a higher exposure to passive 5070

25

smoking for their children

Children in suburban and rural areas had a 50% higher risk of experimentation with smoking than urban children 4898

From a rural area, a one parent family, having low parental supervision, depression, low attachment to school correlated with earlier smoking initiation

4814

FACTORS WHICH DECREASE THE LIKELIHOOD OF SMOKING INITIATION

Restricted access to R-rated films for under-17s reduces the risk of early initiation of smoking 4837

Good academic performance at school predicts lower susceptibility to smoking. 4930,4791

Higher tobacco prices and taxes may delay smoking initiation especially among black or female students 4986

In households with two parents where the mother is educated to higher level children are significantly less likely to experiment with smoking and are more likely to report that they do not want to smoke in the future

5070

Persistence of conduct disorders (measured at 7 and 11 yrs) does not predict early smoking initiation 4894

6. Other As well as all the factors mentioned above, the literature analysis brought up a small number of miscellaneous issues which have an impact of smoking initiation. Interventions such as tobacco free schools, homes and public places, and teaching young people to resist negative influences from families, peers, and communities.

4832,4898,4781

The ATOD prevention program PALS seems to delay the onset of experimentation with alcohol and tobacco for most pupils for up to 2 years after participating in program

5065

Children who initiate smoking before 12 are also more likely to initiate early alcohol and marijuana use and unprotected sex 4846, 4851

Children who thought it was polite to offer cigarettes to guests were at greater risk of trying smoking 4898

Engaging in health promoting behaviour (e.g. teeth brushing) can protect against likelihood of risk taking behaviours. 4893

26

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4781 Amey,Vidya Health Education 110 (6): 445. 2010

Evolution of the perception of smoking by children in Guernsey

4783 Andrews,J. A.Hampson,S. H.Christiansen,S. M.

Nicotine & Tobacco Research 16(1), 2014

Long-term efficacy of click city(r): tobacco: a school-based tobacco prevention program.

4784

Andrews,Judy A.Hampson,Sarah E.Gunn,Barbara., Severson,Herbert H.

Prevention Science 12(1): 89-102, 2011

Short-term efficacy of Click City®: Tobacco: Changing etiological mechanisms related to the onset of tobacco use

4788 Armstrong,K. E.Jones,J.

Public Health Reports 125 (3): 440 - 433, 2010

Television and video game viewing and its association with substance use by Kentucky elementary school students, 2006.

4790 Ausems,M.van Breukelen,G.

Health Education Research 24 (5):818 -828, 2009

Smoking among Dutch elementary schoolchildren: gender-specific predictors.

4791 Azagba,S. Nicotine & Tobacco Research 15(8): 1458, 2013

School connectedness and susceptibility to smoking among adolescents in Canada.

4795 Barlow,Alexandra Early Child Development and Care 179 (4):529 -537, 2009

Relationships between self-esteem and smoking experimentation in childhood

4803 Brook,Judith S.Balka,Elinor B.

The Journal of Genetic Psychology: Research and Theory on Human Development 173 (2): 175-197, 2012

Pathways to children's externalizing behavior: A three-generation study

4805 Burton,D. Johnson,C.A. Vartiainen,E.

Journal of Health Communication 15(6): 656-664, 2010

Perceptions of smoking prevalence by youth in countries with and without a tobacco advertising ban

4826 Combs,J. L. Caudill,L. Smith,G. T.

Addictive Behaviours 37 (3): 331- 334, 2012

The acquired preparedness risk model applied to smoking in 5th grade children.

4828 Corte,Colleen Journal of Child and Adolescent Substance Abuse19(5) :406-423 , 2010

Self-Cognitions, Risk Factors for Alcohol Problems, and Drinking in Preadolescent Urban Youths

4830 Cremers,H. P. Mercken,L.de Vries,H.

Explaining socio-economic differences in intention to smoke among primary school children.

BMC Public Health 14: 191, 2014

4832 Crone,M. R.Dijkstra,N. S.Paulussen,T. G.

Does a smoking prevention program in elementary schools prepare children for secondary school?

Preventative Medicine 52(1): 53-59, 2011

4837

de Leeuw, Rebecca N. H. Stoolmiller,Mike Engels,Rutger C. M. E.

