Early adolescents' perceptions of cigarette smoking: a cross-sectional survey in a junior high school

Adolescence, Winter, 1998 by Deqing Sun, Martha Anderson, Ashish Shah, Kell Julliard

Cigarette smoking among adolescents has been found to increase fivefold between junior and senior high school (Telch, Killen, McAlister, Perry, & Maccoby, 1982). Pressure from peers and the influence of the media are two important factors in the onset of smoking (Evans, 1976). In addition to the harmful effects of cigarettes, a strong relationship between smoking and levels of alcohol and other drug consumption has been reported (Lavik, 1987). For example, research suggests that smoking is a gateway substance for alcohol use among Hispanic adolescents (Parra- Medina, Talavera, Elder, & Woodruff, 1995).

Research among adult smokers shows that most of them started smoking during adolescence (Wada & Fukui, 1994). Surveys indicate that the percentage of American high school students (ninth to twelfth graders) who smoke cigarettes may be as high as 34.8% (Kann, Warren, Harris, Collins, Williams, Ross, & Kolbe, 1996), but data about junior high school students (sixth to eighth graders) are sparse. Knowledge about their perception of smoking would help in the development of better preventive strategies and reduce the number of teenagers who begin to smoke.

The purpose of the present study was to investigate junior high school students' perception of, and attitudes toward, cigarette smoking, especially as they relate to the following questions: When did they first start smoking? Did they receive any information that would discourage cigarette smoking? Who provided this information?

METHOD

A cross-sectional survey was conducted at a public junior high school in Sunset Park, Brooklyn, New York. Sunset Park consists mostly of middle- and low-income Hispanic immigrant families.

A structured, anonymous questionnaire was administered to all students in grades 6 to 8 who visited the nurse's office for checkups, minor health complaints, or vaccine shots over a 6-month period (10/1/96 to 12/15/96, 2/15/97 to 4/30/97). Students were asked about their smoking status and, depending on their answer, the appropriate questionnaire was provided. Questions pertained to smoking behavior, influence of cigarette advertising, attitudes toward cigarette advertising and whether it should be banned, perception of the effects of cigarette smoking, who provided information on the health effects of smoking, and presence of smokers in the family. The questionnaire also asked whether the students had ever tried smoking, at what age, and why. Confidentiality was assured; names and class records were not linked with the survey. To encourage participation, the school nurse explained that the information gathered would not be used in any way other than for the study. The chi-square test (Fisher exact probability) was used for analysis.

RESULTS

One hundred students (48 females, 52 males) completed the questionnaire. Their ethnic distribution was similar to that of the school population (see Table 1). Their ages ranged from 10 to 14 years (mean = 12.9). Ten students identified themselves as former smokers who had quit more than 3 months before, 2 students indicated that they were smokers, and 88 students were nonsmokers. Former and current smokers were combined to form Group S; Group N encompassed nonsmokers. Group S consisted of 7 females and 5 males. Although only 52% of the sample was Hispanic, Group S was entirely Hispanic.

Twenty-seven percent of Group N and 25% of Group S believed that cigarette advertising significantly influenced their classmates or themselves. Forty-two percent of Group S and 70% of Group N believed that cigarette advertising should be banned. The difference, however, was not statistically significant (p = .09).

Cigarette smoking was recognized as seriously harmful to their health by 90% of the students. Information on the harmful effects of smoking was obtained mainly from teachers (noted by 50 students) and parents (noted by 42 students); the media were noted by 15 students and only 2 students mentioned health care providers (e.g., private physician, community clinic, nursing office) as information sources (some students gave more than one response).

While 53% of the students said their parents taught them not to smoke, 47.8% of these parents were smokers themselves. Nine students in Group S (75%) and 39 students in Group N (44%) had parents who were smokers. The difference between groups did not quite reach statistical significance (p = .064). Overall, 53% of the students had at least one family member who was a smoker.

Curiosity and imitating peers were the reasons students in Group S gave for smoking. One student had his first cigarette at age 7, two at age 11, six at age 12, one at age 13, and two at age 14.

Table 1. Gender and Ethnic Distribution

                              School                 Sample

Total                          1376                   100

Male                        735 (53%)               52 (52%)

Female                      641 (47%)               48 (48%)

White                       161 (11.7%)             13 (13%)

Black                        72 (5.2%)               3 (3%)

Hispanic                    717 (52.1%)             52 (52%)

Asian and                   423 (30.7%)             32 (32%)
Pacific Islanders