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Factors influencing openness to future smoking among nonsmoking adolescents *.

Although the vast majority of morbidity and mortality caused by tobacco use occurs in adulthood, the initiation of tobacco use and the development of addiction typically occur during adolescence. (1-3) More than 80% of adult tobacco users started their smoking regularly before they reached age 18. (1) Study findings indicate that nicotine can produce addiction as powerful as heroin and cocaine. (4-6) This is affirmed by Anthony et al (7) and McNeill (8) who suggest that 32-50% of people who have tried cigarettes show addictive patterns of use, whereas a smaller percentage of people who have tried cocaine or heroin do. In addition to a host of negative health consequences for adolescents who smoke, smoking is associated with several other risk behaviors such as increased use of illicit drugs, fighting, and engaging in unprotected sex. (9)

The evidence from these aforementioned findings warrants serious inquiry into prevention strategies of youth tobacco initiation. Thus, it is critically important to have a thorough understanding of correlates of youth tobacco initiation and use as well as to monitor changes related to youth tobacco use over time.

Although the association of youth tobacco use with race/ethnicity, (10-13) peer influence, (14-20) tobacco advertisements, (21-29) and acceptance of tobacco marketing promotional items (30-32) is well established, less is known about other moderators and mediators of youth tobacco use such as exposure to antitobacco messages and information, exposure to environmental tobacco smoke (ETS) either in home or in cars, perceived benefit of smoking, and perceived peer acceptance to smoking. Also, few studies have examined whether these factors may affect nonsmoking adolescents' openness to future smoking. In addition, considering that adolescents' behavior is rapidly evolving and variable due to the biological, cognitive, psychological, and sociocultural factors that define their developmental stage, (33) there is a need to closely monitor changes related to youth tobacco use in terms of correlates as well as prevalence.

Understanding the factors that are related to openness to future smoking is imperative to plan effective prevention strategies during the critical time in adolescence before the initiation of tobacco use. A recent study (34) that examined the progression to established smoking among US youths suggested that interventions should be focused on youths open to future smoking (susceptible never smokers) to prevent adolescents from progressing to established smoking. Exposure to ETS has recently been shown to predict adolescent smoking, even when controlling for sex, socioeconomic status of parents, a crowding index, and the numbers at home of siblings, adult smokers, and cigarettes smoked. (35) Further inquiry into the risk factors for tobacco uptake among never-smoking adolescents is still needed.

This study aimed to examine correlates of openness to future smoking among nonsmoking adolescents in grades 6-12 by analyzing the Indiana Youth Tobacco Survey (IYTS) data of 2000 and 2004. It was hypothesized that after controlling for demographic variables such as gender, grade, and race/ethnicity, nonsmoking adolescents' openness to future smoking would be predicted by exposure to protobacco or tobacco countermarketing messages, exposure to information about health consequences of tobacco use, exposure to secondhand smoke in homes and/or cars, perceived benefit of smoking, and perceived peer acceptance toward smoking.

METHODS

Sampling

The 2000 and 2004 IYTS data collection protocol was designed by the Centers for Disease Control and Prevention (CDC). A 2-stage cluster sample design was used to produce a representative sample. All public schools containing grades 6-12 were included in the sampling frame. Schools were selected with probability proportional to school enrollment size. Then, classes were chosen using systematic equal probability sampling from each school that participated in the survey.

2000 IYTS Sample. Data were obtained from 2932 students at 80 schools across the state (1516 in grades 6-8 and 1416 in grades 9-12; 48% female). Thirty-eight of 47 selected middle schools participated (80.85% school response rate) and 1516 of 1690 middle school students completed usable questionnaires (89.7% student response rate), resulting in an overall response rate of 72.53%. Of the high schools, 42 of 50 selected high schools participated (84.0%) and 1416 of 1665 students completed usable questionnaires (85.05%), resulting in an overall response rate of 71.44%.

2004 IYTS Sample. The sample in 2004 was considerably larger than in 2000, with a sample of 5423 students in 92 schools across the state (1990 in grades 6-8 and 3433 in grades 9-12; 48% female). Forty-seven of 60 selected middle schools participated (78.33% school response rate) and 1990 of 2382 middle school students completed usable questionnaires (83.54% student response rate), resulting in an overall response rate of 65.44%. Of the high schools, 45 of 57 selected high schools participated (78.95%) and 3433 of 4299 students completed usable questionnaires (79.86%), resulting in an overall response rate of 63.04%.

