Category: Smoking

— In one of the largest studies of its kind to date, researchers have found that babies born to mothers who smoke while pregnant face substantial delays in early neurological development, and the effects may be stronger than researchers had previously thought.

According to the study, published in the Journal of Human Capital, smoking may cause as much as a 40 percentage point increase in the probability of being at risk of developmental problems in babies between 3 and 24 months old. The effects were strongest among children from poor families, the research found.

"This study underscores the dangers of prenatal smoking," said George Wehby, a professor at the University of Iowa's College of Public Health and the study's lead author. "We hope it also highlights the need for continued efforts to discourage expectant mothers from smoking."

Study subjects were recruited from health clinics in Argentina, Brazil, and Chile. In all, nearly 1,600 children were included, making this one of the largest studies of prenatal smoking and neurodevelopment. The researchers surveyed mothers about their smoking habits, and neurological screening, which included cognitive tests and assessments of communication and basic neurological function, were administered to children by trained physicians.

Nearly 11 percent of mothers in the sample had smoked during pregnancy.

Part of the reason smoking affects poor children to a greater degree is that poor mothers who smoke tend to do so in greater quantity, the study found. But the number of cigarettes doesn't fully explain the difference. "Being of higher socioeconomic status may offset some of the adverse smoking effects through better health behaviors and improved access to prenatal care," Wehby said.

Previous studies have found similar adverse effects of prenatal smoking, but no previous work has tried to isolate the smoking effect from other potentially confounding factors, the researchers say. For example, mothers who smoke may also be more likely to drink and engage in other activities that could harm their babies. If that's the case, then studies may overestimate the adverse effects of cigarettes. On the other hand, women who have high risk pregnancies have an extra incentive to avoid smoking, but still have babies with reduced neurodevelopment. If that's the case, then studies may underestimate the effects of smoking.

Wehby and his team used a statistical technique that helps to account for these biases, which are difficult to observe directly. They took advantage of differences in smoking behaviors across the geographic locations of the mothers. Geographic differences in smoking are expected to be caused by variation in cigarettes prices and smoking policies, but are unlikely to be related to the unobservable individual-level preference for taking risk. This control allows the researchers to pin-point the smoking effect specifically.

With the controls in place, the smoking effect was found to be stronger than without them, suggesting previous studies that didn't use such controls had actually underestimated the effects of smoking.

Despite increased awareness of the dangers of smoking, rates of prenatal smoking remain surprisingly high. According to the Centers for Disease Control and Prevention, 12 percent of pregnant American women reported that they smoked while pregnant in 2005.

"Given the importance of early child health and neurodevelopment for future wellbeing, targeted interventions to reduce prenatal smoking may result in significant improvements in child development and long-run human capital," Wehby said.

Journal Reference:

1. George L. Wehby, Kaitlin Prater, Ann Marie McCarthy, Eduardo E. Castilla, Jeffrey C. Murray. The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. Journal of Human Capital, 2011; 5 (2): 207 DOI: 10.1086/660885

— Tobacco related disease is a primary source of mortality for African American men. Recent studies suggest that "alternative" tobacco products may have supplanted cigarettes as the most common products used by young African Americans, according to new research published in the August 2011 issue of Otolaryngology — Head and Neck Surgery.

While the tobacco-related disease burden is higher in African American adults, prevalence rates of tobacco use among young African American teens are surprisingly lower than those reported for whites. This picture changes in early adulthood. According to the National Survey on Drug Use and Health conducted between 2002-2005, 29.7% of white males 18 years of age and older reported smoking cigarettes in the past 30 days as compared to 33.6%% of African American men.

Study results show cigarettes were the most common product ever (54%) and currently (39.9%) used. Participants who attended school for 12 years or attended religious services were less likely to use cigarettes. Marijuana and blunts, mini-cigars, were used next most commonly. Only 35 respondents (8.9%) currently used mini-cigars. Other products, bidis/kreteks, smokeless tobacco, and pipes were used uncommonly in this sample.

"Tobacco-related disease disparities are magnified in the rural counties of the Black Belt region in rural Alabama," said study author William Carroll, MD. "The Black Belt counties are named for the rich dark soil that supported the agricultural industry of an earlier era. These counties are predominantly African American, among the poorest counties in the US, and are characterized by striking health disparities when compared to the remainder of the state and the nation as a whole."

