The early use of alcohol and tobacco: its relation to children's competence and parents' behavior

Cigarette smoking among adolescents in Northwest Ohio: correlates of prevalence and age at onset

This study examined the prevalence and correlates of smoking initiation among adolescents. We have used data from adolescents (n=5,392) ages 10-18 who participated in the 2003 Tobacco Survey, a representative sample of adolescents in Northwest Ohio. A self-report of cigarette smoking was obtained using a questionnaire administered in classrooms. Data were analyzed using weighted chi-square and multiple logistic regressions in SAS that accounted for the survey design. The prevalence rates for adolescents that ever tried smoking were 7.4% in elementary (grades 4-5); 17.7% in middle (grades 6-8), and 41.4% in high (grades 9-12) schools, respectively. The highest prevalence rate was among Hispanics. Having a close friend that smoked and a smoker at home correlated significantly with both initiation of smoking and smoking at an earlier age. Smoking was correlated with low academic achievement among adolescents in all grades. Students who reported smoking by parents or siblings were significantly more likely to start smoking at an earlier age, compared to other students living in a non-smoking home environment. Smoking prevention program should include components focused on adolescents' home environment and should start as early as the 4th grade.

Multi-ethnic adolescents' attitudes toward smoking: a focus group analysis

PURPOSE

To explore young, multi-ethnic adolescents' attitudes and influences related to cigarette smoking for the purpose of developing and producing a youth-led, tobacco prevention drama.

DESIGN

Focus groups and demographic surveys.

SETTING

Island of Oahu, Hawaii.

PARTICIPANTS

Fifty-four multi-ethnic youth, ranging in age from 10 to 14 years, participated. The study was promoted in schools with a large representation of Hawaiian, Filipino, and Pacific Islander students.

METHODS

Each of five focus groups was audio-recorded, and an observer recorded extensive notes throughout the sessions. Content analysis consisted of coding focus group notes for recurrent themes and using the audio recording as confirmation.

RESULTS

Just more than one quarter (n = 15) of the youth had tried smoking, and two-thirds (n = 35) currently lived with someone who smoked. Participants expressed the feeling of being surrounded by smoking influences at home, in their communities, and at school. Youth were negatively affected by family members' tobacco use, and they desired skills that could enable them to help family members stop using tobacco.

CONCLUSION

Family influences may play an important role in youth attitudes toward tobacco use, especially given the cultural significance of extended family and of filial piety that are reflected in many traditional, Asian and Pacific Islander families. Interventions targeting youth in Asian and Pacific Islander communities should incorporate key cultural references to the extended family and to a respect for elders to establish relevance in the life experiences of young people in these population groups.

Substance use, resistance skills, decision making, and refusal efficacy among Mexican and Mexican American preadolescents

This article examines the relationships among resistance skills, refusal efficacy, decision-making skills, and substance use for a sample of Mexican and Mexican American 5th grade students who were attending public schools in Phoenix, Arizona. An analysis of self-report questionnaire data indicated that the likelihood that male students reported ever having used one or more substances increased as they reported a greater willingness to use passive decision-making (e.g., going along) and decreased as they reported greater refusal efficacy and a greater willingness to utilize active decision making (e.g., thoughtful processing). No significant relationships emerged between the 4 predictors and lifetime substance use among the girls. These findings support the role of social skills in substance use prevention, shed light on an understudied group, and suggest the importance of continuing to examine gender differences in skills-based interventions.

Drug resistance strategies and substance use among adolescents in Monterrey, Mexico

This study examined drug resistance strategies and substance use among adolescents from Monterrey, Mexico. The focus was strategies that U.S. adolescents use most often to resist using substances, including refuse (saying no), explain (declining with an explanation), avoid (staying away from situations where drugs are offered), and leave (exiting situations where drugs are offered). Using self-administered questionnaire data from a convenience sample of 327 Mexican students enrolled at two secondary schools (preparatorias), we tested whether frequent use of particular drug resistance strategies predicted actual substance use. Multiple regression results showed that different strategies were effective for different substances, that some effects were mediated by number of offers received, and that certain effects were stronger for females than for males. Students using the refuse strategy reported less cigarette use and less binge drinking; those using the avoid strategy reported less alcohol and cigarette use; and those using the leave strategy reported less binge drinking and, for females only, less marijuana use. Use of the explain strategy was not significantly related to substance use after controlling for use of other strategies. Findings are discussed in terms of Mexican cultural values and their implications for the design of prevention programs for Mexican youth. EDITORS' STRATEGIC IMPLICATIONS: Replication is necessary to evaluate some of the effects of sampling, the prevention model, implementation, and culture on these findings, but the study underscores the importance of recognizing and understanding the cultural context in which prevention programs--and the clients they serve--exist.

Receptivity to alcohol marketing predicts initiation of alcohol use

PURPOSE

This longitudinal study examined the influence of alcohol advertising and promotions on the initiation of alcohol use. A measure of receptivity to alcohol marketing was developed from research about tobacco marketing. Recall and recognition of alcohol brand names were also examined.

