title: A survey of adolescent smoking patterns.
abstract: BACKGROUND
  Most adults who smoke regularly started during adolescence. To understand adolescent smoking trends better, we investigated smoking patterns, and habits among vocational high school students.
  
  
  METHODS
  One hundred fifty-four students, aged 14 to 20 years from two vocational schools, completed a 23-item questionnaire. The 99 who were smokers further completed a 55-item questionnaire investigating smoking patterns, criteria for addiction, health concerns, and quitting experiences. All students were tested for objective laboratory measures of smoking, including exhaled carbon monoxide and salivary cotinine.
  
  
  RESULTS
  Sixty-five percent of the student sample smoked at least 10 cigarettes a day, began smoking by 13 years, and easily purchased tobacco over-the-counter. Predictors for smoking included a close friend, parent, or sibling who was a smoker. Significantly poorer grade performance and higher use of alcohol and marijuana were found among smokers. Student's knowledge of health risks of smoking exceeded 95 percent but was of little concern for 70 percent of the smokers. More than one half of smokers had multiple unsuccessful quitting attempts. Exhaled carbon monoxide readings accurately detected smokers and proved more immediate, more sensitive, and less costly than salivary cotinine measurements.
  
  
  CONCLUSIONS
  The high association for poor school performance and alcohol and marijuana use among adolescent smokers is a growing trend. These issues carry immediate short-term health and social implications, which physicians should explore. Almost all the smokers had tried at least once to quit but relapsed rapidly. One third remain highly motivated to quit. Physicians should not hesitate to offer smoking cessation assistance; one third might be willing to listen.
authors.affiliation: Department of Pediatrics, Fairfax Hospital, Falls Church, Virginia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Dappen
authors.forename: R H
authors.initials: RH
authors.lastname: Schwartz
authors.forename: R
authors.initials: R
authors.lastname: O'Donnell
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000704:Analysis of Variance; D001294:Attitude to Health; D002248:Carbon Monoxide / Q000032:analysis; D003367:Cotinine / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D012907:Smoking / Q000453:epidemiology / Q000523:psychology / Q000639:trends*; D016540:Smoking Cessation
chemical_list: D002248:Carbon Monoxide; D003367:Cotinine