Procedures

The IYTS is a state-level survey, beginning in 2000, whose protocol is similar to the National Youth Tobacco Survey, a nationwide initiative to track and understand youth tobacco usage over a series of years. (34,36) The IYTS questionnaire was developed by CDC and included questions about tobacco use, familiarity with pro- and antitobacco media messages, exposure to ETS, minors' ability to purchase or obtain tobacco products, and general knowledge, attitudes, and beliefs about tobacco. Each IYTS was an anonymous, school-based, self-administered paper-and-pencil survey. Each questionnaire took about 25 minutes to complete.

Measures

Several key variables of interest were generated using the operational definitions provided by Indiana Tobacco Prevention and Cessation. Openness to future smoking is the primary outcome variable in this analysis. The students who were open to future smoking were those respondents who had never smoked, not even a few puffs, but who answered "definitely yes," "probably yes," or "probably no" to the question about smoking in the future: (1) "Do you think you will smoke a cigarette at anytime during the next year?" or (2) "If one of your best friends offered you a cigarette, would you smoke it?" (34)

Six items were used to measure respondents' exposure to protobacco messages and advertisements through various media including TV, movies, Internet, convenience stores, or a racing event. These 6 items were summated and the score was categorized into low, medium, and high exposure. Two items that measured respondents' exposure to tobacco countermarketing through various media were also summated and categorized into low, medium, and high exposure. A dichotomous variable was generated to indicate respondents' exposure to information about health consequences of tobacco use based upon reported exposure to the messages received from their parents, doctors, dentists, schoolteachers, or peers. Respondents' exposure to secondhand smoke was measured by 2 separate questions: (1) "During the past 7 days, on how many days were you in the same room with someone who was smoking cigarettes?" and (2) "During the past 7 days, on how many days did you ride in a car with someone who was smoking cigarettes?" Perceived benefit of smoking was measured by a summated scale of 5 variables: "having more friends," "looking cool" "helping relaxation," "feeling more comfortable in social situations," and "helping keep weight down." Finally, respondents' perceived peer acceptance to smoking was measured by the question "Do most people of your age think it is okay to smoke?" The response options included "definitely yes," "probably yes," "probably not," and "definitely not."

Data Analysis

For each year, middle school and high school data were combined and primary sampling unit was recoded using sequential numbers. Then, all the variables were renamed for easy identification and consistency between 2000 and 2004 data sets especially given the inconsistencies in the variable names in the original data sets. Small frequency categories were collapsed to compute reliable estimates in bivariate and multivariate data analyses. For example, in IYTS 2000, the age categories "18 years old" and "19+ years old" were merged into "18+ years old" because the frequency for "19+ years old" was too small (n = 6).

The statistical package SUDAAN (Research Triangle Institute, Research Triangle Park, NC) was used to estimate sampling variances and standard errors, which takes into account the complex sample design of IYTS. Sampling weights were used to adjust for unequal probabilities of selection, nonresponse, and disproportionate selection of different population groups. After bivariate relationships were examined using chi-square tests and standard logistic analyses, adjusted odds ratios of each of the significant predictors of openness to future smoking were computed, controlling for gender, grade, and race/ethnicity.

RESULTS

Descriptive Results

Descriptive frequencies and weighted percentages for each category of variables are shown in Table 1. Whereas 74% of students in 2000 were not open to future smoking, 77% were not open in 2004 (z = 2.63, p < .01). The proportion of students who had been highly exposed to antitobacco messages increased from 7% to 15% (z = 10.96, p < .0001) and those exposed to information about health consequences of tobacco use from their parents, doctors, dentists, schoolteachers, or peers increased significantly from 84% to 89% (z = 5.68, p < .0001). Consistent with these desirable changes, students' exposure to ETS was reduced both in homes and in cars. Whereas 30% of students were in the same room everyday with someone who smoked during the past 7 days in 2000, 24% did in 2004 (z = 4.05, p < .0001). Also, whereas 45% of students did not ride in a car with someone who smoked during the past 7 days in 2000, 53% did not in 2004 (z = 5.40, p < .0001). In terms of students' exposure to protobacco messages and advertisements on TV, movies, Internet, convenience stores, or racing events, the proportion of students who were moderately exposed to such messages significantly decreased from 65% in 2000 to 59% in 2004 (z = 5.98, p < .0001), although the proportion of highly exposed students did not differ significantly between 2 years.