The study included interviewer administered surveys that were completed among African American males, aged 19 to 30, in five of the Black Belt counties of rural Alabama. Participants were stratified by income (above and below poverty level) and educational level (12th grade above/below) with target representation in the stratification table informed by U.S. census data for the Black Belt counties. Distribution of survey participants within the stratification table was monitored to ensure representative sampling of the Black Belt counties.

Cigarette use prevalence in rural Alabama far exceeds that measured statewide for African American men of the same age. Effective community based intervention must target cigarette initiation and cessation in this vulnerable population.

Otolaryngology — Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology — Head and Neck Surgery Foundation (AAO-HNSF). The study's authors are William R. Carroll, MD; Herman R. Foushee, Jr., PhD; Claudia M. Hardy, MPA; Tammi Floyd; Catherine F. Sinclair, MD; Isabel Scarinci, PhD.

Journal Reference:

1. W. R. Carroll, H. R. Foushee, C. M. Hardy, T. Floyd, C. F. Sinclair, I. Scarinci. Tobacco Use among Rural African American Young Adult Males. Otolaryngology — Head and Neck Surgery, 2011; 145 (2): 259 DOI: 10.1177/0194599811404968

Raising taxes on cigarettes, a public health measure used by governments to encourage people to quit, doesn't motivate all smokers to stop the deadly habit.

A study on the long-term impact of taxing cigarettes, led by two Concordia University economists and published in the International Journal of Environmental Research and Public Health, found higher taxes do prompt low-and middle-income earners to quit.

Yet price increases don't persuade wealthier smokers or those aged 25 to 44 to butt out.

"Contrary to most studies, we find that the middle-aged group, which constitutes the largest fraction of smokers in our sample, is largely unresponsive to taxes," says first author Sunday Azagba, a PhD candidate in the Concordia Department of Economics. "While cigarette taxes remain popular with policy-makers as a key anti-smoking measure, their effectiveness largely depends on how people respond to them."

The research team examined data collected by Statistics Canada, specifically the National Population Health Survey conducted from 1998-99 to 2008-09. They analyzed three categories of daily smokers: People aged 12 to 24, 25 to 44 and 45 to 65.

A conventional belief among policy makers is that higher cigarette prices will reduce smoking among target populations such as high school students. "Overall, it was smokers from lower socioeconomic groups who are more price-responsive than those from higher socioeconomic groups," says co-author Mesbah Sharaf, a PhD candidate in the Concordia Department of Economics. "If there is a 10 per cent increase in taxes then smoking participation will fall by about 2.3 per cent."

The research team also found people with post-secondary education were less likely to smoke than those with less than high school education. "If smokers are sophisticated about their self-control and responsive to prices, taxes could act as a self-control incentive for them," says Azagba. "Higher taxes for some people, when consumption of addictive goods is driven by cues, may be counterproductive."

Canadian smokers, international picture

The substantial social, economic and health costs caused by tobacco use have led many countries to adopt higher cigarette taxes as a policy to reduce smoking. The World Health Organization estimates five million people around the globe die each year due to smoking-related illnesses and forecasts such deaths will increase to eight million people annually by 2030.

In Canada, cigarettes are taxed by both the federal, provincial and territorial governments. While smoking rates in Canada have been declining for more than two decades, says Azagba, "The lowest percentage of smokers can be found among women who are married, older, with high income and more education."

Journal Reference:

1. Sunday Azagba, Mesbah Sharaf. Cigarette Taxes and Smoking Participation: Evidence from Recent Tax Increases in Canada. International Journal of Environmental Research and Public Health, 2011; 8 (5): 1583 DOI: 10.3390/ijerph8051583

 You might think that you will gain weight if you quit smoking. But it's not that simple. A master's thesis from the Nordic School of Public Health (NHV) in Sweden shows that smoking doesn't help you get thinner.

While cigarette smoking has decreased in western countries, obesity has increased. Recent studies have suggested that today's smokers may have less weight problems than non-smokers. "That's why I wanted to study whether the relationship between smoking and overweight has changed over time," said Lisa Webb, Master of Public Health at NHV.

Approximately 6,000 people have participated in a study on the relationship between smoking and obesity. Two measure of body fat have been used: BMI (body mass index) and WHR (waist hip ratio). The master's thesis "Smoking in the age of obesity: an investigation of secular trends in body fat and cigarette smoking" shows higher WHR for male and female smokers but lower BMI for female smokers, as compared with non-smokers.

A particularly noteworthy finding was that the difference between WHR among female smokers and never-smokers increased during the study.

Proactive telephone counseling helps smokers quit regardless of how they are recruited to a telephone quitline, according to a study published online June 10th in the Journal of the National Cancer Institute.