Association of smoking onset with R-rated movie restrictions and adolescent sensation seeking

Pediatrics 127(1):e96-e105, 2011

4838 de Leeuw,R. N.Scholte,R. H.

Parental smoking and pretend smoking in young children.

Tobacco Control 19(3):201-205, 2010

4839 de Leeuw,R. N.de Wit,C.Engels,R. C.

'One cigarette for you and one for me': children of smoking and non-smoking parents during pretend play.

Tobacco Control 20(5):344-348, 2011

27

4841 De Los Reyes,A. Wang,F. Lejuez,C. W.

Discrepancy between how children perceive their own alcohol risk and how they perceive alcohol risk for other children longitudinally predicts alcohol use

Addictive Behaviours 35(12):1061-1066, 2010

4846 DiNapoli,P. P. Early initiation of tobacco use in adolescent girls: key sociostructural influences.

Applied Nursing Research 22(2):126-132, 2009

4850 Duncan,Lindsay R. Latimer-Cheung,Amy Brackett,Marc A.

Mapping the protective pathway of emotional intelligence in youth: From social cognition to smoking intentions

Personality and Individual Differences 54(4):542-544, 2013.

4851 Eadie,D. Pre-teens learning about alcohol: drinking and family contexts

Joseph Rowntree Foundation, October 2010.

4853 Farmer,Siobhan

The relationship between subjective wellbeing, low income and substance use among schoolchildren in the north west of England: a cross-sectional study

Journal of Public Health 34(4):512-522, 2012

4861 Freeman,D. Wallendorf,M.

Youths' understandings of cigarette advertisements.

Addictive Behaviours 34(1):36-42, 2009

4866 Giannotta,Fabrizia Ciairano,Silvia

A two-year follow-up investigation of parenting and peer influences on tobacco use onset among Italian early adolescents

European Journal of Developmental Psychology 8(5):573-586, 2011

4876 Gunn,R. L.

Risk Factors for Elementary School Drinking: Pubertal Status, Personality, and Alcohol Expectancies Concurrently Predict Fifth Grade Alcohol Consumption.

Psychology of Addictive Behaviours 24(4): 617-627, 2010

4891 Hiemstra,M. Otten,R. Jackson,C.

Long-term effects of a home-based smoking prevention program on smoking initiation: a cluster randomized controlled trial.

Preventive Medicine 60:65-70, 2014

4893 Horner,Sharon D. Brown,Adama

Risk-taking behaviors engaged in by early adolescents while on school property

Issues in Comprehensive Pediatric Nursing 35(2):90-110, 2012

4894 Hruba,D. Okrajek,P.

Persistence of conduct disorders and their relation to early initiation of smoking and alcohol drinking in a prospective ELSPAC Study.

Central European Journal of Medicine 7(5):628-634, 2012

4895 Hruba,D. What limits the effectiveness of school-based anti-smoking programmes?

Central European Journal of Public Health 20(1):18-23

4896 Hruba,D. Why to smoke? Why not to smoke? Major reasons for children's decisions on whether or not to smoke.

Central European Journal of Public Health 18(4):202-8, 2010

4897 Hruba,D. Matejova,H.

Similarities and differences between smoking and non-smoking ten-year-old children in primary schools.

Central European Journal of Public Health 18(1):19-24, 2010

4899 Huang,H. L. Hsu,C. C.Chen,T. Shi,H. Y. Lee,C. H.

A multilevel-based study of school policy for tobacco control in relation to cigarette smoking among children in elementary schools: gender differences.

Health Education Research 25(3):451-463, 2010

28

4900 Huang,H. L.Chen,F. L.Rice,J.Hsu,C. C.

A study of smoking disparity and factors associated with children smoking behavior in the mountain and city schools in Taiwan.

Journal of School Health 79(2):67-73, 2009.

4901 Huizink,A. C. Crijnen,A. A. M.

Attention deficit hyperactivity disorder symptoms mediate early-onset smoking.

European Addiction Research 15(1);1-9, 2009

4903 Isensee,B. Maruska,K.

Effects of a school-based prevention programme on smoking in early adolescence: A 6-month follow-up of the 'Eigenstandig werden' cluster randomised trial.