Bivariate and Multivariate Analyses

As shown in Tables 2 and 3, gender, grade, race/ethnicity, and exposure to pro- or antitobacco messages and information were insignificant or weak predictors for openness to future smoking (hereafter OFS). Only in 2004, students who experienced a high level and a moderate level of exposure to protobacco messages were more likely than those with a low level of exposure to such messages to be open to future smoking by a factor of 2.85 and 1.40, respectively, controlling for the 3 demographic variables.

For both years, students' exposure to ETS was significantly associated with OFS. Students who were in the same room every day with someone who smoked during the past 7 days were more likely than those who were not in any of the past 7 days to be open to future smoking by a factor of 2.18 (95% confidence interval [CI]: 1.54-3.10) in 2000 and 1.88 (95% CI: 1.31-2.70) in 2004, controlling for the 3 demographic variables. Students who rode in a car with someone who smoked 1 or 2 days in the past 7 days were more likely than those who did not in any of the past 7 days to be open to future smoking by a factor of 1.91 (95% CI: 1.32-2.76) in 2000 and 1.73 (95% CI: 1.30-2.31) in 2004 in the adjusted model.

Perceived benefit of smoking ([chi square] = 55.56, p < .0001) and perceived peer acceptance to smoking ([chi square] = 16.14, p < .002), measured only in 2004, were also significantly associated with OFS. Students with high and moderate perceived benefit of smoking were more likely than those with low perceived benefit to be open to future smoking by a factor of 3.97 (95% CI: 2.63-5.98) and 2.56 (95% CI: 2.06-3.17), respectively, in the adjusted model. Students who answered "definitely yes," "probably yes," and "probably not" to the question "Do most people of your age think it is okay to smoke?" were more likely than those who answered "definitely not" to be open to future smoking by a factor of 4.18 (95% CI: 2.34-7.47), 1.99 (95% CI: 1.34-2.95), and 1.62 (95% CI: 1.17-2.24), respectively, in the adjusted model.

DISCUSSION

Findings of this study indicate that desirable changes occurred between 2000 and 2004 in adolescents' smoking-related environmental factors. The adolescent cohort in 2004 became more exposed to antitobacco messages and less exposed to protobacco messages and ETS compared with their counterpart in 2000. During the same time frame, the proportion of nonsmoking adolescents who were not open to future smoking significantly increased. Although no valid causal inference can be made from this repeated cross-sectional data analysis, this finding is indicative of a possible impact of environmental factors on adolescents' intention to smoke. Future studies are warranted to examine temporal trends of OFS among comparable adolescent cohorts especially with regard to the changes in smoking-related environmental factors.

The finding that the proportion of students who were highly exposed to antitobacco messages was only 15% in 2004 might imply that there is still an increased need for concerted efforts by state and local governments and tobacco control and prevention coalitions. However, exposure to antitobacco messages was not predictive of lack of OFS in the adjusted model. This is contrary to previous studies that have indicated that antitobacco messages seem to have the desired effect on adolescents' perceptions of tobacco (31,37) and help deter tobacco use initiation. (37,38) This can be interpreted in a few different ways. First, although frequencies of counter tobacco marketing and resulting students' exposure to these antitobacco messages might have increased significantly, the actual impact of these messages on students' intention to smoke might be intrinsically minimal, that is, a low effect size. The magnitude and enduring psychological impact of the antitobacco messages might not be strong enough to combat protobacco messages. Second, the study population may have received different messages or the quality of the messages may have been different. Third, given the different study designs and operational definitions of key variables among different studies, any delayed or concurrent effects of environmental factors on students' OFS could be captured differently. Related to this finding, it is noteworthy that students who experienced a moderate or high level of exposure to protobacco messages were more likely than those with a low level of exposure to such messages to be open to future smoking both in the unadjusted and in the adjusted models in 2004. This association was marginally significant in 2000, primarily due to the small cell size. These findings converge on the idea that it might be more important to make efforts to reduce students' exposure to protobacco messages than to increase their exposure to antitobacco messages. Future studies are desirable to examine various strategies of counter tobacco marketing in terms of their relative impact on student's intentions to smoke or actual tobacco use initiation.