METHODS

Data were obtained from in-class surveys of sixth, seventh, and eighth graders at baseline and 12-month follow-up. Participants who were classified as never drinkers at baseline (n = 1,080) comprised the analysis sample. Logistic regression models examined the association of advertising receptivity at baseline with any alcohol use and current drinking at follow-up, adjusting for multiple risk factors, including peer alcohol use, school performance, risk taking, and demographics.

RESULTS

At baseline, 29% of never drinkers either owned or wanted to use an alcohol branded promotional item (high receptivity), 12% students named the brand of their favorite alcohol ad (moderate receptivity), and 59% were not receptive to alcohol marketing. Approximately 29% of adolescents reported any alcohol use at follow-up; 13% reported drinking at least 1 or 2 days in the past month. Never drinkers who reported high receptivity to alcohol marketing at baseline were 77% more likely to initiate drinking by follow-up than those were not receptive. Smaller increases in the odds of alcohol use at follow-up were associated with better recall and recognition of alcohol brand names at baseline.

CONCLUSIONS

Alcohol advertising and promotions are associated with the uptake of drinking. Prevention programs may reduce adolescents' receptivity to alcohol marketing by limiting their exposure to alcohol ads and promotions and by increasing their skepticism about the sponsors' marketing tactics.

The relationship between exposure to alcohol advertising in stores, owning alcohol promotional items, and adolescent alcohol use

AIM

This paper describes adolescents' exposure to alcohol advertising in stores and to alcohol-branded promotional items and their association with self-reported drinking.

METHODS

A cross-sectional survey was administered in non-tracked required courses to sixth, seventh, and eighth graders (n = 2125) in three California middle schools. Logistic regressions compared the odds of ever (vs. never) drinking and current (vs. ever) drinking after controlling for psychosocial and other risk factors for adolescent alcohol use.

RESULTS

Two-thirds of middle school students reported at least weekly visits to liquor, convenience, or small grocery stores where alcohol advertising is widespread. Such exposure was associated with higher odds of ever drinking, but was not associated with current drinking. One-fifth of students reported owning at least one alcohol promotional item. These students were three times more likely to have ever tried drinking and 1.5 times more likely to report current drinking than students without such items.

CONCLUSIONS

This study provides clear evidence of an association of adolescent drinking with weekly exposure to alcohol advertising in stores and with ownership of alcohol promotional items. Given their potential influence on adolescent drinking behaviour, retail ads, and promotional items for alcohol deserve further study.

Variable-oriented and person-oriented perspectives of analysis: The example of alcohol consumption in adolescence

This article presents person-oriented and variable-oriented approaches to data analysis. To illustrate these two approaches and the types of information they provide the researcher, data from 3,558 control group youth from the National Cross-Site Evaluation of High Risk Youth Programs were analysed. The relationship, over time, between parent attitudes and gender as it relates to youth alcohol consumption were examined. Data were analysed and compared using a variable-oriented approach (repeated measures ANOVA) and a person-oriented approach (Configural Frequency Analysis). Data analysis demonstrated that variable- and person-oriented approaches provide the researcher with different information that can be complementary. The ANOVA identified an overall trend that accounted for little variance; the CFA explained why this was the case by identifying groups of respondents whose behaviour was different from the overall trend. The implications of these results and the use of both types of approaches are discussed.

Do Competence Skills Moderate the Impact of Social Influences to Drink and Perceived Social Benefits of Drinking on Alcohol Use Among Inner-City Adolescents?

Only a few studies have found competence skills to be a protective factor against adolescent alcohol use; others did not find a direct effect on alcohol. A possible reason for this is that competence skills may moderate the effects of risk factors for alcohol use and that aspect has not been examined often or in a longitudinal design. This study tested whether several competence skills served either as direct protective factors against alcohol use or moderators of the impact of social risk factors on alcohol use. Participants (N = 1318) completed questionnaires that included measures of decision-making skills, refusal skill techniques, resisting media influences, friends' drinking and perceived social benefits of drinking, as well as current drinking amount and future drinking at baseline, one-year follow-up and two-year follow-up. Data analyses were conducted using multi-level mixed effects generalized linear models with random intercept. All the competence skills and the risk factors predicted current and future drinking. Several significant interactions were found between (1) perceived social benefits of drinking and decision-making skills, (2) perceived social benefits of drinking and refusal skill techniques and (3) friends' drinking and refusal skill techniques. Competence skills served as protective factors, as well as moderators. One possible reason that competence enhancement approaches to alcohol prevention are effective may be due to the inclusion of the competence skills component.

Tobacco, heart disease, and practical counseling

As a large part of the care for children is preventive health, knowledge about the effects of tobacco exposure, risk factors, prevention strategies, and intervention are important. Because most smokers begin smoking while being cared for by physicians who care for children, pediatricians are particularly well suited to identify those at risk and to provide meaningful prevention. As physicians, we need to also assist parents to quit smoking, thereby setting a good example to their children, while improving their health as well as that of their children. Likewise, when identifying a youth experimenting or regularly smoking tobacco, intervention needs to be offered through counseling, referral, or medical therapy.

