Background: Smoking has long been one of the principal causes for morbidity and mortality and is ranked as the third leading cause for preventable health deaths in the world, posting serious threat to public health. Most smokers start smoking during adolescence. Adolescence describes teenagers aged 13-19 years old which can be considered as the transitional period from childhood to adulthood, about 88% of adult smokers who smoke daily started their smoking behavior by age of 18 years old and 68.2% of smokers started smoking below age of 20 in Hong Kong. Therefore, there is an urgent need to direct the public health effort towards the prevention of smoking in adolescents. It has been found that family has important influences on smoking behavior among adolescents. Objective: The objective of this review is to examine the effect of family influences on adolescents smoking behavior, particularly the association of parenting style, parental smoking and adolescent smoking behavior. Methods: he online databases PsycINFO, Medline and EMBASE were searched by using keywords “adolescents smoking” or “youth smoking” and “family influence” or “parental influence”. The last search was done on 10th August, 2013. Total 13 English articles, of which 10 were cross-sectional studies and 3 were longitudinal studies, were included in this review. Results: Literature showed authoritative parenting style could reduce the risk of smoking among adolescents; all studies showed authoritative parenting style, disapproval to smoke with higher level of parental monitoring could reduce risk of regular smoking behavior among adolescents. On the other hand, results from articles examining the association of parental smoking and smoking behavior among their children were almost homogenous. Adolescents who lived with smoking parents were more likely to initiate the smoking behavior compared to those with non-smoking family members. Meanwhile, studies showed adolescents from single-parent families were more likely to smoke when compared with those came from complete family. A negative association between single parent and daily smoking was observed among the adolescents. Conclusion: Future campaigns on smoking prevention should increase the involvement of family members, encourage parents to quit smoking and act as role model to their children; parents are suggested to practice authoritative parenting which will increase the acceptance of adolescents to their rules and suggestions and thus, avoid them from smoking. On the other hand, adolescents from single-parents are more likely to attain smoking and should increase awareness. More local researches, with randomized control trial studies, are needed in the future to examine family influences that fit the situation in Hong Kong. The aim of campaign is to further decrease smoking prevalence in adolescents. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

Thesis (M.A.)--University of British Columbia, 2004. / Includes bibliographical references (leaves 110-115). Also available online (PDF file) by a subscription to the set or by purchasing the individual file.

Thesis (M.A.)--University of British Columbia, 2004. / Includes bibliographical references (leaves 110-115).

published_or_final_version / Public Health / Master / Master of Public Health

Wan, Lai Yin. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 100-126). / Abstract also in Chinese. / ABSTRACT --- p.i / 摘要(ABSTRACT IN CHINESE) --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.vi / LIST OF FIGURES --- p.vii / Chapter CHAPTER I: --- INTRODUCTION --- p.1 / APPLYING THE THEORY OF PLANNED BEHAVIOR TO ADOLESCENT SMOKING --- p.5 / ATTITUDES TOWARDS THE BELIEFS ABOUT SMOKING --- p.6 / SUBJECTIVE NORMS ABOUT SMOKING --- p.11 / PERCEIVED BEHAVIORAL CONTROL OVER SMOKING --- p.14 / BEHAVIORAL WILLINGNESS AS A COMPLEMENTARY ASSESSMENT TO BEHAVIORAL INTENTION --- p.15 / EXTENSION OF THE TPB´ؤIMPORTANCE OF PERSONALITY IN ADOLESCENT SMOKING --- p.16 / ROLE OF DIRECT FAMILY AND PEER SMOKING --- p.24 / GENDER AS MODERATOR IN ADOLESCENT SMOKING --- p.25 / OVERVIEW OF THE STUDY --- p.29 / Chapter CHAPTER II: --- METHOD --- p.35 / PARTICIPANTS --- p.35 / PROCEDURE --- p.37 / MEASURES --- p.38 / DATA ANALYSES --- p.45 / Chapter CHAPTER III: --- RESULTS --- p.48 / DESCRIPTIVE STATISTICS AND CORRELATIONS AMONG MAJOR VARIABLES --- p.48 / DIFFERENCES IN MAJOR VARIABLES ACROSS GENDER AND ACROSS CURRENT SMOKING STATUS --- p.53 / MEASUREMENT APPLICABILITY OF INSTRUMENTS --- p.56 / IDENTIFICATION OF THE BASIC TPB MODEL --- p.57 / INCORPORATION OF BEHAVIORAL WILLINGNESS AS AN OUTCOME VARIABLES INTO TPB MODEL --- p.60 / "EFFECTS OF PERSONALITY, FAMILY SMOKING AND PEER SMOKING" --- p.63 / MULTI-SAMPLE INVARIANCE ANALYSES --- p.68 / MULTI-SAMPLE INVARIANCE ANALYSES WITH MALE AND FEMALE SAMPLES --- p.69 / MULTI-SAMPLE INVARIANCE ANALYSES WITH EVER-SMOKER AND NEVER-SMOKER SAMPLES --- p.75 / Chapter CHAPTER IV: --- DISCUSSION --- p.82 / GENERALIZABILITY OF RESULTS WITH THE PRESENT SAMPLE --- p.82 / APPLICABILITY OF MEASURES USED IN CHINESE ADOLESCENT SMOKING RESEARCH --- p.83 / SMOKING WILLINGNESS AS A MORE SENSITIVE ASSESSMENT IN ADOLESCENT SMOKING --- p.84 / UTILITY OF TPB COMPONENTS IN PREDICTING SMOKING INTENTION AND WILLINGNESS --- p.85 / THE IMPORTANT ROLE OF PERSONALITY IN EXPLAINING SMOKING INTENTION AND WILLINGNESS --- p.87 / SIGNIFICANT INFLUENCES OF FAMILY AND PEER SMOKING ON ADOLESCENT SMOKING --- p.91 / DIFFERENCES IN PREDICTING ADOLESCENT SMOKING ACROSS GENDER --- p.92 / IMPLICATIONS OF THIS STUDY --- p.94 / LIMITATIONS OF THIS STUDY --- p.95 / DIRECTIONS FOR FUTURE RESEARCH --- p.97 / REFERENCES --- p.100