Another important finding of this study was a strong impact of exposure to ETS either in homes or in cars on adolescents' OFS in both years. This finding is not surprising given the finding that parental smoking has previously been linked with persistence of offspring smoking. (39) This is likely to indicate both genetic and environmental influence, (39) which could offset any positive counter tobacco efforts. An effective, preventive antismoking initiative or intervention program, including enactment of a law that bans smoking in a car when minors are riding the car, would be necessary that targets nonsmoking adolescents whose parents or caretakers are smokers.

The findings of this study support the inclusion of items in IYTS 2004 that measured perceived peer acceptance to smoking as they were significantly associated with OFS. This is in line with the previous finding of a significant association between youth tobacco use and peer influence. (14-20) However, contrary to the previous finding where youth tobacco use was significantly associated with race/ethnicity (ie, white students are more likely than black and Hispanic students to report current cigarette use), (10-13) race/ethnicity was not associated with OFS in this study. This could be interpreted in 2 ways. First, this implies that OFS does not always lead to actual smoking behavior. Students' attitudes and perceptions toward tobacco smoking could change over time. Second, this finding indicates that the rate of transition from OFS to actual tobacco use initiation is higher among white students than among minority students. Future studies are necessary to investigate the determinants of the differential rates in their transition from OFS to tobacco use initiation among different racial/ethnic groups.

The findings of this study are subject to limitations. One limitation is the findings were based on self-report of the students, as opposed to more objective methods of measurement. However, self-report is commonly used for measurement in youth tobacco research and is relied upon by the CDC as an accepted method of national youth tobacco surveillance. (11,12,36) Second, causal relationships should not be inferred from the present findings as the data were collected using a cross-sectional survey design, although the consistent patterns observed across the 2 different years of surveys shed added light on possible causal links such as the link between exposure to ETS and OFS. Third, the findings apply only to the students who attended a public middle school or high school. Fourth, if the nonrespondents had different perceptions from those who participated in the survey, the findings might have reduced external validity, although the response rates were high. Despite these limitations, this study provides valuable information about the factors affecting nonsmoking adolescents' openness to tobacco use.

CONCLUSIONS

Results from this study show that desirable changes occurred between 2000 and 2004 in terms of exposure to anti- or protobacco messages, exposure to ETS, and the proportion of nonsmoking adolescents who were not open to future smoking among Indiana adolescents. Adolescents' OFS is strongly associated with exposure to ETS, exposure to protobacco messages, perceived peer acceptance to smoking, and perceived benefit of smoking. Thus, it may help prevent adolescents from initiating tobacco use to adopt policies to reduce adolescents' exposure to ETS such as a smoking ban in a car when minors are riding in the car. Also, findings of this study suggest that more efforts should be made to reduce adolescents' exposure to protobacco messages than to increase their exposure to antitobacco messages. Results also suggest that the rate of transition from OFS to tobacco use initiation is higher among white adolescents than among minority adolescents. It may therefore be beneficial to examine the determinants of the differential rates in their transition from OFS to tobacco use initiation among different racial/ethnic groups.

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(24.) Gutschoven K, Van den Bulck J. Television viewing and smoking volume in adolescent smokers. Prey Med. 2004;39:1093-1098.

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(27.) Sargent JD, Dalton M, Beach M, Bernhardt A, Heatherton T, Stevens M. Effect of cigarette promotions on smoking uptake among adolescents. Prey Med. 2000; 30:320-327.

(28.) Rombouts K, Fauconnier G. What is learnt early is learn well? A study of the influence of tobacco advertising on adolescents. J Health Commun. 1988;3:303-322.

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(30.) Pierce JP, Choi WS, Gilpin EA, Farkas A J, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998;279:511-515.

(31.) Beiner LB, Seigal M. Tobacco marketing and adolescent smoking: more support for causal inference. Am J Public Health. 2000;90: 407-411.

(32.) Kaufman N J, Castrucci BC, Mowery PD, Gerlach KK, Emont S, Orleans CT. Predictors of change on the smoking uptake continuum among adolescents. Arch Pediatr Adolesc Meal. 2002;156: 581-587.

(33.) Lerner RM, Galambos NL. Adolescent development: challenges and opportunities for research, programs, and policies. Annu Rev Psychol. 1998;49:413-446.

(34.) Mowery PD, Farrelly MC, Haviland L, Gable JM, Wells HE. Progression to established smoking among US youths. Am J Public Health. 2004;94:331-337.