Smokers who use telephone counseling quitlines may do so in response to active recruitment methods, such as physician referral or direct mail or phone calls, or passive methods, such as posters or television ads. Whether quitlines are equally effective for actively recruited smokers and passively recruited smokers has been a key question.

In this study, Flora Tzelepis, Ph.D., of the University of Newcastle in New South Wales, Australia, and colleagues analyzed 24 previous studies of proactive telephone counseling to see whether the method of recruitment made a difference in quit rates. They looked at both point prevalence abstinence — the number of smokers who had not smoked for at least a day or a week before the interview — and at prolonged or continuous abstinence over a period of months.

The researchers found that proactive counseling helped increase long-term smoking cessation regardless of how the smokers were recruited. Quitlines had a statistically significantly positive effect on prolonged and continuous abstinence after 6-9 months and after 12-18 months. Their effect on point prevalence abstinence was also statistically significant at 6-9 months, but not at the longer-term followup.

"In general," the authors write, "our findings have strengthened the support for proactive telephone counseling for smoking cessation. " They note, however, that few active-recruitment trials are available to evaluate the impact of the recruitment channel on prolonged/continuous abstinence, particularly in the midterm, and that additional data are urgently needed.

In an accompanying editorial, Damon Vidrine, Dr.P.H., and Jennifer Irvin Vidrine, Ph.D., of the University of Texas M. D. Anderson Cancer Center in Houston note that smokers in this study who responded to advertisements and other passive recruitment efforts were more willing to set a quit date in the next month compared to actively-recruited smokers. This suggests they were more highly motivated to quit.

Therefore, the editorialists write, the fact that active recruitment methods resulted in quit rates almost as high as passive recruitment has "enormous implications for the public health impact of quitline-delivered cessation treatment." They conclude that an important direction for future research will be to develop and extend active recruitment approaches.

Journal Reference:

1. F. Tzelepis, C. L. Paul, R. A. Walsh, P. McElduff, J. Knight. Proactive Telephone Counseling for Smoking Cessation: Meta-analyses by Recruitment Channel and Methodological Quality. JNCI Journal of the National Cancer Institute, 2011; DOI: 10.1093/jnci/djr169

Where you live, how old you are and whether you're male or female all affect your chances of giving up smoking. These are the findings of a study which suggests that while NHS stop smoking services are effective in supporting some smokers to quit there are significant differences in the longer term success rates for specific groups who are trying to give up smoking.

The study, commissioned by the National Institute for Health and Clinical Excellence (NICE) and undertaken by the UK Centre for Tobacco Control Studies (UKCTCS), reviewed published studies from between 1990 and 2007 to establish success rates for the NHS smoking cessation services. It found that older smokers are more likely than young smokers to successfully quit, some men appear to be more successful at quitting than women despite the fact that more women attend the smoking cessation services, and more disadvantaged groups face greater challenges when giving up smoking.

The findings support other international research that also suggests that while women are highly motivated to quit smoking, men may be more likely to succeed when they access services to help them stop. Several factors seem to explain the lower success rates of women, such as less confidence in quitting, the inter-relationship between gender and deprivation and differences in the meaning and role of tobacco in men and women's lives.

Pregnant women and more disadvantaged groups face particular challenges in quitting. Pregnant smokers who enrol in smoking cessation programmes may just suspend their smoking for the duration of their pregnancy as opposed to quitting altogether. These smokers are more likely to be shift and manual workers and may experience multiple barriers that make it harder to stop smoking in the long-term.

There are similar difficulties for smokers from more deprived areas where smoking is more prevalent. In such areas, smoking is often perceived as the norm which makes quitting harder.

While cessation rates for smokers accessing NHS stop smoking services were lower in disadvantaged areas (52.6 per cent) than elsewhere (57.9 per cent) the proportion of smokers being treated by the services was higher (16.7 per cent compared with 13.4 per cent). The net effect with the additional treatment meant that a higher proportion of smokers in the most disadvantaged areas reported success (8.8 per cent) than in more advantaged areas (7.8 per cent).

The UK remains the only country in the world to have a comprehensive, free-at-the-point-of-use cessation services and the study suggests that these services do provide effective support for smokers who want to quit. However, a number of important research questions remain regarding the effectiveness of different forms of intervention offered by the services.