Correspondence between proxy and self-reports on smoking in a full family study

OBJECTIVES

The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status.

METHODS

Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports.

RESULTS

Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking.

CONCLUSIONS

Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.

Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder

OBJECTIVE

Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder.

METHODS

Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use.

RESULTS

With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with >1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression.

CONCLUSIONS

This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.

The association between adolescent smokers' desire and intentions to quit smoking and their views of parents' attitudes and opinions about smoking

OBJECTIVE

To explore whether an association exists between adolescent smokers' attitudes toward quitting and their beliefs about whether their parents know they smoke, their perceptions of whether their parents disapprove of smoking, their recollection of their parents' expressed disapproval of smoking, and the importance they place on their parents' opinions.

METHODS

This cross sectional study of US high school students included 17,287 respondents. Only those who had smoked in the past 30 days (4593 [26.6%]) were included in the analysis. "Have you ever seriously thought about quitting smoking?" was asked of all adolescent smokers. Those who had seriously thought about quitting were then asked about past attempts and how recent their last attempt was, while those who had not seriously thought about quitting were asked if they thought they would ever want to quit.

RESULTS

Regardless of whether their parents smoked, adolescents who placed value on their parents' opinions were more likely to think seriously about quitting and to have tried to quit in the past 6 months. Recalling parents' expressed desire that their child not smoke was associated with significant increases in the likelihood of seriously thinking about quitting even among those whose parents smoked. Agreeing with the statement, "When I'm older, my parents won't mind that I smoke" was significantly associated with decreased odds of seriously thinking about quitting and recently attempting to quit.

CONCLUSIONS

Parents, both those who smoke and those who do not, may have a significant role in influencing young smokers' desire to quit smoking.

Understanding the Association Between Authoritative Parenting and Adolescent Smoking

BACKGROUND

Research on adolescent cigarette smoking has attempted to measure the role of parents in preventing smoking experimentation and uptake. However, aspects of parental influence have often been limited to parental smoking behavior or antismoking socialization. Only a limited number of studies considered the hypothesis that the influence of parenting on adolescent current cigarette smoking may extend beyond parental behavior and antismoking socialization to consider broader measures of the parent-child relationship, such as parenting style.

METHODS

The sample was nationally representative and included 17,287 high school students nationwide. Data were used to categorize the parenting style--authoritative, permissive, autocratic, and unengaged--experienced by each respondent. Logistic regression analysis was used to assess the association between parenting style and adolescent current cigarette smoking.

RESULTS

Authoritative parenting was associated with a reduction in the odds of adolescent current cigarette smoking (OR: 0.74, 99% CI: 0.58, 0.95). When authoritative parenting is simultaneously considered with believing parents' opinions about smoking are important, authoritative parenting was no longer a significant correlate of adolescent current cigarette smoking, while believing parents' opinions about smoking are important was associated with a 45% (99% CI: 0.48, 0.64) reduction in the odds of adolescent current cigarette smoking. Authoritative parenting was associated with a more than three-fold increase (OR: 3.65, 99% CI: 2.87, 4.66) in the odds of believing parents' opinions about smoking are important.

DISCUSSION

Interventions may want to educate parents about authoritative parenting, which includes the importance of having appropriate and routine conversations with their children, requiring chores, and implementing general rules and boundaries.

[Smoking among adolescents: population study on parental and school influences]

OBJECTIVE

Smoking represents a public health problem, one which begins during adolescence. The main objective of this study was to analyze the association between smoking and parental and school factors.

SUBJECTS AND METHODS

The study sample consisted of the students from the 20 secondary schools in the region of Osona, Barcelona, Spain. A self-report questionnaire was used to obtain information on the following variables: smoking habit, age of initiation, frequency, type of school (state school or private-subsidized), sex, age, persons living in the home, town, whether the student had lunch at school, whether the student often had lunch or dinner alone at home.

RESULTS

A total of 2280 students participated in the study (91%). Mean age was 15.5 years. Of the participants, 20% said they were smokers; 5%, ex-smokers; 34% had tried smoking at least once, and 41% had never smoked. Factors significantly associated with smoking in the multivariate analysis were age, rural town, state school, single parent family, eating alone, and not lunching at school.

CONCLUSIONS

Smoking prevalence is high among adolescents in our society and there is no gender difference. Our results show that family structure and dynamics can influence smoking in adolescents. Smoking is less prevalent among adolescents who have lunch at school.

