The Cigarette Smoking Initiation and Continuation in Adolescents Undergoing a Long-Term Behavioral Intervention

Abstract

Introduction Targeting adolescents’ smoking reduces its burden on health systems. We investigated the effects of the first multidisciplinary community-based lifestyle intervention in the Eastern-Mediterranean region, on smoking initiation, continuation and risk of current smoking in Iranian adolescents. Methods The current analyses were conducted on 945 non-smoker adolescents (12-18 years) who participated in Phase II of Tehran Lipid and Glucose Study (TLGS) and were examined four times in 12 years. The lifestyle intervention including school-based and public programs was implemented, focusing on all components of healthy lifestyle. Using two-step cluster analysis families were classified as high- and low-risk, based on parental risk factors of adolescents’ smoking. Participants who failed to complete all the follow-ups (n=99) and those with missing smoking data were excluded. Subsequently, 872 adolescents (538 control, 334 intervention) were included in the Cox model on smoking initiation and 674 adolescents (414 control, 260 intervention) were included in the logistic regression on smoking status. Results Mean age of adolescents was 15.08±1.94 years at baseline. The hazard of the smoking initiation was significantly lower in the intervention (HR=0.71, 95% CI: 0.51-0.99; P=0.044) compared to control group. At the end of the 4 th follow-up, intervention reduced the odds of current cigarette smoking by 29%. Within the intervention group, the high-risk cluster was at a 35% lower risk of initiating smoking and had 37% lower odds of becoming a current smoker. However, the intervention could not make a difference in preventing those who initiated smoking from maintaining it during the follow-ups. Conclusions Our results demonstrate that lifestyle modification programs targeting at-risk populations could reduce risk of smoking initiation and current smoking in adolescents in long-term. Implications Experiencing cigarette smoking at the critical period of adolescence could result in adulthood habitual smoking. Therefore, identifying adolescents who are more at risk of smoking initiation and implementing targeted interventions are of great importance in public health. Our findings highlight the long-term effectiveness of a multidisciplinary community-based behavioral intervention on forming smoking behaviors in adolescents. The current intervention was successful in reducing smoking uptake in adolescents living in high-risk families.

The Long‐Term Effectiveness of a Multisetting Lifestyle Intervention on Tobacco‐Related Habits in Adolescent Boys and Girls: Tehran Lipid and Glucose Study

“…14 The co-occurrence and inter-relations of parental risk factors in the family context affect children's tobacco use, and alters interventions effectiveness. 15 Although family-centered interventions have shown some effectiveness in smoking prevention in children, the evidence is not strong enough. 16 The methodological and design heterogeneity among existing interventions and behavioral programs make it difficult to draw conclusions about the best strategy, especially when maintaining the long-term effects.…”

“…In Iran, in particular, interventions have mostly targeted cigarette rather than other forms of tobacco use. [21][22][23][24] Our previous study in Iran 15 showed that although a multidisciplinary healthy lifestyle intervention could postpone smoking initiation and reduce the risk of becoming a current smoker in nonsmoking adolescents, it could not prevent continuation in those d Senior Researcher, (Jf˙sara@yahoo.com ), Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. e Biostatistician, (leila˙cheraghi63@yahoo.com ), Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.…”

“…Many antitobacco programs target families, as parental factors are among several influential factors in the formation and continuation of smoking behavior in the offspring 14 . The co‐occurrence and inter‐relations of parental risk factors in the family context affect children's tobacco use, and alters interventions effectiveness 15 . Although family‐centered interventions have shown some effectiveness in smoking prevention in children, the evidence is not strong enough 16 .…”

“…In Iran, in particular, interventions have mostly targeted cigarette rather than other forms of tobacco use 21‐24 . Our previous study in Iran 15 showed that although a multidisciplinary healthy lifestyle intervention could postpone smoking initiation and reduce the risk of becoming a current smoker in nonsmoking adolescents, it could not prevent continuation in those who initiated. Previous results have led us to answer whether this success in prevention can reduce the prevalence of cigarette smoking in the population level in the long‐term and whether this intervention can simultaneously reduce the prevalence of other direct and indirect forms of tobacco.…”