Smoking among school adolescents in Salvador (BA)

Abstracts

BACKGROUND: Most tobacco users become addicted during adolescence. In Brazil, smoking prevalence among teenagers varies from 1% to 35%. OBJECTIVE: To estimate the prevalence of smoking among teenagers, aged from 13 to 20, in fundamental and high school in Salvador, Bahia, Brazil. METHOD: Cross-sectional exploratory study. Thirty five hundred questionnaires were applied to students at fundamental and high school in five schools at the metropolitan region of Salvador (BA). Statistical analysis: descriptive and associative measurements (Prevalence Rate), Student's t and qui-square tests. RESULTS: Smoking prevalence among teenagers in Salvador (BA) was 9.6%, considering 3,180 valid questionnaires. The frequency was higher in males (14%) than in females (6%). The prevalence increased with age. The mean age ± SD for tobacco initiation was 14 ± 2 years. Among the teenagers, 46% tried cigarettes, and 20% became addicted. The frequency was higher among teenagers whose parents were smokers. The mean ± SD number of daily cigarettes smoked by adolescent tobacco users (n = 132) was 7.4 (± 6.4) units per day, with a higher frequency among boys. CONCLUSION: Smoking prevalence in a selected set of adolescent students in Salvador (BA) was 9.6%, and it was higher among males. Parental smoking and cigarette experimentation were the major factor found to be associated to tobacco addiction among teenagers.

Smoking; Adolescents; Students; Tobacco

INTRODUÇÃO: O hábito de fumar em geral se inicia na adolescência. No Brasil, as estimativas da freqüência deste hábito entre adolescentes variam de 1% até 35%. OBJETIVO: Estimar a prevalência do tabagismo entre os adolescentes da oitava série do ensino fundamental à terceira série do curso médio, em escolas de Salvador - Bahia, Brasil. MÉTODO: Feito um estudo do tipo corte transversal de caráter exploratório. Foram aplicados 3.500 questionários a alunos matriculados entre a 8ª série do ensino fundamental e a 3ª série do ensino médio, em cinco escolas da região metropolitana de Salvador (BA). Análise estatística: medidas descritivas e de associação (razão de prevalência) e o teste t de Student e o do qui-quadrado. RESULTADOS: A prevalência do tabagismo entre adolescentes de Salvador (BA) foi de 9,6%, considerando-se os 3.180 questionários válidos, sendo maior no sexo masculino (14%) que no feminino (6%). À medida que aumentava a idade, elevava-se essa prevalência. A média de idade do início do tabagismo foi de 14 ± 2 anos. Dentre adolescentes, 46% experimentaram o cigarro e 20% destes continuaram fumando. Entre filhos de fumantes a freqüência foi maior. O número médio de cigarros consumidos por dia pelos adolescentes que fumavam diariamente (n = 132) foi de 7 ± 6, sendo maior no sexo masculino. CONCLUSÃO: A prevalência do tabagismo em uma amostra selecionada de adolescentes escolares de Salvador (BA) foi de 9,6%, sendo maior entre os indivíduos do sexo masculino. A experimentação e a influência dos pais foram associadas ao tabagismo nos adolescentes.

Tabagismo; Adolescente; Estudantes; Tabaco

ORIGINAL ARTICLE

Smoking among school adolescents in Salvador (Bahia)^*

Adelmo Souza Machado Neto^I (te-sbpt); Álvaro A. Cruz^II (te-sbpt)

^IPostgraduate student in Internal Medicine at the UFBA School of Medicine, and Specialist, as designated by the Brazilian Society of Pulmonology and Phthisiology

^IICoordinator of the Respiratory Diseases Center, Associate Professor in Internal Medicine at the UFBA School of Medicine, and Specialist, as designated by the Brazilian Society of Pulmonology and Phthisiology

^{Correspondence}

ABSTRACT

BACKGROUND: Most smokers take up the habit during adolescence. In Brazil, estimates regarding the percentage of adolescent smokers vary from 1% to 35%.

OBJECTIVE: To estimate the prevalence of smoking among students between the ages of 13 and 20 in junior high and high school in the city of Salvador, in the state of Bahia, Brazil.

METHOD: Cross-sectional survey study. Questionnaires were administered to 3,500 students at 5 junior high and high schools in the metropolitan area of Salvador, Bahia. Statistical analysis involved descriptive and associative measurement (prevalence rates), chi-square test and student's t-test.

