Higher rates of smoking initiation and continuation by female compared with male adolescents, as found in many developed countries, may call for gender-specific prevention programs. Risk factors of smoking initiation and continuation were examined prospectively (1997-2002) among 3205 Dutch elementary schoolchildren (mean age 11.64) in an intervention trial using written questionnaires and multilevel logistic regression. At baseline, smoking prevalence was lower among girls than among boys; at follow-up, smoking initiation was lower among girls than among boys. Concerning smoking initiation, girls and boys shared the following risk factors: age, modeling from parents and siblings ('modeling nuclear'), modeling from other members in the social circle ('modeling diffuse') and perceived pro-tobacco pressure to smoke. The only gender-specific predictor of smoking initiation was parent origin; girls with non-Dutch parents could be targeted for prevention programs. Concerning continuation, girls and boys shared the following risk factors: older age, more modeling nuclear and diffuse, fewer smoking disadvantages and lower self-efficacy to refrain from smoking. This study confirms that social modeling, smoking attitude and self-efficacy information to refrain from smoking deserve a prominent place in smoking prevention programs for schoolchildren. Besides booster sessions, family-directed programs are suggested. No gender-specific predictors of later smoking initiation were found, apart from parent origin, which is not amenable to intervention.

This paper evaluates a smoking prevention intervention aimed at vocational school students, consisting of an existing Dutch in-school program (three lessons each lasting 50 min) and a computer-based tailored out-of-school program (three tailored letters with smoking prevention messages mailed to students' homes). Nineteen schools that already participated in the in-school program were randomly assigned to the in-school or to the combined in-school and out-of-school condition. The remaining 17 schools were randomly assigned to the out-of-school condition or to the control group. Effect outcomes were assessed at 6, 12 and 18 months after a pre-test, and were based on initiation among never-smokers and continuation among ever-smokers. Twelve months after the pre-test (post-test 2), the in-school intervention was successful in preventing vocational school students from continuing to smoke, compared with students in the control condition [odds ratio (OR) = 0.49; 95% confidence interval (CI) = 0.29-0.84]. Eighteen months after the pre-test (post-test 3), the tailored out-of-school intervention was successful in preventing smoking initiation, compared with students in the control condition (OR = 0.42; 95% CI = 0.18-0.96). The effect of the combined approach was not larger than the sum of the effects of the in-school and the out-of-school effects.

In this cross-sectional pilot study of couples in whom the man was diagnosed with prostate cancer or the woman with breast cancer, the purpose was to identify and compare the variables that characterize couples where both spouses are in high psychological distress with couples where the psychological distress of both spouses is within the normal range.Psychological distress and perception of family support in 574 individuals (118 consecutive prostate cancer patients and their spouses, and 169 randomly selected breast cancer patients and their spouses) were assessed using the Brief Symptom Inventory (BSI) and the Perceived Family Support (PFS) self-report questionnaires.Couples experiencing high psychological distress reported lower levels of perceived family support than couples in whom both spouses reported normal levels of psychological distress.The findings support the notion that perceived family support is associated with the psychological distress in both patients and spouses.

Background: Most adolescent smokers start smoking before the age of twelve. Little is known about the behavioural smoking determinants of Dutch primary school children. Methods: A cross-sectional study was carried out on a sample of students from the final year of 143 Dutch primary schools. A total of 3700 students (mean age =11.6 years) completed a questionnaires based on the ASE model, measuring the attitude, social influences and self-efficacy expectations concerning smoking. Results: Students were categorized as never smokers (64.3%), experimental smokers (28.0%), and regular smokers (7.8%). Multinomial logistic regression analyses showed that never smokers were younger, and were more often female, religious and from two-parent families than experimental smokers. Never smokers perceived more disadvantages, long-term physical consequences, more negative social norms and less pressure regarding smoking, higher self-efficacy expectations towards non-smoking, and had fewer parents, siblings or best friends who smoked. Looking at differences between experimental and regular smokers showed that experimental smokers received less pocket money. They also perceived more disadvantages, fewer advantages, more negative social norms and less pressure towards smoking, higher self-efficacy expectations towards non-smoking, and were less likely to be surrounded by friends, peers, family or teachers who smoked. Generally, the low scores for physical consequences and risk perception regarding addiction were striking. Conclusions: Smoking prevention aimed at primary schoolchildren should consider the different smoking categories, with their specific motives and influences. For instance, the influences on smoking initiation of parents, siblings and best friends suggest more comprehensive programmes aimed at the entire family. Youngsters' ignorance of addiction needs more attention.