(35.) Becklake MR, Ghezzo H, Ernst P. Childhood predictors of smoking in adolescence: a follow-up study of Montreal school children. CMAJ. 2005;173(4):377-379.

(36.) Evans WD, Powers A, Hersey J, Renaud J. The influence of social environment and social image on adolescent smoking. Health Psychol. 2006;25(1):26-33.

(37.) Hersey JC, Niederdeppe J, Evans WD, et al. The effects of state counter-industry media campaigns on beliefs, attitudes, and smoking status among teens and young adults. PrevMed. 2003;37:544-552.

(38.) Reinert B, Carver V, Range LM. Anti-tobacco messages from different sources make a difference with secondary school students. J Public Health Manag Pract. 2004; 10(6):518-523.

(39.) White VM, Hopper JL, Wearing A J, Hill DJ. The role of genes in tobacco smoking during adolescence and young adulthood: a multivariate behaviour genetic investigation. Addiction. 2003;98:1087-1100.

* Indicates CHES and Nursing continuing education hours are available. Also available at" http://www.ashaweb.org/continuing_education.html

DONG-CHUL SEO, PhD (a)

MOHAMMAD R. TORABI, PhD (b)

AMY E. WEAVER, MPH (c)

(a) Assistant Professor, (seo@indiana.edu), Department of Applied Health Science, Indiana University, HPER 116, 1025 E Seventh St, Bloomington, IN 47405.

(b) Chancellor's Professor and Chair, (torabi@indiana.edu), Department of Applied Health Science, Indiana University, HPER 116, 1025 E Seventh St, Bloomington, IN 47405.

(c) Doctoral Student and Research Assistant, (weavera@indiana.edu), Department of Applied Health Science, Indiana University, H PER 116, 1025 E Seventh St, Bloomington, IN 47405.

Address correspondence to: Dong-Chul Seo, Assistant Professor, (seo@indiana.edu), Department of Applied Health Science, Indiana University, HPER 116, 1025 E Seventh St, Bloomington, IN 47405.

American Institutes for Research (00001-1784.009) and Indiana Tobacco Prevention and Cessation funded this research.
Table 1. Demographic Characteristics and Descriptive Results, IYTS

                                                 2000

                                 Unweighted    Weighted     Standard
                                 Frequency     Percent       Error
Gender
  Female                            1438        48.42         1.42
  Male                              1488        51.58         1.42
Grade
  6th                                434        15.40         3.81
  7th                                492        15.01         3.06
  8th                                579        14.39         2.88
  9th                                301        15.49         3.09
  10th                               435        14.26         2.52
  11th                               344        13.05         2.54
  12th                               325        12.39         2.32
Race/ethnicity
  White                             2345        84.57         1.86
  Black                              316         8.88         1.66
  Hispanic                           100         2.71         0.54
  Other                              128         3.83         0.44
Exposure to protobacco
  message
  Low                                819        26.96         1.23
  Moderate                          1780        65.16         1.17
  High                               133         4.87         0.47
Exposure to antitobacco
  message
  Low                                720        25.67         1.20
  Moderate                          1879        67.43         1.17
  High                               203         6.90         0.54
Exposure to information about
  health consequences of tobacco use
  No exposure                        459        16.27         0.84
  Exposed                           2421        83.73         0.84
Exposure to ETS in homes
  (days)
  0                                  943        31.65         1.74
  1 or 2                             642        22.52         0.90
  3 or 4                             301        10.58         0.57
  5 or 6                             169         5.72         0.49
  7                                  820        29.53         1.51
Exposure to ETS in cars
  (days)
  0                                 1327        45.13         1.67
  1 or 2                             542        18.98         0.80
  3 or 4                             320        11.40         0.76
  5 or 6                             150         5.20         0.52
  7                                  535        19.29         1.06
Perceived benefit of smoking *
  High perceived benefit
  Moderate perceived benefit
  Low perceived benefit
Perceived peer acceptance to
  smoking *
  Definitely yes
  Probably yes
  Probably not
  Definitely not
Open to future smoking among
  those who never smoked
  Not open to smoking               997         73.67         1.41
  Open to smoking                   357         26.33         1.41