The effect of immigrant generation on smoking

Immigrants to the US are not only an increasingly significant demographic group but overall they also have lower socioeconomic status (SES) than the native-born. It is known that tobacco use is a major health risk for groups that have low SES. However, there is some evidence that tobacco use among certain immigrant groups is lower than among the respective native-born ethnic group, and that immigrant assimilation is positively related to tobacco use. We investigated the relationship between immigrant generation and daily smoking, using the Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 1995-96, a national data set representative of the US general and immigrant populations. Our multivariate logistic regression analysis of the relationship between immigrant generation and daily smoker status (n = 221,798) showed that after controlling for age, gender, race/ethnicity, SES variables (i.e. equivalized household income, education, occupation), and central-city residence, the odds of being a daily smoker were highest among US-born individuals of US-born parents (reference group) and lowest among foreign-born individuals (95% CI: 0.54-0.62). Being a second-generation immigrant (i.e. US born) with two immigrant parents also conferred a protective effective from smoking (95% CI: 0.64-0.77). However, having only one foreign-born parent was not protective against smoking. Testing for interaction effects, we also found that being foreign born and being second generation with two immigrant parents were especially protective against smoking among females (vis-à-vis males); racial/ethnic minorities (vis-à-vis whites); and low-income individuals (vis-à-vis high-income individuals). We discuss possible mechanisms that may explain the protective effect against smoking of being foreign born and being second generation with two immigrant parents, including differences in the stage of the tobacco epidemic between immigrants' countries of origin and the US, the "healthy immigrant effect", and anti-smoking socialization in immigrant families.

School connectedness and daily smoking among boys and girls: the influence of parental smoking norms

BACKGROUND

The objective was to test whether an association between school connectedness and smoking exists among Danish school children, and if so, to examine whether parental smoking attitude and parental smoking behaviour influenced this association.

METHODS

Data were collected by the Danish contribution to the cross-national study Health Behaviour in School-Aged Children (HBSC) 1998. Analyses were performed on questionnaire-based data from 1537 students at grade nine from a random sample of schools in Denmark.

RESULTS

An independent inverse association was found between school connectedness and smoking among both boys and girls. Parents' attitude to their children's smoking significantly modified this association among boys. Among girls the modifying effect was less marked. Neither among boys nor girls did parental smoking behaviour significantly modify the association between school connectedness and smoking, although a modifying tendency was observed among girls.

CONCLUSIONS

The smoking behaviour of Danish adolescents may be influenced by complicated interactions of varying sets of experienced smoking norms, and any research project or preventive programme focusing on the influence of school life on adolescent smoking behaviour needs to consider the family smoking norms. Additionally, the results stress the important role of gender by indicating that the smoking behaviour of girls may be more sensitive to restricting social influences than the smoking behaviour of boys.

Alcohol abuse in Russian delinquent adolescents. Associations with comorbid psychopathology, personality and parenting

INTRODUCTION

Adolescent delinquency and alcohol abuse have become a growing concern in Russia. Psychopathology, a dysfunctional family and specific personality factors have all been linked to addictive and antisocial behavior. Since delinquent youth represent a specific risk group, where alcohol misuse tends to be more pronounced than in the general population, the objectives of this study were: 1) to compare differences in personality and parenting factors, and in psychopathology in juvenile delinquents with and without alcohol abuse; and 2) to evaluate the associations between alcohol abuse, personality and parenting factors, after controlling for comorbid psychopathology.

METHODS

Psychopathology, including alcohol abuse, was assessed by means of a psychiatric interview in 229 Russian incarcerated male juvenile delinquents. In addition, alcohol use, personality, and parenting factors were assessed by self-reports.

RESULTS

Alcohol-abusing delinquents (n=138) scored significantly higher on novelty seeking and maternal emotional warmth and reported higher levels of psychopathology, as compared to nonalcohol-abusing delinquents (n=91). Logistic regression analysis demonstrated that personality and parenting factors were significantly related to alcohol abuse, even after controlling for comorbid psychopathology.

CONCLUSION

Alcohol-abusing delinquents are at risk for a wide spectrum of psychiatric disorders. Alcohol abuse is associated with personality and parenting factors independently of comorbid psychopathology. Early interventions with high-risk youths may help to reduce their psychiatric problems and alcohol abuse.

Father's occupational group and daily smoking during adolescence: patterns and predictors

OBJECTIVES

We investigated the relationship among father's occupational group, daily smoking, and smoking determinants in a cohort of New Zealand adolescents.

METHODS

The longitudinal Multidisciplinary Health and Development Study provided information on adolescents' self-reported smoking behavior and potential predictors of smoking, such as social and material factors, personality characteristics, educational achievement, and individual attitudes and beliefs regarding smoking. Longitudinal logistic generalized estimating equation analyses were used.

RESULTS

Adolescents whose fathers were classified in the lowest-status occupational group were twice as likely as those whose fathers occupied the highest-status occupational group to be daily smokers. This high risk of daily smoking among the adolescents from the lowest occupational group was largely predicted by their lower intelligence scores and by the higher prevalence of smoking among fathers and friends.

CONCLUSIONS

To prevent socioeconomic differences in smoking, school-based interventions should seek to prevent smoking uptake among adolescents, particularly those of lower socioeconomic status. Programs need to provide positive, nonsmoking role models consonant with the culture and norms of lower-socioeconomic-status groups. Adolescents need to acquire resistance skills and protective behaviors against social pressure and influences.