Background: Even though a series of restrictions aimed at protecting dwellers from being addicted to tobacco are implemented in Hong Kong, the loopholes utilized by tobacco industry can still promote tobacco marketing by various strategies such as sponsorship in movies and charity activities. Therefore, it is still quite necessary to monitor the associations of intention to smoke with exposure to anti-smoking media messages and pro-smoking media messages among adolescents in Hong Kong. Objectives: Objectives of this study were to investigate exposure to pro- smoking media messages and pro-smoking media messages and their association with intention to smoke among adolescents in Hong Kong. Methods: This is a cross-sectional study based on secondary data collected from Smoking and Health Survey among Hong Kong Students 2010/11. Data from 61,810 secondary school students were analyzed. Exposure to anti- and pro- smoking media messages among adolescents in Hong Kong was assessed. Logistic regression was conducted to examine the association of intention to smoke with exposure to anti- and prosmoking media messages separately, and then examine the association of intention to smoke with exposure to anti- and pro- smoking media messages with taking exposure to anti- and pro- smoking media messages as a whole. Sub group analysis splitting the sample into never smokers and ever smokers were made throughout logistic regression models above. Results: In terms of prevalence of exposure to media, higher possibilities of exposure to prosmoking media messages and of exposure to anti-smoking media messages was found among females relative to males (39.9% versus 37.1% and 69.5% versus 68.1% respectively, both p<0.001). Besides, significant higher possibilities of exposure to pro-smoking media messages and of exposure to anti-smoking media messages than those without were detected (43.9% versus 34.4% and 71.9% versus 65.7% respectively, both p<0.001). Statistically significant positive associations were found between exposure to pro-smoking media messages and intention to smoke both among never smokers (OR=1.39, 95% CI: 1.26-1.52, p<0.001) and ever smokers (OR=1.35, 95% CI: 1.24-1.46, p<0.001). And, statistically significant negative associations were observed between exposure to anti-smoking media messages and intention to smoke among never smokers (OR=0.58, 95% CI: 0.53-0.63, p<0.001) and among ever smokers (OR=0.82, 95% CI: 0.76-0.89, p<0.001). In logistic regression models for both anti- and pro- smoking media messages, among never smokers, we found the lowest odd ratio was 0.56 (95% CI: 0.51-0.63, p<0.001), for category with exposure to anti-smoking media messages and no exposure to pro-smoking media messages. And the highest odds ratio was 1.33 (95% CI: 1.11-1.56, p=0.001), for the category with exposure to pro-smoking media messages and no exposure to antismoking media messages. For ever smokers, the lowest odds ratio was 0.82 (95% CI:0.75-0.89, p<0.001), for category with exposure to anti-smoking media messages and no exposure to pro-smoking media messages. And, the hightest odds ratio was 1.35 (95% CI: 1.10-1.66, p=0.004), for the category with exposure to pro-smoking media messages and no exposure to anti-smoking media messages. Conclusions: In both ever and never smokers, positive associations of intention to smoke with exposure to pro-smoking media messages were observed. However, a negative association of intention to smoke with exposure to anti-smoking media messages was only found for sub group of never smokers. For both never smokers and ever smokers, the group with exposure to pro-smoking media messages and no exposure to anti-smoking media messages had positively higher increase in the odds of intention to smoke relative to the group with exposure both to anti- and pro smoking media messages. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction Though the associations of general parenting styles and smoking-specific parenting practices with adolescent smoking have received much attention in recent years, important questions remain. Most general parenting studies focused on Caucasian parents but much less in the literature is known about Chinese parents. As for smoking-specific parenting practices in the household, anti-smoking practices have been the focus, with pro-smoking practices seldom being studied. The objectives of the present study were: 1) to examine general parenting styles of Hong Kong fathers and mothers, and their associations with adolescent current smoking; 2) to explore potential effect modifiers of the above associations—age/sex of the adolescent and parental smoking status; 3) to estimate the prevalence of adolescents’ exposure to smoking-specific parenting practices and the coexistence of pro-smoking and anti-smoking practices within a family; and 4) to examine the associations of smoking-specific parenting practices with adolescent current smoking status and their intention to smoke. Methods Data from 2 large-scale school surveys were used. In the Hong Kong Student Obesity Surveillance project (HKSOS), 34,678 secondary students aged 12-17 completed an anonymous questionnaire. Current smoking denoted any smoking in the past 30 days. The parenting style of each parent was classified as authoritative (high care/high control), authoritarian (low care/high control), permissive (high care/low control) or neglectful (low care/low control). Binary logistic regressions generated adjusted odds ratios (AORs) of current smoking for parenting styles, and parental care and control. In the Youth Smoking Survey (YSS) (2003/04), information of adolescent smoking behaviours, their exposure to smoking-specific parenting practices at home and socio-demographic characteristics was collected among 36,612 secondary 1-5 students. Pro-smoking practices included “buy cigarettes/hand cigarettes/light a cigarette/clean the ashtray for family members”, “easily see packages of cigarettes of family members at home”, “exposure to secondhand smoke at home” and “smoking among family members”. Anti-smoking practices were “parent-child communication about harms of smoking” and “anticipated control from father/mother if you were to smoke”. AORs of adolescent current smoking and their intention to smoke for each pro-smoking and anti-smoking practice were calculated. Results In HKSOS, over half of the fathers (51.5%) and mothers (66.2%) were authoritative. Current smoking (3.1%) was associated with lower levels of care both from father and mother, lower levels of maternal control, but higher levels of paternal control. Compared with authoritative fathers, the AORs (95% CI) of adolescent current smoking were 0.74 (0.59-0.93) for permissive, 1.13 (0.87-1.43) for authoritarian, and 0.99 (0.77-1.28) for neglectful. The corresponding AORs for mothers were 1.30 (1.04-1.61), 1.80 (1.34-2.41), and 2.49 (1.90-3.28). In YSS, 9.7% of adolescents were current smokers and 33.2% had the intention to smoke. About half the students (52.7%) reported pro-smoking practices and 87.8% reported anti-smoking practices at home. Anti-smoking practices were associated with lower odds of adolescent current smoking and intention to smoke, whereas pro-smoking practices were linked to higher odds. Conclusions Authoritative mothers and permissive fathers seemed to have protective effects against adolescent smoking. Pro-smoking practices were associated with higher odds of adolescent current smoking and intention to smoke, while anti-smoking practices were protective. / published_or_final_version / Community Medicine / Master / Master of Philosophy

