Research paper
CC-BY-NC 4.0

Prevalence and predictors of cigarette smoking among Greek urban adolescents: A cross-sectional study

Athanasia Liozidou 1, 2  ,  
Niki Dimou 3,  
Areti Lioupa 4,  
Biomedical Research Foundation of the Academy of Athens, Greece
First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
Department of Computer Science and Biomedical Informatics, University of Thessaly, Greece
Company of Consulting Management and Training, CMT Prooptiki, Greece
Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Greece
Tob. Prev. Cessation 2015;1(October):4
Publish date: 2015-10-19
Studies on smoking prevalence of Greek adolescents are sparse and ambiguous. We aimed to investigate prevalence and predictors of cigarette smoking for adolescents in the cities of Athens and Thessaloniki.

We conducted a cross-sectional study of 1.802 randomly selected Greek students. Multistage sampling with quotas was used with regard to the geographical distribution of the target population, gender and grade. Data were collected by a self-completed questionnaire. Multiple logistic regression analysis was applied to evaluate the association between selected variables and the likelihood of being a current smoker.

Cigarette smoking was reported by 18.2% (95% CI=16.4 - 20.0); 8.1% (95% CI=6.2 – 10.0) of Gymnasium and 26.1% (95% CI=23.4 – 28.8) of Lyceum students reported being smokers. An estimated 38.0% (95% CI=35.8 - 40.2) had ever tried cigarette, 27.1% (95% CI=25.1 - 29.2) hookah and 17.7% (95% CI=15.9 - 19.5) electronic cigarette. Older age (OR= 11.59; 95% CI [6.25, 21.50], parental (OR=1.71; 95% CI [1.19, 2.46]), siblings’ (OR=2.07; 95% CI [1.43, 2.99] and teachers’ smoking OR=1.97; 95%CI [1.23, 3.17])and exposure to smoking through the entertainment media (OR= 1.48; 95% CI[1.03,2.14] and the tobacco promotion activities (OR=3.73;95% CI[2.88,4.83] predicted current smoking.

Greek adolescents report lower smoking rates than previously reported, yet it is a population experimenting with tobacco products. Electronic cigarette emerged as the third most likely product of experimentation. The social origin of smoking behavior is confirmed, as well as the imperative need to encourage tobacco-free school policies and bans on tobacco advertising, promotion and sponsorship.