Adolescent alcohol misuse: methodological issues for enhancing treatment research

AIMS

The objective of this article is to present an overview of the current state of the field of adolescent alcohol treatment research and to discuss several priorities for future research directions.

METHOD

The authors identified trends in adolescent alcohol treatment research from multiple sources, including searches of the National Institutes of Health grantee listings, proceedings from annual meetings of the Research Society on Alcoholism and relevant English-language journal articles available in MEDLINE and PSYCHLIT databases over the past decade.

RESEARCH RECOMMENDATIONS

This field must build on its major strength, which has been its success in appreciating the unique developmental characteristics of adolescence and meaningfully incorporating them into adolescent alcohol treatment approaches. Priorities for future research include: empirically investigating the potential value of harm reduction approaches for promoting public health and reducing total harm for adolescents; developing efficacious interventions across a wide range of intensities and settings; increasing the reach and relevance of randomized treatment efficacy trials and their products, with a particular focus on enhancing the recruitment and retention of diverse treatment samples; increasing a focus on key individual difference variables such as co-occurring diagnoses, that may serve as the basis for treatment tailoring; and exploration of the potential benefits of transdisciplinary research.

Potentially modifiable psychosocial factors associated with alcohol use during early adolescence

This study was conducted to identify factors associated with alcohol use among early adolescents. A survey was administered to all Grade 7 and 8 students in 16 Vermont school districts. The questionnaire covered demographics, alcohol, tobacco, and marijuana use, and measures of psychosocial mediators of alcohol use drawn from social cognitive theory. These included positive and negative expectancies about alcohol effects, perceived peer and parent alcohol norms, perceived prevalence of adolescent alcohol use, and confidence in ability to refuse alcohol. Of the 2919 respondents, 29% reported having at least one drink of beer in the preceding 30 days. In logistic regression, factors independently related to risk of drinking beer in the past 30 days were smoking (odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.8-3.0), marijuana use (OR 3.9, 95% CI 3.0-5.2), negative expectancies (OR 0.4, 95% CI 0.3-0.6), parent norms (OR 1.4, 95% CI 1.1-1.7), and estimated percentage of high school students who drink (OR 1.3, 95% CI 1.1-1.5). Gender, positive alcohol expectancies, and lack of confidence in ability to refuse alcohol all significantly interacted with peer norm, with these items more strongly associated with alcohol use when peer norm is toward "shouldn't drink." Modifiable perceptions of alcohol use were strongly associated with actual use in this adolescent sample, providing a basis for intervention program design.

The association between environmental tobacco smoke and primary tooth caries

OBJECTIVE

Environmental tobacco smoke (ETS) has been associated with a number of negative health outcomes for exposed children. The goal of this study was to assess the association between ETS and dental caries in a pediatric population.

METHODS

This study included 637 Iowa Fluoride Study children whose parents provided socioeconomic information, completed at least three questionnaires during the first year of life, and had a primary dentition exam at age 4-7 years. Households reporting in all questionnaires that someone smoked in the home were categorized as regularly smoking homes. Socioeconomic status (SES) was divided into three groups (low, middle, and high) based on family income and mother's education. Children were classified as having caries if any of the primary teeth had fillings or cavitated lesions at the primary dentition exam.

RESULTS

Overall, children residing in regularly smoking homes had a higher prevalence of caries. For the middle SES group and overall, the children from smoking homes had a significantly higher prevalence of caries compared to nonregular/nonsmoking homes (52% vs 24%, P=.05 and 44% vs 25%, P=.002, respectively). After adjusting for age, SES, toothbrushing frequency, total ingested fluoride, and combined intake of soda pop and powdered drink beverages, the relationship of smoking and caries still remained significant (odds ratio [OR]=3.38; P=.001).

CONCLUSIONS

Environmental tobacco smoke was associated with an increased risk of caries among children.

Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence

The objectives of this longitudinal study were to determine the prevalence of smoking among primary school children in Liverpool, and to identify the predictors of experimentation with cigarettes during pre-adolescence. A cohort of children (n = 270) completed questionnaires that elicited patterns of child smoking behaviour and children's experiences of smoking in their families and communities each year between the ages of 9 and 11 years. Parents also completed questionnaires. Children's first trials with cigarettes and repeated smoking were reported. The independent variables measured were socio-economic status, familial and peer smoking, and intentions to smoke. By age 11, 27% of children had tried smoking, 12% had smoked repeatedly and 3% were smoking regularly. Variables measured at age 9 predicting experimentation with cigarettes by age 11 were male gender 9P = 0.041) paternal smoking (P = 0.001) fraternal smoking (P = 0.017) a best friend who smoked (P = 0.026) and knowing someone with a smoking-related disease (P = 0.006) Intentions to smoke at age 9 did not predict smoking at age 11 (P < 0.001). In univariate analyses, child smoking was also associated with maternal smoking (P = 0.002 at age 11), living in a low-income household (P < 0.001 at age 10) and living in a deprived area ( P = 0.025 at age 11). Early smoking presents a considerable challenge to health promoters, not least because it is socially patterned. The interventions required must tackle the structural and social pressures that shape smoking behaviour during childhood.

