Characteristics of adolescent smoking in high school students in California

This pilot study assessed smoking-related behaviors, experiences, and beliefs among a sample of continuation high school students in California to inform dental hygienists about adolescent tobacco use and to assist with the development of effective tobacco cessation intervention strategies.

After gaining informed consent, we conducted a self-administered questionnaire among 117 adolescent volunteers in rural northern California. The questionnaire assessed demographic variables, lifetime tobacco use, current alcohol use and tobacco use status, early smoking experiences and sensations, factors that might motivate a quit attempt, depression index scores, and other psychosocial variables associated with adolescent smoking. Means and frequencies were generated to evaluate characteristics of tobacco use in this sample of adolescents. Variables of interest were stratified by regular and social smokers. Univariate association of smoking with alcohol use is described by an odds ratio with a 95% confidence interval. Wilcoxon rank sum tests were used to evaluate gender differences among mean depression index scores.

Fifty percent of subjects were current smokers, 21% had tried smoking, 5% were former smokers, and 24% had never smoked. Current smokers were 8 times more likely to drink alcohol compared to nonsmokers (OR = 8.0; 95% CI 3.1 - 21.2). Among current smokers, 32% were classified as regular smokers and 18% as social smokers. Sixty-three percent of regular smokers and 42% of social smokers reported smoking within 30 minutes of waking, an indicator of nicotine dependence. Patterns of smoking were variable in rate and frequency ranging from 1 to 30 cigarettes per day. Current female smokers scored higher on the modified Beck Depression Inventory (0-3) than current male smokers (p < 0.001). Oral health issues related to tobacco use, such as gum disease and tooth staining, were identified as factors that might motivate a quit attempt. Frequently reported reasons for use (eg, tension and craving) and reasons for relapse (eg, desire remained high, withdrawal symptoms) were related to nicotine dependence. Fifty-three percent of all smokers had tried to stop smoking but were unsuccessful. Intrapersonal characteristics such as risk-taking, rebellion, and impulsive spending appeared to be related to smoking.

In this sample of adolescents, smoking patterns were variable and many adolescents experienced symptoms of nicotine dependence. The dental hygiene care appointment provides a unique opportunity to discuss oral health effects of smoking, relate oral changes to smoking, and to deliver a brief smoking cessation intervention.