                                                 2004

                                 Unweighted    Weighted     Standard
                                 Frequency     Percent       Error
Gender
  Female                            2712        48.19         1.24
  Male                              2682        51.81         1.24
Grade
  6th                                343        15.09         4.22
  7th                                898        14.54         3.36
  8th                                719        15.28         2.99
  9th                                989        16.02         2.97
  10th                              1044        14.30         2.18
  11th                               832        12.72         2.06
  12th                               516        12.04         2.06
Race/ethnicity
  White                             3825        76.08         2.02
  Black                              921        13.57         1.70
  Hispanic                           342         5.26         0.71
  Other                              244         5.09         0.47
Exposure to protobacco
  message
  Low                               1740        36.36         1.00
  Moderate                          2772        58.93         0.96
  High                               226         4.71         0.45
Exposure to antitobacco
  message
  Low                               1754        34.33         1.28
  Moderate                          2603        50.86         1.23
  High                               755        14.81         0.77
Exposure to information about
  health consequences of tobacco use
  No exposure                        597        10.94         0.99
  Exposed                           4592        89.06         0.99
Exposure to ETS in homes
  (days)
  0                                 1863        35.95         1.36
  1 or 2                            1166        23.16         0.85
  3 or 4                             543         9.95         0.50
  5 or 6                             330         6.46         0.42
  7                                 1256        24.49         1.07
Exposure to ETS in cars
  (days)
  0                                 2728        53.21         1.41
  1 or 2                             873        16.73         0.67
  3 or 4                             524        10.20         0.62
  5 or 6                             300         5.73         0.31
  7                                  731        14.13         0.79
Perceived benefit of smoking *
  High perceived benefit             599        11.24         0.64
  Moderate perceived benefit        1878        33.34         1.40
  Low perceived benefit             2886        55.42         1.68
Perceived peer acceptance to
  smoking *
  Definitely yes                    1118        19.94         1.19
  Probably yes                      2113        37.85         1.65
  Probably not                      1427        29.40         1.79
  Definitely not                     616        12.81         1.15
Open to future smoking among
  those who never smoked
  Not open to smoking               2087        76.72         1.04
  Open to smoking                    649        23.28         1.04

* These variables were measured only for 2004.

Table 2. Bivariate Association for OFS, IYTS

                                               2000

                                Unweighted   Weighted     [chi square]
                                Frequency     Percent      (P Value)

Gender                                                    2.25 (.1386)
  Female                           191         54.74
  Male                             166         45.26
Grade                                                     5.45 (.4947)
  6th                               77         22.74
  7th                               78         20.10
  8th                               87         17.91
  9th                               38         16.63
  10th                              31         8.68
  11th                              29         8.67
  12th                              17         5.28
Race/ethnicity                                            2.84 (.4243)
  White                            292         86.88
  Black                             34         7.54
  Hispanic                          13         3.09
  Other                             11         2.50
Exposure to protobacco
  message                                                 4.11 (.1370)
  Low                              110         31.64
  Moderate                         214         64.20
  High                              13         4.16
Exposure to antitobacco
  message                                                 0.23 (.8924)
  Low                               93         27.31
  Moderate                         238         66.93
  High                              20         5.75
Exposure to information about
  health consequences of tobacco use                      1.71 (.1961)
  No exposure                       61         16.98
  Exposed                          293         83.02
Exposure to ETS in homes                                 23.50 (.0005)
  (days)
  0                                121         33.04
  1 or 2                            99         29.44
  3 or 4                            37         9.89
  5 or 6                            24         6.78
  7                                 73         20.85
Exposure to ETS in cars                                  22.99 (.0006)
  (days)
  0                                184         51.36
  1 or 2                            75         21.89
  3 or 4                            38         10.29
  5 or 6                            16         4.86
  7                                 41         11.59
Perceived benefit of
  smoking *
  High perceived benefit
  Moderate perceived benefit
  Low perceived benefit
Perceived peer acceptance
  to smoking *
  Definitely yes
  Probably yes
  Probably not
  Definitely not

                                               2004

                                Unweighted   Weighted     [chi square]
                                Frequency     Percent      (P Value)