RESULTS: Based on 3,180 valid questionnaires, smoking prevalence among adolescents in Salvador was found to be 9.6%. There were more male (14%) than female (6%) smokers, and smoking prevalence increased with age. The mean age for tobacco initiation was 14 ± 2 years. Among adolescents, 46% had tried cigarettes, and 20% became smokers. Adolescents whose parents were smokers were more likely to become smokers themselves. The mean number of cigarettes smoked per day by adolescent tobacco users (n = 132) was 7.4 (± 6.4), with higher numbers among boys.

CONCLUSION: Smoking prevalence in a selected set of adolescent students in Salvador was 9.6%, and it was higher among males. Parental smoking and cigarette experimentation were the major factors found to be associated with the smoking habit among adolescents.

Key words: Smoking/epidemiology. Adolescents. Students. Tobacco.

Abbreviations used in this paper

95% CI – 95% confidence interval

PR – Prevalence ratio

MAS – metropolitan area (of the city of) Salvador

SD – Standard deviation

Introduction

Most cigarette smokers develop the habit during adolescence. It is well known that smoking can lead to premature disability and disease and that diseases which affect adults and the elderly can also occur among young people.^(1,2) Data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994, National Center for Health Statistics, Centers for Disease Control, USA), showed a 10% to 15% prevalence of obstructive respiratory functional changes related to tobacco among people from 17 to 24 years of age.⁽³⁾ In addition, adolescents who smoke suffer from respiratory symptoms and infections, diseases of the mouth and decreased physical capacity more frequently than do adolescent nonsmokers.^(4-8) Formation of the smoking habit is, of course, common among adolescent smokers.⁽⁹⁾ Evaluating smoking behavior among adolescents is therefore important.

Despite increased knowledge about the health risks related to smoking, the percentage of adolescents who smoke has remained constant, and falling percentages have been observed only among adults.⁽¹⁰⁾ Epidemiological data from the USA reveals that, from 1965 to 1995, 15% to 49% of the younger population smoked cigarettes and that 90% of adult smokers started to smoke by the age of 18.^(2,10) In the USA, 3,000 children become smokers every day and, since 1991, 22% to 27% of young adults have maintained the habit, despite decreased numbers of cigarette advertisements and increased numbers of preventive campaigns.^(11,12) In the year 2000, a study conducted in the European Union showed that the prevalence of smoking among adolescents was higher among males, reaching 35% in France.⁽¹³⁾ In Latin America, varying statistics have been published regarding adolescent smoking: in 1988, 1997 and 1999 in Chile, the rate was between 10% and 64%, with a mean age of initiation of 13.6 years; in Costa Rica in 1987, a 28.4% prevalence was seen for this age group; and, in 1994 on Easter Island (Rapa Nui), the rate was 50%.^(14-18)

In Brazil, estimates of the prevalence of smoking among adolescents have varied from 1% to 37.7%.^(19–22) Data from a 1989 report by the Brazilian Ministry of Health show that there were 30.6 million smokers (18 million males and 12.6 million females), corresponding to 24.6% of the population above the age of 5.⁽²³⁾ In 2001, the prevalence of smoking among adolescents between 12 and 17 years of age was 15.7%: 16.2% among males and 15.2% among females.⁽²⁰⁾ The Ministry of Health also published data showing that, between 1987 and 1997, there was an increase in cigarette experimentation in 10 state capitals.⁽²³⁾ Another study showed that 53% of Brazilians over the age of 35 had tried tobacco.⁽²⁰⁾ The most recent study of smoking among adolescents in the city of Salvador (in the state of Bahia, Brazil) was conducted in 1987.⁽¹⁹⁾ Among public and private school students, the authors found the prevalence of smoking to be 1%.

Based on these epidemiological data, the primary objective of this study was to estimate the prevalence of smoking among adolescents – from 8th-graders to high-school seniors – in the metropolitan area of the city of Salvador (MAS). An additional objective was to identify the proportion of adolescents who had tried cigarettes and the age at which they did so, since this is the main step towards formation of the smoking habit among adolescents.⁽²⁴⁾ Moreover, we wanted to determine whether there was an association between parental smoking and the use of cigarettes by their offspring, since it has been shown that parental smoking may increase the probability that an adolescent will become a smoker.^(24,25)

