Florida Department of Health: Shino Oba MSPH, Ursula Bauer Ph.D, Robert G Brooks MD

1. 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

2. 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

3. 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

4. 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

5. Response Rate 1998 1999 2000 (2001) Middle 80% 82% 82% (73%) High 72% 70% 81% (74%)

6. 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

7. Results – Prevalence:

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

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

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

11. Fig. 4 ETS Exposure by Smoker in Household

12. Fig.5 ETS Exposure by Rules about Smoking in Household

13. Fig. 6 ETS Exposure by Cigarette Smoking Status

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

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

16. 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)

17. 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

18. 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

19. 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

20. 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

21. 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.

22. Shino_Oba@doh.state.fl.us