Gender                                                    0.08 (.7751)
  Female                           342         49.36
  Male                             306         50.64
Grade                                                    13.79 (.2401)
  6th                               46         15.89
  7th                              144         19.18
  8th                              117         21.33
  9th                              139         18.35
  10th                              92         10.14
  11th                              65         7.94
  12th                              38         7.16
Race/ethnicity                                            4.29 (.2401)
  White                            464         77.01
  Black                             98         11.56
  Hispanic                          43         5.44
  Other                             35         6.00
Exposure to protobacco
  message                                                 8.58 (.0169)
  Low                              221         34.47
  Moderate                         336         60.84
  High                              23         4.69
Exposure to antitobacco
  message                                                 5.08 (0.851)
  Low                              236         39.46
  Moderate                         309         48.53
  High                              69         12.01
Exposure to information about
  health consequences of tobacco use                      0.00 (1.000)
  No exposure                       70         9.84
  Exposed                          560         90.16
Exposure to ETS in homes                                 16.61 (.0041)
  (days)
  0                                270         40.55
  1 or 2                           148         26.36
  3 or 4                            56         7.97
  5 or 6                            30         3.93
  7                                122         21.18
Exposure to ETS in cars
  (days)                                                 15.73 (.0057)
  0                                396         60.33
  1 or 2                           108         18.35
  3 or 4                            42         7.06
  5 or 6                            25         4.30
  7                                 56         9.97
Perceived benefit of
  smoking *                                              55.56 (<.0001)
  High perceived benefit            60         9.42
  Moderate perceived benefit       249         39.01
  Low perceived benefit            338         51.57
Perceived peer acceptance
  to smoking *                                           16.14 (.0020)
  Definitely yes                   127         20.24
  Probably yes                     239         34.39
  Probably not                     206         34.93
  Definitely not                    68         10.44

* These variables were measured only for 2004.

Table 3. Logistic Regression of OFS, IYTS

                                             2000

                                      OR           95% CI
Gender
  Female                             1.21        0.94-1.57
  Male                               1.00        Reference
Grade
  6th                                0.72        0.41-1.25
  7th                                0.82        0.49-1.37
  8th                                0.91        0.57-1.47
  9th                                1.00        Reference
  10th                               0.68        0.39-1.19
  11th                               0.68        0.37-1.25
  12th                               0.58        0.29-1.16
Race/ethnicity
  White                              1.00        Reference
  Black                              0.93        0.62-1.41
  Hispanic                           2.00        1.02-3.91
  Other                              0.90        0.46-1.77
Exposure to protobacco
  message

  Low                                1.00        Reference
  Moderate                           1.23        0.91-1.64
  High                               1.97        0.90-0.31
Exposure to antitobacco
  message
  Low                                1.03        0.52-2.01
  Moderate                           1.10        0.55-2.17
  High                               1.00        Reference
Exposure to information about
  health consequences of
  tobacco use
  No exposure                        1.23        0.90-1.67
  Exposed                            1.00        Reference
Exposure to ETS in homes
  (days)
  0                                  1.00        Reference
  1 or 2                             2.08        1.40-3.10
  3 or 4                             1.99        1.29-3.05
  5 or 6                             3.44        1.78-6.65
  7                                  2.15        1.51-3.05
Exposure to ETS in cars
  (days)
  0                                  1.00        Reference
  1 or 2                             1.87        1.31-2.67
  3 or 4                             2.10        1.30-3.40
  5 or 6                             2.15        1.03-4.52
  7                                  1.97        1.30-2.98
Perceived benefit of smoking *
  High perceived benefit
  Moderate perceived benefit
  Low perceived benefit
Perceived peer acceptance to
  smoking *
  Definitely yes
  Probably yes
  Probably not
  Definitely not

                                             2000

                                     AOR           95% CI
Gender
  Female
  Male
Grade
  6th
  7th
  8th
  9th
  10th
  11th
  12th
Race/ethnicity
  White
  Black
  Hispanic
  Other
Exposure to protobacco
  message

  Low                                1.00        Reference
  Moderate                           1.24        0.92-1.66
  High                               2.04        0.95-4.39
Exposure to antitobacco
  message
  Low                                1.03        0.53-2.02
  Moderate                           1.10        0.55-2.16
  High                               1.00        Reference
Exposure to information about
  health consequences of
  tobacco use
  No exposure                        1.28        0.93-1.76
  Exposed                            1.00        Reference
Exposure to ETS in homes
  (days)
  0                                  1.00        Reference
  1 or 2                             2.11        1.40-3.17
  3 or 4                             2.00        1.30-3.07
  5 or 6                             3.65        1.87-7.13
  7                                  2.18        1.54-3.10
Exposure to ETS in cars
  (days)
  0                                  1.00        Reference
  1 or 2                             1.91        1.32-2.76
  3 or 4                             2.09        1.28-3.41
  5 or 6                             2.18        1.03-4.62
  7                                  2.00        1.35-2.97
Perceived benefit of smoking *
  High perceived benefit
  Moderate perceived benefit
  Low perceived benefit
Perceived peer acceptance to
  smoking *
  Definitely yes
  Probably yes
  Probably not
  Definitely not