Athanasia Liozidou   
Biomedical Research Foundation of Athens Academy, 4, Soranou Ephesiou, 11527 Athens, Greece
1. Lenney W, Enderby B. “Blowing in the wind”: a review of teenage smoking. Archives of disease in childhood. 2008;93(1):72-5. doi: 10.1136/adc.2006.109702.
2. Peto R, Lopez, AD. The future worlwide health effects of current smoking patterns. Tobacco: Science, policy and public health. New York: Oxford University Press; 2004.
3. Prevalence of current tobacco use among adolescents aged 13-15 years: World Health Organization European Region; Available from: topics/disease-prevention/ tobacco/data-and-statistics/who-is-smoking/adolescents. (accessed 06 Nov 2014).
4. Arvanitidou M, Tirodimos I, Kyriakidis I, Tsinaslanidou Z, Seretopoulos D, Dardavessis T. Cigarette smoking among adolescents in Thessaloniki, Greece. International journal of public health.2008;53(4):204-7.doi: 10.1007/s00038-008-8001-5.
5. Giannakopoulos G, Panagiotakos D, Mihas C, Tountas Y. Adolescent smoking and health-related behaviours: interrelations in a Greek school-based sample. Child: care, health and development. 2009;35(2):164-70. doi: 10.1111/j.1365-2214.2008.00906.x.
6. Kyrlesi A, Soteriades ES, Warren CW, Kremastinou J, Papastergiou P, Jones NR, et al. Tobacco use among students aged 13-15 years in Greece: the GYTS project. BMC public health. 2007;7:3. doi:10.1186/1471-2458-7-3.
7. Tobacco use among students aged 13-15 years in Greece: The GYTS project. [press release]. Athens, 27/01/2014 2014.
8. Rachiotis G, Muula AS, Rudatsikira E, Siziya S, Kyrlesi A, Gourgoulianis K, et al. Factors associated with adolescent cigarette smoking in Greece: results from a cross sectional study (GYTS Study). BMC public health. 2008;8:313. doi:10.1186/1471-2458-8-313.
9. Damianaki A, Kaklamani S, Tsirakis S, Clarke R, Tzanakis N, Makris D. Risk factors for smoking among school adolescents in Greece. Child Care Health and Development. 2008;34(3):310-5. doi: 10.1111/j.1365-2214.2008.00839.x.
10. Vardavas CI, Agaku I, Patelarou E, Anagnostopoulos N, Nakou C, Dramba V, et al. Ashtrays and signage as determinants of a smokefree legislation’s success. PloS one. 2013;8(9):e72945. doi: 10.1371/journal.pone.0072945.
11. National Health Interview Survey, Methodology Report. National Youth Tobacco Survey, Centers for Disease Control and Prevention, 2009b.
12. Johnston L, O’Malley, PM., Backman, JG., Schulenberg, JE. Monitoring the Future National Survey Results on Drug Use, 1975-2010. Bethesda MD: US: Department of Health and Human Services, National Institutes on Health, National Institute on drug Abuse 2011a.
13. Tobacco Free Initative Meeting on Tobacco and Religion. Geneva, Switzerland: World Health Organization, 1999 3 May. Report No.: WHO Report WHO/NCD/TFI/99.12.
14. Goldberg ME, Baumgartner H. Cross-country attraction as a motivation for product consumption. Journal of Business Research. 2002;55(11):901-6. HYPERLINK. doi:10.1016/S0148-2963(01)00209-0.
15. Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. Jama. 1998;279(7):511-5. doi:10.1001/jama.279.7.511.
16. Kokkevi A, Terzidou M, Politikou K, Stefanis C. Substance use among high school students in Greece: outburst of illicit drug use in a society under change. Drug and alcohol dependence. 2000;58(1–2):181-8.
17. Filippidis FT, Vardavas CI, Loukopoulou A, Behrakis P, Connolly GN, Tountas Y. Prevalence and determinants of tobacco use among adults in Greece: 4 year trends. European journal of public health. 2013;23(5):772-6. doi: 10.1093/eurpub/cks148.
18. Vardavas C, Behrakis P. Greece: consumption down at last. Tobacco control. 2012;21:2.
19. Kinnunen JM, Ollila H, El-Amin SE, Pere LA, Lindfors PL, Rimpela AH. Awareness and determinants of electronic cigarette use among Finnish adolescents in 2013: a population-based study. Tobacco control. 2014. doi: 10.1136/tobaccocontrol-2013-051512.
20. Vardavas CI, Anagnostopoulos N, Kougias M, Evangelopoulou V, Connolly GN, Behrakis PK. Short-term pulmonary effects of using an electronic cigarette: Impact on respiratory flow resistance, impedance, and exhaled nitric oxide. Chest. 2012;141(6):1400-6. doi: 10.1378/chest.11-2443.
21. Bauman A, Phongsavan P. Epidemiology of substance use in adolescence: prevalence, trends and policy implications. Drug and alcohol dependence. 1999;55(3):187-207. doi: 10.1016/S0376-8716(99)00016-2.
22. Rudatsikira E, Muula AS, Siziya S. Prevalence, correlates of and perceptions toward cigarette smoking among adolescents in South Korea. The Indian Journal of Pediatrics. 2009;76(5):505-10. doi: 10.1007/s12098–009–0073–6.
23. Rudatsikira E, Abdo A, Muula AS. Prevalence and determinants of adolescent tobacco smoking in Addis Ababa, Ethiopia. BMC public health. 2007;7(1):176. doi:10.1186/1471-2458-7-176.
24. Young S, Corley R, Stallings M, Rhee S, Crowley T, Hewitt J.Substance use, abuse and dependence in adolescence: prevalence,symptom profiles and correlates. Drug and alcohol dependence. 2002;68(3):309-22. doi:10.1016/S0376-8716(02)00225-9.
25. Conrad KM, Flay BR, Hill D. Why children start smoking cigarettes:predictors of onset. British journal of addiction. 1992;87(12):1711-24. doi: 10.1111/j.1360-0443.1992.tb02684.x.
26. Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tobacco control. 1998;7(4):409-20. doi:10.1136/tc.7.4.409.
27. Villanti A, Boulay M, Juon H-S. Peer, parent and media influences on adolescent smoking by developmental stage. Addictive behaviors. 2011;36(1):133-6. doi: 10.1016/j.addbeh.2010.08.018.
28. McVicar D. Estimates of peer effects in adolescent smoking across twenty six European countries. Social Science & Medicine. 2011;73(8):1186-93. doi:10.1016/j.socscimed.2011.08.006.
29. Avenevoli S, Merikangas KR. Familial influences on adolescent smoking. Addiction (Abingdon, England). 2003;98:1-20. doi: 10.1046/j.1359-6357.2003.00586.x.
30. Whitesell M, Bachand A, Peel J, Brown M. Familial, Social, and Individual Factors Contributing to Risk for Adolescent SubstanceUse. Journal of Addiction. 2013;2013:9 doi: 10.1155/2013/579310.
31. Bandura A. Social foundations of thought and action, a social cognitive theory. Englewood Cliffs, New Jersey: Prentice Hall; 1986.
32. Poulsen LH, Osler M, Roberts C, Due P, Damsgaard MT, Holstein BE. Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark. Tobacco control. 2002;11(3):246-51. doi: 10.1136/tc.11.3.246.
33. Thomas RE, McLellan J, Perera R. School-based programmes for preventing smoking. The Cochrane database of systematic reviews. 2013;4:Cd001293. doi: 10.1002/14651858.CD001293.
34. Steptoe A, Wardle J, Cui W, Baban A, Glass K, Tsuda A, et al. An international comparison of tobacco smoking, beliefs and risk awareness in university students from 23 countries. Addiction (Abingdon, England). 2002;97(12):1561-71. doi: 10.1046/j.1360-0443.2002.00269.x.
35. Dalton MA, Beach ML, Adachi-Mejia AM, Longacre MR, Matzkin AL, Sargent JD, et al. Early exposure to movie smoking predicts established smoking by older teens and young adults. Pediatrics. 2009;123(4):e551-8. doi: 10.1542/peds.2008-2102.
36. Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics. 2005;116(6):1516-28. doi: 10.1542/peds.2005-0141.
37. Hanewinkel R, Sargent JD, Karlsdottir S, Jonsson SH, Mathis F, Faggiano F, et al. High youth access to movies that contain smoking in Europe compared with the USA. Tobacco control. 2013;22(4):241-4. doi:10.1136/tobaccocontrol-2011-050050.
38. Institute of Medicine Committee on Preventing Nicotine Addiction in C, Youths. In: Lynch BS, Bonnie RJ, editors. Growing up Tobacco Free: Preventing Nicotine Addiction in Children and Youths. Washington (DC): National Academies Press (US).
39. Lovato C, Linn G, Stead LF, BestA. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. The Cochranedatabase of systematic reviews.2003(4):Cd003439. doi: 10.1002/14651858.CD003439.