BMJ Open 4:e004422, 2014

4904 Jackson,C. Anti-smoking parenting practices: recall by and effect on children's risk of smoking after 3 years.

International Journal of Public Health 56(3):263-270, 2011

4912 Kelly,A. B. Family Relationship Quality and Early Alcohol Use: Evidence for Gender-Specific Risk Processes

Journal of Studies on Alcohol and Drugs 72(3): 399-407, 2011

4921 Kulis,Stephen S., Kopak,Albert M., Crossman,Ashley

Ethnic identity and substance use among Mexican-heritage preadolescents: Moderator effects of gender and time in the United States

Journal of Early Adolescence 32(2):165-199, 2012

4924 Kupersmidt,J. B. Austin,E. W.

Media literacy education for elementary school substance use prevention: study of media detective.

Pediatrics 126(3):525-531, 2010

4926 Lamis,Dorian A. Lansford,Jennifer E.

Maternal Depressive Symptoms as a Predictor of Alcohol Use Onset and Heavy Episodic Drinking in Youths

Journal of Consulting and Clinical Psychology 80(5):887-896, 2012

4930

Lessov-Schlaggar, Christina, Liles, Sandy Hughes,Suzanne C. Jones,Jennifer A. Hovell,Melbourne F.

Sensitivity to secondhand smoke exposure predicts future smoking susceptibility

Pediatrics 128(2):254-262, 2011

4931 Lessov-Schlaggar,C. N. Liles,S .Ji,M. Swan,G. E.

Sensitivity to secondhand smoke exposure predicts smoking susceptibility in 8-13-year-old never smokers.

Journal of Adolescent Health 48(3):234-40, 2011

4934 Lewis,Sue Young smokers' narratives: public health, disadvantage and structural violence

Sociology of Health & Illness 35(5):746-760, 2013

4937 Lochbuehler,K. Voogd,H.

Parental smoking and children's attention to smoking cues.

Journal of Psychopharmacology 26(7):1010-1016, 2012

4943

Low,Nancy C. P. O’Loughlin,Erin Contreras,Gisele O’Loughlin,Jennifer

Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents

BMC Psychiatry 12:116-116, 2012

4945 MacPherson,Laura Reynolds,Elizabeth K. Lejuez,C. W.

Changes in sensation seeking and risk-taking propensity predict increases in alcohol use among early adolescents

Alcoholism: clinical and experimental research 34(8):1400-8, 2010

29

4957 Marmorstein,N. R. Loeber,R.

Anxiety as a predictor of age at first use of substances and progression to substance use problems among boys.

Journal of Abnormal Child Psychology 38(2):211-224, 2010

4959 Maruska,K. Florek,E. Tobacco marketing and susceptibility to smoking: cross-sectional survey of Polish children.

Przeglad Lekarski 69(10):721- 725, 2012

4962 McCool,Judith Robinson,Elizabeth

Do parents have any influence over how young people appraise tobacco images in the media?

Journal of Adolescent Health 48(2):170-175, 2011

4971 Milton,Beth S. Porcellato,Lorna A.

"My Mum and Dad Said It Calms You down": Children's Perceptions of Smoking as a Coping Strategy

Children & Society 26(2):89-99, 2012

4974 Molina,Brooke S. G. Belendiuk,Katherine A.

Familial loading for alcoholism and offspring behavior: Mediating and moderating influences

Alcoholism: Clinical and Experimental Research 34(11):1972-1984, 2010

4982 Muenster,Eva Letzel,Stephan Weirich,Horst H.

Low social support and further risk factors for nicotine abuse in childhood and adolescence in Germany

Social Work in Health Care 50(3):230-41, 2011

4993 O'neill,J. M. Jones,J. A.

Promoting mental health and preventing substance abuse and violence in elementary students: a randomized control study of the Michigan Model for Health.