                                             2004

                                      OR           95% CI
Gender
  Female                             1.03        0.82-1.30
  Male                               1.00        Reference
Grade
  6th                                0.56        0.37-0.85
  7th                                0.88        0.66-1.16
  8th                                1.17        0.77-1.78
  9th                                1.00        Reference
  10th                               0.65        0.46-0.92
  11th                               0.60        0.42-0.86
  12th                               0.71        0.42-1.22
Race/ethnicity
  White                              1.00        Reference
  Black                              1.02        0.76-1.36
  Hispanic                           1.48        0.98-2.23
  Other                              1.32        0.74-2.35
Exposure to protobacco
  message

  Low                                1.00        Reference
  Moderate                           1.41        1.14-1.74
  High                               2.62        1.05-6.51
Exposure to antitobacco
  message
  Low                                1.29        0.84-1.98
  Moderate                           0.98        0.66-1.45
  High                               1.00        Reference
Exposure to information about
  health consequences of
  tobacco use
  No exposure                        1.00        0.73-1.37
  Exposed                            1.00        Reference
Exposure to ETS in homes
  (days)
  0                                  1.00        Reference
  1 or 2                             1.20        0.88-1.63
  3 or 4                             1.20        0.76-1.89
  5 or 6                             0.99        0.57-1.72
  7                                  1.91        1.41-2.60
Exposure to ETS in cars
  (days)
  0                                  1.00        Reference
  1 or 2                             1.71        1.29-2.26
  3 or 4                             1.06        0.76-1.47
  5 or 6                             1.68        0.81-3.51
  7                                  1.94        1.38-2.73
Perceived benefit of smoking *
  High perceived benefit             4.25        2.87-6.31
  Moderate perceived benefit         2.61        2.15-3.16
  Low perceived benefit              1.00        Reference
Perceived peer acceptance to
  smoking *
  Definitely yes                     3.82        2.23-6.53
  Probably yes                       1.87        1.23-2.86
  Probably not                       1.76        1.26-2.45
  Definitely not                     1.00        Reference

                                             2004

                                     AOR           95% CI
Gender
  Female
  Male
Grade
  6th
  7th
  8th
  9th
  10th
  11th
  12th
Race/ethnicity
  White
  Black
  Hispanic
  Other
Exposure to protobacco
  message

  Low                                1.00        Reference
  Moderate                           1.40        1.13-1.74
  High                               2.85        1.09-7.42
Exposure to antitobacco
  message
  Low                                1.28        0.82-2.00
  Moderate                           0.97        0.63-1.49
  High                               1.00        Reference
Exposure to information about
  health consequences of
  tobacco use
  No exposure                        1.00        0.72-1.40
  Exposed                            1.00        Reference
Exposure to ETS in homes
  (days)
  0                                  1.00        Reference
  1 or 2                             1.21        0.87-1.67
  3 or 4                             1.16        0.75-1.79
  5 or 6                             0.96        0.54-1.70
  7                                  1.88        1.31-2.70
Exposure to ETS in cars
  (days)
  0                                  1.00        Reference
  1 or 2                             1.73        1.30-2.31
  3 or 4                             1.04        0.74-1.45
  5 or 6                             1.81        0.88-3.75
  7                                  1.77        1.29-2.45
Perceived benefit of smoking *
  High perceived benefit             3.97        2.63-5.98
  Moderate perceived benefit         2.56        2.06-3.17
  Low perceived benefit              1.00        Reference
Perceived peer acceptance to
  smoking *
  Definitely yes                     4.18        2.34-7.47
  Probably yes                       1.99        1.34-2.95
  Probably not                       1.62        1.17-2.24
  Definitely not                     1.00        Reference

OR, odds ratio; AOR, adjusted odds ratio.

* These variables were measured only for 2004.
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Title Annotation:Research Article
Author:Seo, Dong-Chul; Torabi, Mohammad R.; Weaver, Amy E.
Publication:Journal of School Health
Article Type:Report
Geographic Code:1USA
Date:Jun 1, 2008
Words:6391
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