Method

A total of 3,500 students from five schools (four private and one public) in the MAS were selected. Student ages ranged from 13 to 20. A questionnaire designed jointly by the authors of this paper and the students of Internal Medicine of the Universidade Federal da Bahia School of Medicine was used. A broad range of subjects were assessed (Appendix 1) and the questionnaire had good content validity.⁽²⁶⁾

Select variables from the questionnaire were evaluated in this study. The category variables chosen were gender, smoking habits (regularly smoked for at least 30 days; only at social gatherings; only when drinking; daily), cigarette experimentation (if the adolescent had ever tried cigarettes), parental smoking, ethnic group (based on the 1965 Krieger et al classifications of caucasian, light mulatto, medium mulatto, dark mulatto and black).⁽²⁷⁾ As for numeric variables, age, age at which first (isolated) experimentation occurred, age at which the smoking habit (regular use according to the accepted definition) was initiated.

The questionnaire was administered to the above mentioned students in the second semester of 1998, in randomly selected classrooms in the presence of the teacher and only after approval by the principal. Completed questionnaires were only included in the study if they were returned in perfect order (without tears, drawings or inkblots), contained coherent answers (appropriate and unambiguous, with no apparent redundancies), were completed by students between 13 and 20 years of age and were completed inside the classroom. Questionnaires were automatically excluded if they contained incoherent answers (declared nonsmokers answering the questions addressed to smokers; more than one answer given), were completed by students below 13 or above 20, contained crossed-out and overwritten answers, were completed outside the classroom or were handed back without being answered. The sample was chosen according to ease of access. The data were entered into the SPSS 10^® software program. The analysis of the data was performed using the software programs SPSS 10^®, Epi info version 6.04^® and PEPI^®.

The protocol was not submitted to the Research Ethics Committee of the Hospital Universitário Prof. Edgard Santos, since the committee had not yet been established at the time the research was undertaken.

The study design was cross-sectional and exploratory. In estimating the sample size, it was necessary to establish a minimum number (n) of subjects required for determining proportions. We considered precision (5.0%), expected prevalence (16.0%), design effect (1.5) and 95% confidence interval (95% CI) and population size (91,000),⁽²⁸⁾ – resulting in 310 subjects. To compare two proportions, we considered 95% CI, power (80%), exposed/non-exposed ratio (1:1.5), prevalence of smoking among males (12%) and prevalence of smoking among females (6.5%) – resulting in 855. Descriptive measures were used in the statistical analysis: mean ± standard deviation (SD); prevalence ratio (PR), chi-square (c²), Student’s t-test (t). The predetermined level of significance was 0.05 and the variability of prevalence in the sample and PR were assessed through the calculation of a 95% CI. The n of the study corresponded to 3,180 valid questionnaires, thus exceeding the minimum sample size calculated. This was done for two reasons: to make the analysis of subgroups possible and to obtain an n greater than the sample calculation.

Results

We distributed 3,500 questionnaires, 320 (9.1%) of which were considered invalid. Table 1 shows some of the data compiled from the remaining 3,180 valid questionnaires. The prevalence of adolescent students who smoked was found to be 9.5% (303/3,178; 95% CI = 8.5–10.6). The estimated prevalence was 14.4% for males (185/1,293; 95% CI = 12.5–16.4) and 6.2% for females (116/1,878; 95% CI = 5.4–7.8). The PR for males was 2.33 (14.4/6.2; 95% CI = 1.87–2.90).

Percentages of smokers by age were: 13-15 years, 5.6% (77/1,383; 95% CI = 4.4–6.9); 16-17 years, 11.9% (171/1,438; 95% CI = 10.2–13.6); 18-20 years, 16.4% (51/311; 95% CI = 12.4–20.9) (c² = 51.4; p < 0.001, Table 1).

Percentages of smokers by ethnic group were: caucasian, 10.9% (55/504; 95% CI = 8.3–13.9); light mulatto, 9.5% (133/1,405; 95% CI = 8.0–11.1); medium mulatto, 9.2% (76/827; 95% CI = 7.3–11.4); dark mulatto, 8.5% (18/211; 95% CI = 5.1–13.1); black, 8.5% (11/130; 95% CI = 4.3–14.6). No statistically significant differences were found among the groups (Table 1).