For example, because gender, ethnicity, class, age and level of dependency affect success in giving up smoking, tailored interventions may help to improve cessation rates. In the case of pregnant women, two reviews of NHS smoking cessation services provide evidence that the most effective treatment for pregnant smokers includes elements such as systematic training of midwives in how to refer pregnant smokers, flexible home visits, and providing intensive multi-session treatments delivered by a small number of dedicated staff.

The research team concluded that NHS stop smoking services have made a contribution to reducing inequalities in smoking prevalence. To achieve government targets will require both the development of more innovative cessation interventions for some specific groups of smokers and recognition that tobacco control policy will need to take account of the unique challenges these groups face when trying to quit smoking.

Journal Reference:

1. L. Bauld, K. Bell, L. McCullough, L. Richardson, L. Greaves. The effectiveness of NHS smoking cessation services: a systematic review. Journal of Public Health, 2009; 32 (1): 71 DOI: 10.1093/pubmed/fdp074

 When a new tobacco-free policy was instituted at an Ohio women's substance abuse treatment center, both smokers and non-smokers were more likely to leave treatment early in the first few months after the policy change, a new study found.

The results don't mean treatment centers shouldn't try smoking bans, according to the researchers, but they do highlight the challenges involved with implementing a new policy that goes against years of conventional thinking.

Researchers found that the number of patients who completed a program at the women's treatment center decreased 28 percentage points — from 70 to 42 percent — following the center's implementation of a tobacco-free policy.

"Following the implementation of the new policy, clients were significantly less likely to complete treatment than they were prior to the adoption of tobacco-free policies," said Thomas Gregoire, co-author of the study and associate professor of social work at Ohio State University.

This treatment center was the first to go tobacco-free in Ohio, Gregoire said. Tobacco-free treatment facilities began in New Jersey during the 90's and they are now making their way to other parts of the country.

"Despite the growing body of research about the problems of smoking in treatment facilities, the use of tobacco still retains a protected status in the addictions community and is largely untreated," said Gregoire.

The study appears in the current issue of Journal of Social Work Practice in the Addictions.

Treatment facilities tend to allow patients to smoke because many officials believe that treating a person for smoking in addition to other substance abuse would be too difficult and most likely result in failure, Gregoire said. Treatment centers may also fear that a smoking ban could cause them to lose business.

Many patients use cigarettes as a crutch to help them cope while trying to defeat other addictions, although smoking may be just as much of a problem.

"You behave very similarly with a cigarette as you would with any other drug," said Gretchen Hammond, who works for Amethyst Inc. in Columbus, Ohio and collaborated with Gregoire on the research. "So, for example, if I'm having a bad day I'll try to smoke it away verses talking to someone or going to therapy and working on the problem."

"Just like any other substance abuse, smoking is more than just a habit — it's an addiction. But, cigarettes are still commonly used today by treatment facilities as a means of maintaining sobriety within patients," Gregoire continued.

"In our study, 78 percent of the patients were tobacco-users," said Hammond. "The leading causes of death in chemically dependent persons are tobacco-related illnesses, which is why it is so important that treatment facilities offer treatment from all substance abuse, including smoking," Hammond said.

Looking at past records in a sample of 401 women, 147 of them admitted within the first 18 months of the study — when tobacco was allowed — and 214 women admitted within the last 18 months — when tobacco was banned from the premises — the researchers found that success rates dropped within the first 3 months after implementing the policy.

The center had an average success rate of 70 percent over the first 18 months, and this dropped to an average success rate of 42 percent by the end of the first 90 smoke-free days, Gregoire and Hammond noted. Not only did success rates drop, but the average number of days that patients remained in the program fell from 61 to 48 days. The center allowed a maximum of 90 days stay for their patients.

Gregoire and Hammond found that the rate that smokers checked themselves out before successfully completing the program increased after the tobacco-free policy. But the number of early checkouts for nonsmokers also increased after the center instigated the policy.

They noticed that 20 percent of smokers and 7 percent of non-smoking clients checked out early when the facility allowed tobacco. Those numbers increased to 42 and 22 percent respectively after the policy was issued.

In addition to client-initiated discharges, the rate of staff-initiated dismissals also experienced an initial increase during the first 90 days following the policy's implementation — increasing approximately 5 percentage points regardless of whether the patient used tobacco.

After the first 90 days, the staff-discharge rate decreased close to its original rate before the policy, while the client-initiated discharge rate remained unusually high.

"General climate and the sense of dissatisfaction in the treatment agency at the time of the initial implementation could pose as a possible explanation for the higher rate of staff-initiated discharges," said Gregoire.