Journal of School Health 81(6):320-30, 2011

4998 Perle,Jonathan G. Odland,Anthony P. Cannon,Megan A.

The association between internalizing symptomology and risky behaviors

Journal of Child & Adolescent Substance Abuse 22(1):1-24, 2013

4999 Pierce,J. P. James,L. E. Kealey,S. Healton,C. G.

Camel No. 9 cigarette-marketing campaign targeted young teenage girls. Pediatrics 125(4): 619, 2010

5000 Rasoloharimahefa-Rasamoela,M. Jacob,L., Lagasse,R.

Smoking among children aged 10-11 years in Brussels. Public Health 127(9):872-874, 2013

5006 Ringlever,L. Van Schayck,O. C.

Early smoking in school-aged children with and without a diagnosis of asthma.

European Journal of Public Health 22(3):394-398, 2012

5010 Sargent,J. D. Heatherton,T. F.

Comparing the effects of entertainment media and tobacco marketing on youth smoking

Tobacco Control 18(1): 47-53, 2009

5014 Schuck,Kathrin Engels,Rutger C. M. E.

The role of environmental smoking in smoking-related cognitions and susceptibility to smoking in never-smoking 9–12year-old children

Addictive Behaviors 37(12):1400-5, 2012

5018 Singh,Veeran-Anne S., Tonmyr,Lil

Determinants of Substance Abuse in a Population of Children and Adolescents Involved with the Child Welfare System

International Journal of Mental Health and Addiction 9(4):382-397, 2011

30

5020

Spelman,A. R. Kelder,S. H. Bondy,M. L. Wilkinson,A. V.

Cognitive susceptibility to smoking: Two paths to experimenting among Mexican origin youth.

Cancer Epidemiology, Biomarkers & Prevention 18(12):3459-3467, 2009

5028 Thakur,G. A. Grizenko,N .Joober,R.

Family-based association study of ADHD and genes increasing the risk for smoking behaviours.

Archives of Disease in Childhood 97(12):1027-1033, 2012

5029 Tharp,A. T.

Associations between three characteristics of parent-youth relationships, youth substance use, and dating attitudes.

Health Promotion Practice 13(4):515-523, 2012

5033

Throckmorton-Belzer,Leslee Robinson,Leslie A. Lensing,Shelly

Anti-Smoking Communication to Preadolescents With and Without a Cancer Diagnosis: Parents and Health Care Providers as Important Communicators

Children’s Health Care 38(4):283-300, 2009

5036 Tyc,Vida L. Lensing,ShellyRai, Shesh N.

A comparison of tobacco-related risk factors between preadolescents with and without cancer

Journal of Cancer Survivorship 3(4):251-259, 2009

5038 van Lier,P. A. Crijnen,A.

Impact of a preventive intervention targeting childhood disruptive behavior problems on tobacco and alcohol initiation from age 10 to 13 years.

Drug and Alcohol Dependence 100(3):228-233, 2009

5039 van Lier,P. A., Vuijk,P.

The role of friends' disruptive behavior in the development of children's tobacco experimentation: results from a preventive intervention study.

Journal of Abnormal Child Psychology 39(1):45-57, 2011

5047 Wang,M. P., Lam,T. H.

Parental smoking, exposure to secondhand smoke at home, and smoking initiation among young children.

Nicotine & Tobacco Research 13(9):827-832, 2011

5048 Wang,M. P., Lo,W. S.

Overestimation of peer smoking prevalence predicts smoking initiation among primary school students in Hong Kong.

Journal of Adolescent Health 48(4):418-420, 2011

5054 Weller,Joshua A. Decision-Making Deficits Among Maltreated Children

Child Maltreatment 18(3):184-194, 2013

5060 Wilkinson,A. V. Yu,X., Shete,S.

Cigarette experimentation and the population attributable fraction for associated genetic and non-genetic risk factors.

PLoS One 8(1): e53868, 2013

5062 Wills,Thomas A. Sargent,James D. Lee,Hye-Ryeon

Good self-control moderates the effect of mass media on adolescent tobacco and alcohol use: Tests with studies of children and adolescents

Health Psychology 29(5(:539-549, 2010

31

5063 Wong,Maria M. Zucker,Robert A.

Childhood sleep problems, early onset of substance use and behavioral problems in adolescence

Sleep Medicine 10(7):787-796, 2009

5070 Zaloudikova,I. Samara,I.

Parental education and family status--association with children's cigarette smoking.

Central European Journal of Public Health 20(1):38-44, 2012

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