Occupational level of the father and alcohol consumption during adolescence; patterns and predictors

STUDY OBJECTIVE

This paper describes and attempts to explain the association between occupational level of the father and high alcohol consumption among a cohort of New Zealand adolescents from age 11 to 21.

DESIGN

Data were obtained from the longitudinal Dunedin multidisciplinary health and development study. At each measurement wave, those who then belonged to the quartile that reported the highest usual amount of alcohol consumed on a typical drinking occasion were categorised as high alcohol consumers. Potential predictors of high alcohol consumption included environmental factors, individual factors, and educational achievement measured at age 9, 11, or 13. Longitudinal logistic GEE analyses described and explained the relation between father's occupation and adolescent alcohol consumption.

SETTING

Dunedin, New Zealand.

PARTICIPANTS

About 1000 children were followed up from birth in 1972 until adulthood.

MAIN RESULTS

A significant association between fathers' occupation and adolescent alcohol consumption emerged at age 15. Overall adolescents from the lowest occupational group had almost twice the odds of being a large consumer than the highest occupational group. The association between father's occupation and high alcohol consumption during adolescence was explained by the higher prevalence of familial alcohol problems and friends approving of alcohol consumption, lower intelligence scores, and lower parental attachment among adolescents from lower occupational groups.

CONCLUSIONS

Socioeconomic background affects adolescent alcohol consumption substantially. This probably contributes to cumulation of disadvantage. Prevention programmes should focus on adolescents from lower socioeconomic groups and make healthier choices the easier choices by means of environmental change.

Alcohol use in adolescents whose fathers abuse drugs

This study examined the interrelation of several domains, including father attributes, father-child relations, peer influences, environmental factors, and youth personality, as they related to adolescent alcohol use. Several aspects of the father-child relationship were also examined as possible protective factors against adolescent drinking. Subjects consisted of 204 HIV-positive and HIV-negative drug-abusing fathers and their adolescent children between the ages of 12-20. Data were collected via individual structured interviews of both the fathers and the youth. Results indicated that several items from each domain were related to adolescent drinking, and that an affectionate father-child bond had a protective effect. Moreover, hierarchical regression analyses demonstrated that the youth's personality mediated between all other domains and adolescent alcohol use. There was also a direct effect of peer influences on adolescent drinking. Findings extend the literature on the specific mechanisms which link parental substance use with adolescent alcohol use in a high-risk population.

Familial influences on adolescent smoking

The family unit is the primary source of transmission of basic social, cultural, genetic, and biological factors that may underlie individual differences in smoking. Existing information on the role of familial factors in tobacco use is characterized by two separate, but somewhat overlapping, lines of research: genetic epidemiological studies and risk-factor research. The present paper summarizes and evaluates studies assessing the association between adolescent smoking and parent and sibling smoking behaviors. A review of 87 studies reveals that methods are limited by a lack of standardized instruments, failure to measure important confounding and mediating factors, reliance on cross-sectional designs and the use of inconsistent definitions of tobacco-related behavior and assessment procedures. Moreover, there are no systematic family studies of the acquisition and continuation of smoking that have employed contemporary methodological standards for examining familial aggregation of tobacco behaviors among adolescents. Findings across studies show weak and inconsistent associations between parent and adolescent smoking; inconsistent findings may be attributed to methodological issues or associated factors that may complicate the relation between parent and adolescent smoking. Sibling and peer smoking show greater associations with adolescent smoking. Suggestions for future research include contemporary family studies that delineate meaningful phenotypes of tobacco use and prospective work on the later stages of tobacco use and the timing of the influence and valence of parent and family factors. Integration of the risk factor approach within the family study design may enrich both approaches to elucidate familial influences on smoking.

Struggling to understand: the experience of nonsmoking parents with adolescents who smoke

Smoking among adolescents is a major public health concern. Most parents would not want their children engaged in this risk-taking behavior. Although a majority of parents of smokers are themselves smokers, many are nonsmokers. The purpose of this grounded theory study was to understand what nonsmoking parents experience due to their adolescent children 's smoking behavior. The purposive sample consisted of 25 parents. The interview data generated the theory that nonsmoking parents struggle to understand their adolescents' smoking. They experienced four stages: discovering the smoking, facing the problem, reflecting, and waiting it out. Their experience can be examined from a stress paradigm. Programs are needed that provide parents with the knowledge and skills required for effective prevention and intervention strategies.

An exploration of family influences on smoking among ethnically diverse adolescents

In an attempt to better understand mechanisms through which families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that they would get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.

Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma

BACKGROUND

Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children.

OBJECTIVE

We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among inner-city children with asthma.