This initial increase in program failure rates may discourage facilities from implementing a tobacco-free policy because of the loss of revenue, said Gregoire. However, past research has proven that treating patients for tobacco and other substance abuse is most likely the best choice for the patient in the long run.

Journal Reference:

1. Gretchen Clark Hammond, Thomas Gregoire. Breaking Ground in Treating Tobacco Dependence at a Women's Treatment Center. Journal of Social Work Practice in the Addictions, 2011; 11 (1): 1 DOI: 10.1080/1533256X.2011.544606

The effects of nicotine upon brain regions involved in addiction mirror those of cocaine, according to new neuroscience research.

A single 15-minute exposure to nicotine caused a long-term increase in the excitability of neurons involved in reward, according to a study published in The Journal of Neuroscience. The results suggest that nicotine and cocaine hijack similar mechanisms of memory on first contact to create long-lasting changes in a person's brain.

"Of course, for smoking it's a very long-term behavioral change, but everything starts from the first exposure," said Danyan Mao, PhD, postdoctoral researcher at the University of Chicago Medical Center. "That's what we're trying to tackle here: when a person first is exposed to a cigarette, what happens in the brain that might lead to a second cigarette?"

Learning and memory are thought to be encoded in the brain via synaptic plasticity, the long-term strengthening and weakening of connections between neurons. When two neurons are repeatedly activated together, a stronger bond forms between them, increasing the ability of one to excite the other.

Previous research in the laboratory of Daniel McGehee, PhD, neuroscientist and associate professor in the Department of Anesthesia & Critical Care at the Medical Center, discovered that nicotine could promote plasticity in a region of the brain called the ventral tegmental area (VTA). Neurons that originate in the VTA release the neurotransmitter dopamine, known to play a central role in the effects of addictive drugs and natural rewards such as food and sex.

"We know that a single exposure to physiologically relevant concentrations of nicotine can lead to changes in the synaptic drive in the circuitry that lasts for several days," said McGehee, senior author of this study. "That idea is very important in how addiction forms in humans and animals."

In the new experiments, Mao monitored the electrical activity of VTA dopamine neurons in slices of brain dissected from adult rats. Each slice was bathed for 15 minutes in a concentration of nicotine similar to the amount that would reach the brain after smoking a single cigarette. After 3-5 hours, Mao conducted electrophysiology experiments to detect the presence of synaptic plasticity and determine which neurotransmitter receptors were involved in its development.

Mao discovered that nicotine-induced synaptic plasticity in the VTA is dependent upon one of the drug's usual targets, a receptor for the neurotransmitter acetylcholine located on the dopamine neurons. But another element found necessary for nicotine's synaptic effects was a surprise: the D5 dopamine receptor, a component previously implicated in the action of cocaine. Blocking either of these receptors during nicotine exposure eliminated the drug's ability to cause persistent changes in excitability.

"We found that nicotine and cocaine employ similar mechanisms to induce synaptic plasticity in dopamine neurons in VTA," Mao said.

While the subjective effects of nicotine and cocaine are very different in humans, the overlapping effects of the two drugs on the reward system of the brain may explain why both are highly addictive substances, the researchers said.

"We know without question that there are big differences in the way these drugs affect people," McGehee said. "But the idea that nicotine is working on the same circuitry as cocaine does point to why so many people have a hard time quitting tobacco, and why so many who experiment with the drug end up becoming addicted."

The overlap between nicotine and cocaine effects at the D5 receptor may also offer a novel strategy for preventing or treating addiction. However, currently-known blockers of the receptor also block another dopamine receptor, D1, that is important for normal, healthy motivation and movement.

"This dopamine receptor is attractive as a potential target," McGehee said. "The real challenge is to tweak the addictive effect of drugs like nicotine or other psychostimulants without totally crushing the person's desire to pursue healthy behavior."

Future research will also focus on whether repeated exposure to nicotine, as would occur in a regular smoker, changes the drug's effects on synaptic plasticity in the VTA. In the meantime, the current study builds evidence that addictive drugs appropriate the neurobiological tools of learning and memory to create long-term changes in brain reward pathways.

"It's all fitting with the overriding idea that changes in synaptic strength are part of the way these drugs motivate behavior in a persistent way," McGehee said.

The study, "Nicotine Potentiation of Excitatory Inputs to Ventral Tegmental Dopamine Neurons," will be published May 4, 2011 by The Journal of Neuroscience. In addition to Mao and McGehee, Keith Gallagher of the University of Chicago is a co-author.

The research was supported by grants from the Women's Council of the Brain Research Foundation and the National Institutes of Health.

