Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008–11

Background: Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting. Methods: Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking. Results: Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P \u3c 0.001). Smoking prevalence increased every year after year 2 for current smoking (P \u3c 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P \u3c 0.001). Conclusion: This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking

Polydrug use among urban adolescent cigarette smokers.

PurposeAdolescent smokers are at increased risk for polydrug use, which is associated with more consequences than use of a single drug. Here we classified subgroups of polydrug use among urban adolescent cigarette-smokers; described the sociodemographic, smoking, and depression correlates; and identified three-year outcomes associated with subgroup membership.MethodsAdolescent cigarette smokers (N=176; Mage=16.1; 35% male; 27% white) completed surveys assessing drug use, smoking characteristics, demographics, and depressive symptoms at baseline and 12, 24, and 36months follow-up.ResultsAlmost all participants (96%) reported using, on average, two (SD=0.97) substances (including other tobacco products) in addition to cigarettes. Latent class analysis revealed two distinct classes of polydrug users. "Limited Range Use" (84%) class members reported current use of other tobacco, alcohol, and marijuana, as did "Extended Range Use" class members (16%) who also reported current use of "harder drugs" (i.e., cocaine/crack, hallucinogens, ecstasy, and misused prescriptions). The classes did not differ on demographics or baseline likelihood of marijuana (χ2=0.25; p<0.62) or alcohol use (χ2=3.3; p<0.07). At baseline, a larger proportion of Extended Range Use class members reported both smoking the entire cigarette and symptoms of clinical depression. Extended Range Use class membership at baseline predicted higher mean depression scores at 24 and 36months.ConclusionAdolescent cigarette-smokers who reported extended range use (18%) also reported symptoms of clinical depression at baseline and follow-up. These findings indicate a need for early monitoring of depression symptoms and prevention and cessation interventions targeting this high-risk group

Polydrug use among urban adolescent cigarette smokers.

PurposeAdolescent smokers are at increased risk for polydrug use, which is associated with more consequences than use of a single drug. Here we classified subgroups of polydrug use among urban adolescent cigarette-smokers; described the sociodemographic, smoking, and depression correlates; and identified three-year outcomes associated with subgroup membership.MethodsAdolescent cigarette smokers (N=176; Mage=16.1; 35% male; 27% white) completed surveys assessing drug use, smoking characteristics, demographics, and depressive symptoms at baseline and 12, 24, and 36months follow-up.ResultsAlmost all participants (96%) reported using, on average, two (SD=0.97) substances (including other tobacco products) in addition to cigarettes. Latent class analysis revealed two distinct classes of polydrug users. "Limited Range Use" (84%) class members reported current use of other tobacco, alcohol, and marijuana, as did "Extended Range Use" class members (16%) who also reported current use of "harder drugs" (i.e., cocaine/crack, hallucinogens, ecstasy, and misused prescriptions). The classes did not differ on demographics or baseline likelihood of marijuana (χ2=0.25; p<0.62) or alcohol use (χ2=3.3; p<0.07). At baseline, a larger proportion of Extended Range Use class members reported both smoking the entire cigarette and symptoms of clinical depression. Extended Range Use class membership at baseline predicted higher mean depression scores at 24 and 36months.ConclusionAdolescent cigarette-smokers who reported extended range use (18%) also reported symptoms of clinical depression at baseline and follow-up. These findings indicate a need for early monitoring of depression symptoms and prevention and cessation interventions targeting this high-risk group

Measures of both perceived general and specific risks and benefits differentially predict adolescent and young adult tobacco and marijuana use: findings from a Prospective Cohort Study.

Health behavior theorists and prevention researchers use a variety of measures of adolescent and young adult (AYA) risk and benefit perceptions to predict tobacco-use and marijuana-use behaviors. However, studies have not examined whether and how perception measures that ask about likelihood of more general outcomes such as "harm" versus ask about specific risk or benefit outcomes compare or whether they differentially predict AYA willingness to use if one of your best friends were to offer it and intentions to use in the next year; and if these measures have differential ability to predict actual use of tobacco and marijuana. We used data from a prospective cohort of California AYAs to create and test new scales to measure perceptions of specific health and social outcomes related to risks (e.g., smell bad) and benefits (e.g., look cool) related to tobacco and marijuana, and then addressed three questions: (1) Whether and how measures of perceptions of specific social and health risks and benefits (for our purposes "specific measures") and measures of perceived general harm are differentially associated with measures of willingness, social norms, and intentions to use? (2) Are specific versus general measures differentially associated with and predictive of tobacco and cannabis use behavior? (3) Are specific perceptions measures differentially predictive of behavior compared to measures of willingness, social norms, and behavioral intentions? Our results demonstrate that to better predict AYA tobacco and marijuana use, measures that address general outcomes, such as harmfulness, as well as willingness and behavioral intention should be used. We also found that measures of specific perceived risks (short-term, long-term, social) and benefits were unrelated and correlated differently with different products. For example, adolescents perceived both risks and benefits from using products like e-cigarettes, and perceived greater risk from smokeless tobacco compared to combustible cigarettes. These findings indicate that measures of specific perceived social and health outcomes can be useful to discern nuanced differences in motivation for using different substances. Study implications are important for survey dimension-reduction and assessing relationships among perceptions, motivations, and use of tobacco and marijuana products

Time trends of cigarette and waterpipe smoking among a cohort of school children in Irbid, Jordan, 2008–11

Background: Coordinated high-impact interventions and community-level changes in smoking behaviour norms effectively reduced prevalence of smoking among youth in many developed countries. Smoking trends among Jordanian adolescents are likely different than their Western counterparts and must be understood in the context of their daily lives to tailor interventions specifically for adolescents in this setting. Methods: Between 2008 and 2011, a school-based longitudinal study was conducted in Irbid, Jordan. All seventh-grade students in 19 randomly selected schools (of 60) were surveyed annually for 4 years. Outcomes of interest were time trends in smoking behaviour, age at initiation and change in frequency of smoking. Results: Among 1781 participants, baseline prevalence of current smoking (cigarettes or waterpipe) for boys was 22.9% and 8.7% for girls. Prevalence of ever-smoking and current any smoking, cigarette smoking, waterpipe smoking and dual cigarette/waterpipe smoking was significantly higher in boys than girls each year (P \u3c 0.001). Smoking prevalence increased every year after year 2 for current smoking (P \u3c 0.05) across all methods (any, cigarette, waterpipe and dual). At all time points for both boys and girls, prevalence of waterpipe smoking was higher than that of cigarette smoking (P \u3c 0.001). Conclusion: This study shows intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of waterpipe smoking and steeper age-related increase in cigarette smoking. It also points to the possibility of waterpipe being the favourite method for introducing youth to tobacco, as well as being a vehicle for tobacco dependence and cigarette smoking