Among the adolescents in the sample, the percentage who had tried cigarettes was 46% (1,455/3,170; 95% CI = 44.2–47.4). Of this number, 53.3% were male (686/1,287; 95% CI = 50.5–56.1) and 41% were female (770/1,877; 95% CI = 38.8–43.3), roughly 1.3 times higher in males (53.3/41.0; 95% CI = 1.21–1.40; p < 0.001). Among those same adolescents (those who experimented with cigarettes), 20.4% took up the smoking habit (297/1,455; 95% CI = 18.4–22.6) (Table 1). For males who experimented, the prevalence was 27% (185/686; 95% CI = 23.7–30.5) and for females it was 14.6% (112/769; 95% CI = 12.1–17.3), showing a PR of 1.85 on the male side (27.0/14.6; 95% CI = 1.55–2.21) (Table 1).

Percentages of smokers by age at which the first experimentation took place were: 0-10 years, 22.3% (21/94; 95% CI = 14.47–32.1); 11-13 years, 28.4% (126/443; 95% CI = 23.7–30.5); 14-16 years, 16.1% (127/787; 95% CI = 24.3–32.9); 17-19 years, 15.5% (11/71; 95% CI = 7.2–26.0) (c² = 127.3, Table 1). The mean age for experimentation was 13.8 ± 2 years (range: 6-19 years) among the adolescents sampled (n = 1,392). Among the smokers (n = 282), it was 13.3 ± 2 years and, among the non-smokers (n = 1,110), it was 13.9 ± 2 years. By gender, the mean age for experimentation was 13.5 ± 2 years among males and 14 ± 1.9 years among females (95% CI = 0.67–0.24; p < 0.001). Among those who had tried cigarettes (n = 1,389), a statistically significant gender-based difference was observed for those between 14 and 16 years of age (p < 0.02), as well as for those between 17 and 19 (p < 0.001) (Table 2).

The percentage of fathers who smoked was 25.3% (795/3,147; 95% CI = 23.8–26.8). The percentage of mothers who smoked was 21% (663/3,164; 95% CI = 19.5–20.4). The percentage of adolescents whose parents both smoked was 8.4% (263/3,149; 95% CI = 7.4–9.4). Among the adolescents who smoked, 33.4% (99/296; 95% CI = 7.4–9.4) of their fathers and 29.6% (89/301; 95% CI = 24.5–35.1) of their mothers also smoked. Among the adolescents who did not smoke, 24.4% (696/2,849; 95% CI = 22.8–26.1) of their fathers and 20.1% (574/2,861; 95% CI = 18.6–21.6) of their mothers smoked. Among the adolescents who smoked, 13.2% (39/296; 95% CI = 9.6–17.7) came from homes where both parents were smokers. Among the adolescents who did not smoke, 7.9% (224/2,851; 95% CI = 6.9–8.9) came from such homes.

As shown in Table 3, the prevalence of smoking for the child was 12.5% (99/795) if only the father smoked (PR = 1.49; 12.5/8.4). If only the mother smoked, the prevalence was 13.4% (89/663; PR = 1.58; 13.4/8.5). When both parents smoked, the prevalence of smoking among the adolescents was 14.8% (39/263; PR = 1.66; 14.8/8.9).

Of the male adolescent smokers, 18.4% (60/326) had fathers who smoked (PR = 1.5; 18.4/12.7; 95% CI = 1.09–1.92) and 19.9% (54/272) had mothers who smoked (PR = 1.5; 19.9/12.9; 95% CI = 1.15–2.04). Among the female adolescent smokers, 8.3% (39/468; 95% CI = 6.0–11.2) had fathers who smoked (PR = 1.6; 8.3/5.4; 95% CI = 1.07–2.25) and 9% (35/390) had mothers who smoked, PR = 1.7 (9.0/5.4; 95% CI = 1.13–1.43). When both parents smoked, 22.1% (25/113) of the male adolescents became smokers (PR = 1.7; 22.1/13.4; 95% CI = 1.13–2.41) and 9.4% (14/149) of the female adolescents became smokers (PR = 1.6; 9.4/5.8; 95% CI = 0.94–2.74) (Table 4).

The mean age at which the adolescents became smokers was 14.1 ± 1.7 years (range: 7-19 years). The mean was 13.9 ± 1.7 years among males and 14.3 ± 1.6 years among females. By the age of 10, 2.6% (7/274; 95% CI = 1.0–5.2) had become smokers. Between 11 and 13 years of age, the percentage was 32.8% (90/274; 95% CI = 27.3–38), between 14 and 16, it was 58% (159/274; 95% CI = 51.9–63.9), and only 6.6% (18/274; 95% CI = 3.9–10.2) took up the habit between the ages of 17 and 19. There was no statistically significant difference between genders.