NewsPsychology (May 3, 2011) — Exposure to secondhand smoke, such as a person can get by riding in an enclosed car while someone else smokes, has a direct, measurable impact on the brain — and the effect is similar to what happens in the brain of the person doing the smoking. In fact, exposure to this secondhand smoke evokes cravings among smokers, according to a study funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

The study, published May 1 in Archives of General Psychiatry, used positron emission tomography (PET) to demonstrate that one hour of secondhand smoke in an enclosed space results in enough nicotine reaching the brain to bind receptors that are normally targeted by direct exposure to tobacco smoke. This happens in the brain of both smokers and non-smokers.

Previous research has shown that exposure to secondhand smoke increases the likelihood that children will become teenage smokers and makes it more difficult for adult smokers to quit. Such associations suggest that secondhand smoke acts on the brain to promote smoking behavior.

“These results show that even limited secondhand smoke exposure delivers enough nicotine to the brain to alter its function,” said NIDA Director Nora D. Volkow, M.D. “Chronic or severe exposure could result in even higher brain nicotine levels, which may explain why secondhand smoke exposure increases vulnerability to nicotine addiction.”

“This study gives concrete evidence to support policies that ban smoking in public places, particularly enclosed spaces and around children,” said Arthur Brody, M.D., of the UCLA Department of Psychiatry & Biobehavioral Sciences and corresponding author for the article.

The Surgeon General’s Report concluded in 2006 that secondhand smoke causes heart disease and lung cancer in nonsmoking adults and many serious health conditions in children, including sudden infant death syndrome, respiratory infections, and more severe asthma. According to the CDC, almost 50,000 deaths per year can be attributed to secondhand smoke.

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The above story is reprinted (with editorial adaptations by newsPsychology staff) from materials provided by NIH/National Institute on Drug Abuse.

Journal Reference:

1. C. S. Culbertson, J. Bramen, M. S. Cohen, E. D. London, R. E. Olmstead, J. J. Gan, M. R. Costello, S. Shulenberger, M. A. Mandelkern, A. L. Brody. Effect of Bupropion Treatment on Brain Activation Induced by Cigarette-Related Cues in Smokers. Archives of General Psychiatry, 2011; DOI: 10.1001/archgenpsychiatry.2010.193

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of NewsPsychology or its staff.

Parents shouldn't let up when it comes to discouraging their kids from smoking. That's the message of a study presented on May 2, at the Pediatric Academic Societies (PAS) annual meeting in Denver.

Previous research has shown that parents can deter adolescents from smoking by monitoring them and enforcing anti-smoking practices at home. Researchers, led by E. Melinda Mahabee-Gittens, MD, an emergency medicine physician at Cincinnati Children's Hospital Medical Center, sought to determine if family factors continue to protect adolescents as they grow older and whether these factors affect youths of varying racial/ethnic backgrounds differently.

Investigators studied 3,473 pairs of white, black and Hispanic parents and nonsmoking youths who participated in the National Survey of Parents and Youth in November 1999-June 2001 (Time 1) and again in July 2002-June 2003 (Time 2). They looked at whether youths remained nonsmokers throughout the study period, and they assessed changes in family factors thought to protect against smoking initiation over time.

Results showed no differences in the rate of smoking initiation between Time 1 and Time 2 by race. In addition, youths in all three racial/ethnic groups reported associating more with peers who smoked at Time 2 than at Time 1.

The levels of protective family factors decreased significantly from Time 1 to Time 2 across all racial/ethnic groups in both smokers and nonsmokers. However, levels of protective factors were consistently higher in nonsmoking youths compared to smokers. Continued, higher levels of connectedness and monitoring by parents decreased the risk of smoking initiation by as much as 30 percent in both whites and Hispanics.

Meanwhile, decreases in the following family factors from Time 1 to Time 2 were associated with an increased risk that youths would start smoking: 1) punishment: up to 43 percent increased risk in all three racial/ethnic groups; 2) monitoring: 42 percent increased risk in blacks only; and 3) connectedness: up to 26 percent increased risk in both blacks and Hispanics.

"Even though the level of protective family factors decreased as youth grew older, they remained important in continuing to protect against smoking initiation," said Dr. Mahabee-Gittens, who is also associate professor of pediatrics at the University of Cincinnati. "These findings support smoking prevention interventions that encourage parents of all three racial/ethnic groups to enforce consistent consequences of smoking behavior, and encourage continued monitoring and connectedness in minority groups."