Environmental Tobacco Smoke (ETS) Exposure among Middle and High School Students: Results from the Florida Youth Tobacco Survey, 1998 to 2000

Florida Department of Health: Shino Oba MSPH,

Ursula Bauer Ph.D,

Robert G Brooks MD

Background:

Adverse Health Effect of ETS Exposure among Adolescents and Children

Increases risk for Lung cancer later in life Asthma Lower and upper respiratory tract infection Fluid in the middle ear

Decreases HDL-Cholesterol level

Methods:

Sample Size 1998 1999 2000 (2001)

Middle 11,865 11,724 14,311 (4,327)High 10,675 9,254 9,484 (4,366)

Schools: 255 242 243 (146*) of

266 266 266 (156 ) selected*Including 49 of the original 266 schools

Sample selected by region (7) Large sample size, overall 1500 MS, 1500 HS students/region State level sample in 2001

Two stage cluster sample design

NorthEast

Panhandle

NorthCentral

TampaBay

SouthCentral

Palm Bch/Broward

Dade/Monroe

Response Rate

1998 1999 2000 (2001)

Middle 80% 82% 82% (73%)

High 72% 70% 81% (74%)

Analysis

Weighting adjustment by grade and gender Nesting adjustment for clustering (SUDAAN) Descriptive - prevalence Multiple Logistic Regression

Controlled for demographic and behavioral variables: grade, gender, race/ethnicity, average grade, receptivity to tobacco promotion, number of smoker friends, smoker in the household, survey year

Results – Prevalence:

Fig.1 ETS Exposure among Florida Public School Students in 2000

87.2

54.2

57.9

77.8

38.6

42.8

90.1

62.2

68.5

81.0

38.7

48.2

0

20

40

60

80

100Perc

ent

in rooms in cars in rooms in cars

Middle School High School

Smokers Non-Smokers Overall

Fig. 2 ETS Exposure by Receptivity to Tobacco Company Promotional Items among Non-smoking Students

48.5%64.8%

76.4%

55.5%70.6%

76.2%

0%

20%

40%

60%

80%

100%

Middle School High School

Low Moderate High

Fig. 3 ETS Exposure by Smoker(s) among the 4 Best Friends

51.7%72.5%

76.8%79.0%

78.5%

56.4%76.3%

80.3%84.2%

82.9%

0%

20%

40%

60%

80%

100%

Middle School High School

0 friend smoke 1 friend smokes 2 friends smoke3 friends smoke 4 friends smoke

Fig. 4 ETS Exposure by Smoker in Household

83.8%

43.3%

86.2%

54.3%

0%

20%

40%

60%

80%

100%

Middle School High School

There is smoker(s) in householdThere is no smoker in household

Fig.5 ETS Exposure by Rules about Smoking in Household

53.4%

89.0%

61.2%

87.2%

0%

20%

40%

60%

80%

100%

Middle School High School

Rules prohibiting smoking in the homeNo rules prohibiting smoking in the home

Fig. 6 ETS Exposure by Cigarette Smoking Status

92.5%

59.1%

94.5%

65.4%

0%

20%

40%

60%

80%

100%

Middle School High School

Current cigarette smokers non-smokers

Fig. 7 Where Youth are Exposed to ETS, FYTS 2001

At home34.3%

At school3.8%

At work3.9%

In a restaurant11.8%

Public place/ Malll7.9%

Someone else's house15.7%

Parent's car3.5%

Someone else's car6.7%

Other12.4%

Fig. 8 Who’s Smoking When Youth are Exposed to ETS, FYTS 2001

Parents32.1%

Relative18.9%

Friends19.2%

Someone at work4.3%

Stranger25.5%

Results – Multivariate Analysis:

Weighted adjusted odds ratios (OR) and 95% confidence intervals (CI) of exposure to environmental tobacco smoke, in various locations, among 46,423 non-smoking public middle and high school students, 1998-2000 Florida Youth Tobacco Survey.

(Please refer the attached table)

Other Results:

ETS and Cigarette Smoking Students who are exposed to ETS were

3.39 (2.98-3.85) times more likely to be current cigarette smokers than students who were not exposed to ETS

Other Results (continued):

ETS and Rules about Smoking in Household: The rule that prohibits smoking in home

significantly decreases the exposure to ETS among students OR=0.21(0.19-0.23) for non-smoking students OR=0.66(0.24-0.44) for smoking students

In the household with a smoker, the same rule prevent students from exposure in similar way OR=0.36 (0.31-0.41) for non-smoking students OR=0.43 (0.27-0.68) for smoking students

Limitations:

Cross-sectional study design Need to follow youth over time to

establish temporal direction of associations

Validity and Reliability of Self-reported Exposure Student self-report of exposure was not

independently verified

Conclusion and Recommendations:

Too many youth are exposed to environmental tobacco smoke

ETS exposure varies by students’ gender, race/ethnicity, grade level, academic grade, receptivity to tobacco company promotion, cigarette smoking status, friends’ smoking status, home environment

Conclusion and Recommendations (continued): Interventions to reduce youth exposure to ETS

can be implemented at a number of levels: Policy level interventions will reduce youth

exposure to ETS in public places and work sites

Educational interventions targeted to adults and parents can reduce exposure at home and in cars

Interventions to reduce youth and adult smoking can reduce youth exposure to ETS from peers, parents, and other adults.

Shino_Oba@doh.state.fl.us

SURVEY RESEARCH UNIT