Discussion

The design of the present study allowed us to estimate the prevalence of smoking and its association with parental smoking in a selected sample of adolescent students. However, there were some limitations. The selection of the schools was not randomized but rather favored those where the collection of data would be easier. Nevertheless, in an attempt to reduce this bias, the classrooms were randomly selected. Data were obtained through self-reporting, using a questionnaire that had not been tested against any standard (although the majority of the questions had good content validity).⁽²⁶⁾ This limitation was minimized due to the anonymous and voluntary nature of the questionnaires, the fact that they were administered in the classrooms during class time and the fact that, while presenting and administering the questionnaires, we guaranteed the students that their answers would be kept confidential. Similar procedures had been used in another study in the MAS, in which the major part of the sample came from private schools (four) and only one from a public school.⁽²¹⁾ This limited the application of the results to the private schools in the MAS, excluding those adolescents who were not enrolled in a school, who were not studying or who were institutionalized.

In the American statistics, a higher frequency of smoking was observed, without a statistically significant difference between genders, except in the 18- to 21-year age bracket.^(29,30). According to data from the Centers for Disease Control (1998–1999), the prevalence of smoking among adolescents in the USA was 20.6% for those in junior high school and 34.8% for those in high school.⁽³¹⁾

When we compare our data with those from European Union surveys carried out in 2000, we can see that there was a higher prevalence of smoking, as well as a gender-related difference in adolescent smoking, in some European countries.⁽¹³⁾ The authors found that the percentage of adolescent smokers varies from country to country, ranging from 13% to 33% among females and from 17% to 35% among males. Among Greek adolescents, more males than females smoke (22% vs. 13%, respectively). In contrast, there are more female (22%) than male (17%) adolescent smokers in Portugal. In France, the frequency of smoking in this age group was much higher than in other European countries (or than in the findings of the present study), reaching 33% and 35%, respectively, for females and males.

Several surveys have been carried out in Brazil. Some presented findings which were similar to ours, whereas others presented contrary results. Cotrim et al., in a study conducted in 2000 in the city of São Paulo (in the state of São Paulo) found a 13.8% prevalence of smoking among adolescents from private schools (12.3% among males and 15.3% among females) and a 5.1% prevalence among adolescents from public schools (5.6% among males and 4.6% among females).⁽²¹⁾ In 1996, Mauad et al. determined that 7.2% of the students in junior high school in the city of Barretos (also in the state of São Paulo) smoked, and found no significant differences between genders.⁽³²⁾ Muza et al., in a study conducted in 1997 in the city of Ribeirão Preto (São Paulo) found a 37.7% prevalence of adolescent smoking, predominantly among males.⁽³³⁾ In 2001, Horta et al. reported an 11.1% prevalence among adolescents in the metropolitan area of the city of Pelotas (in the state of Rio Grande do Sul).⁽³⁴⁾ A 2000/2001 report from Unicef of Brazil reported the incidence of smoking among adolescents to be 12%.⁽³⁵⁾ On the other hand, a 1987 study by Carvalho, conducted in the MAS, determined the prevalence of smoking among adolescents to be only 1%, and found no differences between genders.⁽¹⁹⁾

The most recent nationwide survey made in Brazil was that carried out in 2002 by Carlini et al.⁽²⁰⁾ The authors found the prevalence of smoking to be 15.7% in the 12-17 age group (15.2% among males and 16.2% among females) and considerably higher (37.7%) in the 18-24 age group, with a similar difference between genders. In the northeastern region of Brazil, a 14.3% smoking prevalence was found in the 12-17 age group (16.2% males and 12.6% females), and it was again considerably higher (32.2%) in the 18-24 age group (39.9% among males and 23.9% among females). In the cohort of adolescent students surveyed the present study, a higher prevalence of smoking was shown, as well as a greater experimentation and higher rates of continued tobacco use after experimentation.