BACKGROUND Smoking prevention programs usually run during school hours. In our study, an out-of-school program was developed consisting of a computer-tailored intervention aimed at the age group before school transition (11- to 12-year-old elementary schoolchildren). The aim of this study is to evaluate the additional effect of out-of-school smoking prevention. METHODS One hundred fifty-six participating schools were randomly allocated to one of four research conditions: (a) the in-school condition, an existing seven-lesson program; (b) the out-of-school condition, three computer-tailored letters sent to the students' homes; (c) the in-school and out-of-school condition, a combined approach; (d) the control condition. Pretest and 6 months follow-up data on smoking initiation and continuation, and data on psychosocial variables were collected from 3,349 students. RESULTS Control and out-of-school conditions differed regarding posttest smoking initiation (18.1 and 10.4%) and regarding posttest smoking continuation (23.5 and 13.1%). Multilevel logistic regression analyses showed positive effects regarding the out-of-school program. Significant effects were not found regarding the in-school program, nor did the combined approach show stronger effects than the single-method approaches. CONCLUSIONS The findings of this study suggest that smoking prevention trials for elementary schoolchildren can be effective when using out-of-school computer-tailored interventions.

The cigarette smoking habit continues to be prevalent to a greater degree than would be desirable among teenagers. Innovative prevention programs are needed. This descriptive cross-sectional study sets out the behavior variables related to the cigarette smoking habit and the extracurricular activities in which teenagers are most frequently involved which are useful for setting out extracurricular prevention programs.The data was collected by means of a questionnaire validated in a representative sample of school age youths (ages 10-11 and 13-14) from Asturias. The variables entailed in cigarette smoking were analyzed using the regression method.The starting smoker percentage is 14.5%-42.5%, regular smokers totaling 1.1% and 12.4%, respectively. Two models were constructed with the variables significantly related to smoking behavior, which are properly classified into smoker/non-smoker by 98.85% and 91.39% of the children, by ages. The environmental variables (availability of cigarettes and alcoholic beverages and regular visits to places entailing risk) are the major aspects comprising the model. The most common extracurricular activities are: watching TV, reading and listening to music and watching or playing sports.The findings provide keys to planning extracurricular activities tailored to fit in with the activities most popular among teens: TV commercials and ads on music media (CD's, tapes, etc.) and printed information mailed directly to teens at their homes, with messages conveyed by opinion-leaders among teens in the fields of sports, music and television.

The published data on the effectiveness of programs in schools to prevent addiction to tobacco are not consistent. These programs have not been sufficiently studied, and their variables give rise to confusion. The aim of this study was to evaluate the process of educational action taken in schools.Student leaders and teachers, who were trained and given guides, developed a socially based program. Two students selected at random from each class were interviewed, using a validated and directed questionnaire. A total of 318 children were interviewed. The Kappa Index was used to measure confidence, and the Inter-Class Coefficient of Correlation and Pearson's Coefficient were used together with analysis of individual differences to compare the data for program adjustment, as supplied by pupils and teachers.Mean adjustment per class was 30.07 points (48-100% adjustment). 26% of children were unable to mention any alternative to the advantages of smoking, 71.7% were unaware of the frequency of consumption amongst adults and 19.5% were unable to mention any of the tricks used in cigarette advertising. Less than half had performed psychodrama on this subject, as was required. The ICC was 0.21, Pearson's Coefficient was 0.25 (p = 0.02) and the interval of agreement between the descriptions of teachers and students was 6.93 points (-1.70 to 5.23).The degree to which implementation complied with the proposed model of program was insufficient. We found little agreement between the self-assessment of teachers and the score attained by pupils in compliance with the program. It is essential that this process be evaluated for its impact to be evaluated correctly.