This study explored whether a relationship exists between smoking behaviors and racial discrimination induced anger among Black adolescents. Participants consisted of 134 Black adolescents from 14 to 18 years of age who frequently visited a recreation center in the Northeast. Forty-four participants were males and 90 were females. All participants were administered a modified version of the CAGE questionnaire, a background information questionnaire, and a measure designed to assess the extent to which they feel angry because they had been discriminated against. Only age was found to be predictive of scores on the CAGE. Only gender was found to be predictive of smoking frequency. The Black Anger Measure (BAM) was significantly correlated with smoking behaviors. Some implications for theory, research and practice are suggested.

Using the stress process model, the relationship between pregnancy and depressive symptoms among adolescent girls was investigated. This model posits that stress resulting from social location and related disruptive life events may indirectly affect health by eroding coping, mastery, or social support mechanisms. The effect of low income, minority status and pregnancy on coping processes in adolescent girls was hypothesized and tested. Communication with parents, involvement in activities, and success in school were examined as positive coping strategies. Smoking tobacco, heavy alcohol use, and drug use were examined as negative coping. Data from the National Survey on Drug Use and Health were analyzed. After combining the available cases from the 2006, 2007, and 2008 datasets, selecting girls aged from 12 to 17 years, and removing missing cases; the sample consisted of a total of 22,854 adolescents. A series of binary logistic regression models were estimated. Findings included that coping strategies partially mediate the relationship between pregnancy and depressive symptoms. In particular, success in school, smoking tobacco, and drug abuse played a mediating role. When coping was accounted for, the relationship between pregnancy and depressive symptoms was reduced and became only marginally significant. Implications of the study include a focus on policy that promotes early intervention assisting at-risk adolescents with the development of coping strategies that may help them adjust to unexpected life events, such as pregnancy.