In this survey, as in the other cited studies, the prevalence of smoking increased with age, but the difference between genders varied according to age, state, region and level of education.^(20-22,34) Our data show that the prevalence of adolescent smoking was 2.3 times higher among males. This finding is in agreement with those from other studies carried out in the USA, Europe and Latin America.^{(13,29,36,37)} Those studies showed increased prevalence according to age, but with some variation in the difference between genders. It is surprising that, as adolescents mature and become more well informed about high-risk behavior and prevention and more conscious of the hazards of smoking, the prevalence of smoking increases.^(36,38) This apparent anomaly can be explained by the fact that smoking initiation and the formation of the smoking habit are multifactorial, and are, within each age bracket, influenced by their peers, the behavior of their parents and the high prevalence of smoking in society at large, as well as the characteristics and degree of impressionability inherent to their particular level of maturity.^{(24,25,36,39–41)}

No statistically significant difference was observed among ethnic groups. This could be attributable to the homogeneity of our cohort. However, an American study has shown a higher prevalence among caucasians.⁽⁴²⁾

Various studies have shown the age of initiation to be between 15 and 16, although a prevalence of up to 8.5% has been found in American children below the age of 11.^{(36,37,42-45)} A 1992 study conducted in the USA found that 10.8% of the adolescent smokers had smoked their first cigarette before they were 10 years old.⁽²⁹⁾ In the present study, we observed that initiation occurred more frequently between the ages of 14 and 16. These data coincide with those from the 2001 Unicef report on Brazil but differ from the 2001 findings of Horta et al., who found a higher frequency of initiation between 17 and 18 years of age.^(34,35)

Experimentation is the primary risk factor for formation of the smoking habit.⁽²⁴⁾ In 1997, in the MAS, the frequency of experimentation was approximately 30%, similar to that of other states, and lower than in the cities of Curitiba and Porto Alegre, where it was as high as 45%.⁽²³⁾ Another survey of drug abuse, which included tobacco abuse, conducted in Brazil showed no statistical differences between genders in the 12 to 17 age group. However, a nationwide gender-based difference was seen for those above 18.⁽²⁰⁾ Our data show similar behavior among adolescents over the age of 16. In this study, a greater prevalence of smoking was found among male adolescents who experimented between 11 and 13 years of age. In 2001, Adalbjarnadottir & Rafnsson indicated that smoking prevalence tended to be higher when experimentation occurred before 13 years of age and observed that the probability of becoming a smoker was higher when the experimentation occurred before 14 years of age.⁽²⁴⁾ The habit can last for years due to acquired nicotine tolerance and to the capacity of nicotine to modify the catecholaminergic system of the central nervous system in both the short and the long run.^(9,46)

Parental influence is important in the development of the smoking habit in adolescents.^(24,25) In 1987, Carvalho observed that the smoking habits of both parents had greater influence on adolescent smoking in daughters and that those of the mother had more influence overall.⁽¹⁹⁾ This supports the findings of the present study, in which we showed that the PR was higher among offspring when both parents smoked and that the influence of maternal smoking was preponderant. We also found that adolescents were protected from the habit when neither parent smoked. In a study conducted from 1985 to 1996 in the European Union, maternal smoking increased the probability of adolescents becoming smokers, primarily in female adolescents.⁽¹³⁾ On the other hand, the findings of Adalbjarnadottir & Rafnsson showed that, in Iceland, this typically occurs at 14 years of age, with no difference between genders.⁽²⁴⁾ The findings of these and other authors underscore the idea that, even in the presence of other influences such as peer pressure, the chance of an adolescent becoming a smoker is lower if the parents don’t smoke.⁽²⁴⁾

Despite some limitations, this paper allowed us to draw several conclusions in relation to smoking among adolescent students in the MAS. Among the adolescents surveyed, the prevalence of smoking was 9.5% (14% among males and 6% among females). The age at which they took up the habit was 14 ± 2 years. Most started smoking between the ages of 14 and 16. The prevalence of smoking also increased with age. Of the 46% who had experimented with cigarettes, 53.3% were male and 41% were female and 20.4% later became smokers, with a higher prevalence of habit formation among males. The prevalence of smoking among school adolescents in this sample was higher when experimentation occurred between the ages of 11 and 13. Parental smoking was associated with the offspring becoming smokers, and the greatest influence was that exerted by maternal smoking on the smoking habits of adolescent daughters.

References

Submitted: 04/02/2003. Accepted, after revision: 02/06/2003.

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Appendix 1

*

Research performed at the Respiratory Diseases Center in fulfillment of a postgraduate course in Medicine and Health in the Internal Medicine Department of the Universidade Federal da Bahia (UFBA) School of Medicine

Publication Dates

• Publication in this collection
  02 Mar 2004
• Date of issue
  Oct 2003

History

• Accepted
  02 June 2003
• Received
  04 Feb 2003