METHODS

Data from interviews with primary caregivers of inner-city elementary school children with asthma were evaluated (n = 590). Caregiver reports of child asthma symptoms, exercise limitations, asthma management, health care use, and ETS exposure were examined.

RESULTS

Smoking in the home was reported by 29.4% of primary caregivers. ETS exposure (yes/no) was not related to frequency of child nocturnal symptoms or other select asthma morbidity markers. However, among children exposed to ETS, the frequency and severity of child nocturnal symptoms were highest among children exposed to moderate-to-heavy levels of ETS. After controlling for child age, anti-inflammatory medication use, asthma primary care, and caregiver's education, exposure to higher levels of ETS was associated with nearly a 3-fold increase in nocturnal symptoms in children (odds ratio, 2.83; 95% CI, 1.22-6.55).

CONCLUSION

Among elementary school inner-city children with asthma, exposure to higher levels of ETS was associated with increased frequency of nocturnal symptoms. Reducing the exposure of children with asthma to ETS should be a clear priority in developing effective asthma management plans for inner-city families.

Positive impact of competence skills and psychological wellness in protecting inner-city adolescents from alcohol use

Research has shown that competence enhancement prevention programs for substance use are effective in reducing alcohol use and other problem behaviors. However, less is known about the mechanisms by which high competence helps youth avoid negative outcomes. This study explored whether greater competence is associated with increased levels of psychological wellness that in turn deters subsequent alcohol use. Specifically, 1,459 students attending 22 middle and junior high schools in New York City completed surveys that included measures of competence (decision making, self-efficacy), psychological wellness, and alcohol use. Students completed surveys at baseline, 1-year follow-up, and 2-year follow-up. Data collectors administered the questionnaire following a standardized protocol during a regular 40-min class period. On the basis of a longitudinal structural equation model, adolescents who were highly competent reported greater psychological wellness, which was then associated with less drinking. These findings highlight the potential of alcohol prevention programs designed to enhance competence and psychological wellness.

Social skills and attitudes associated with substance use behaviors among young adolescents

PURPOSE

To examine how adolescents' attitudes and social skills affect current substance use and intentions to use substances in the future.

METHODS

An anonymous questionnaire was administered to 2646 seventh graders in their classrooms. The questionnaire was developed to measure the frequency of tobacco, alcohol, and other substance use, anticipated use, positive attitudes toward drug use, self-efficacy to say "no," decision-making skills, advertising-viewing skills, anxiety-reducing skills, communication skills, drug-resistance skills, perception of peer substance use, and weapon-carrying behavior. Ethnicity classified respondents as "white" or "students of color" and family structure indicated one vs. two-parent families. Data were analyzed with Spearman's r, analysis of variance, and multiple linear regression.

RESULTS

Forty-one percent of students were minority, 50.6% female, over 90% were either 12- or 13-year-olds, and 69.9% lived in two-parent families. A multiple linear regression model demonstrated that self-efficacy to say "no, positive attitudes toward drug use, perception of peer substance use, male gender, weapon-carrying, and fighting accounted for 51% of the variation in the current use multiple substance scale. Anticipated substance use during the subsequent year was significantly associated with current substance use, positive attitudes toward drug use, self-efficacy to say "no, drug-resistance skills, weapon-carrying, and fighting behavior. This model accounted for 73.9% of the variance in anticipated substance use.

CONCLUSIONS

In today's world, where drug use is common, building adolescents' drug-resistance skills and self-efficacy, while enhancing decision-making capacity, may reduce their use of illegal substances.

Child, parent, and peer predictors of early-onset substance use: a multisite longitudinal study

The purpose of this study was to identify kindergarten-age predictors of early-onset substance use from demographic, environmental, parenting, child psychological, behavioral, and social functioning domains. Data from a longitudinal study of 295 children were gathered using multiple-assessment methods and multiple informants in kindergarten and 1st grade. Annual assessments at ages 10, 11, and 12 reflected that 21% of children reported having initiated substance use by age 12. Results from longitudinal logistic regression models indicated that risk factors at kindergarten include being male, having a parent who abused substances, lower levels of parental verbal reasoning, higher levels of overactivity, more thought problems, and more social problem solving skills deficits. Children with no risk factors had less than a 10% chance of initiating substance use by age 12, whereas children with 2 or more risk factors had greater than a 50% chance of initiating substance use. Implications for typology, etiology, and prevention are discussed.

A randomized controlled trial of two primary school intervention strategies to prevent early onset tobacco smoking

In this article, we examine the impact of two universal, grade 1 preventive interventions on the onset of tobacco smoking as assessed in early adolescence. The classroom-centered (CC) intervention was designed to reduce the risk for tobacco smoking by enhancing teachers' behavior management skills in first grade and, thereby, reducing child attention problems and aggressive and shy behavior-known risk behaviors for later substance use. The family-school partnership (FSP) intervention targeted these early risk behaviors via improvements in parent-teacher communication and parents' child behavior management strategies. A cohort of 678 urban, predominately African-American, public school students were randomly assigned to one of three Grade 1 classrooms at entrance to primary school (age 6). One classroom featured the CC intervention, a second the FSP intervention, and the third served as a control classroom. Six years later, 81% of the students completed audio computer-assisted self-interviews. Relative to controls, a modest attenuation in the risk of smoking initiation was found for students who had been assigned to either the CC or FSP intervention classrooms (26% versus 33%) (adjusted relative risk for CC/control contrast=0.57, 95% confidence interval (CI), 0.34-0.96; adjusted relative risk for FSP/control contrast=0.69, 95% CI, 0.50-0.97). Results lend support to targeting the early antecedent risk behaviors for tobacco smoking.

Family processes for children in early elementary school as predictors of smoking initiation

OBJECTIVES

To assess the relationship between family processes measured when children are in early elementary school and initiation of cigarette smoking in early adolescence.

METHODS

The analysis sample of 810 children was drawn from a longitudinal study of students from a suburban school district in the Pacific Northwest. Predictor variables were assessed when children were in second or third grade, and smoking initiation was measured when the children were in sixth or seventh grade. Measures of family processes were entered separately into logistic regression models that included controls for household structure and income, parent smoking, and peer and child characteristics.

RESULTS

Measures of child attachment to parent and parent involvement with the child's school were significantly and negatively associated with smoking initiation. Among control variables, parent smoking, child grade level, and child antisocial behavior and depression were the strongest predictors of smoking initiation.

CONCLUSIONS

The results point to the importance of family bonding and parent supportiveness as protective factors and parent smoking and early childhood antisocial behavior and depression as risk factors for smoking initiation in pre- or early adolescence.

Adolescent antecedents of high-risk driving behavior into young adulthood: substance use and parental influences

Driver history data, in combination with previously collected tenth-grade questionnaire data, for 4403 subjects were analyzed by Poisson regression models to identify the significant substance use and parental characteristics predicting subsequent high-risk driving of new drivers (starting at age 16) through age 23-24 years. Substance use (cigarettes, marijuana, and alcohol) reported at age 15 was shown to be an important predictor of subsequent excess risk of serious offenses and serious crashes for both men and women. In addition, negative parental influences (lenient attitudes toward young people's drinking; low monitoring, nurturance, family connectedness), were also demonstrated to increase the risk of serious offenses and serious crashes for both men and women.

The prospective relation between dimensions of anxiety and the initiation of adolescent alcohol use

Examined the relation between early anxiety symptomatology (generalized and separation) and initiation of alcohol use 4 years later in an epidemiological sample of 936 children (45% girls), assessed at ages 9, 11, and 13, while controlling for the effects of depression. Although earlier overall anxiety symptomatology was unrelated to later onset of drinking, children with early symptoms of generalized anxiety were found to be at increased risk for initiation of alcohol use, whereas children with early symptoms of separation anxiety were at decreased risk. The magnitude of these relations was equally strong for boys and girls. In addition, early depressive symptomatology was associated with increased risk for initiation of alcohol use in adolescence. Results indicate that it is important to consider specific dimensions of anxiety symptomatology when attempting to identify those individuals at risk for early initiation of alcohol use.

Peer and parent influences on smoking and drinking among early adolescents

Social influences can promote or discourage adolescent substance use. The authors surveyed 4,263 sixth- to eighth-grade students to assess the effect of peer and parent influences on adolescent substance use. The authors conducted separate multiple logistic regression analyses for smoking and drinking, controlling for grade, sex, and race. Positive independent associations with smoking and drinking were found for direct peer pressure and associating with problem-behaving friends. Independent negative associations with smoking and drinking were also found for parent involvement, parent expectations, and parent regard. In an analysis of interactions, peer pressure was positively associated with drinking for girls but not for boys and problem-behaving friends was positively associated with drinking for both boys and girls. The findings are consistent with the hypothesis that associating with deviant peers promotes and that authoritative parenting protects against smoking and drinking.

Cigarette use in adolescents: the Cardiovascular Health in Children and Youth Study

Tobacco is the leading cause of preventable death in the United States, and its use is increasing in adolescents. To determine the interventions needed to prevent the initiation of smoking, it is important to know the factors related to tobacco use by adolescents. In this study the following factors related to cigarette use were examined: age, gender, ethnicity, self-esteem, physical activity, parental smoking, and socioeconomic status. Participants were 1,207 youth completing a written survey for the Cardiovascular Health in Children and Youth Study (CHIC II). Participants ranged in age from 10 to 15 years, with a mean age of 12.2 years; 64.2% were White, 24.0% Black, 5.8% Hispanic, and 6.0% other races. White and Hispanic youth and youth of other races had significantly higher rates of smoking than did Black youth. Significant risk factors for smoking were: higher grade in school, White race, and for girls only, lower self-esteem. In White youth those in the lowest socioeconomic status were most likely to be current and experimental smokers. Smoking was as common in girls as in boys at these ages. Multivariate analysis showed that neither physical activity nor parental smoking were significant predictors of smoking behaviors. These results suggest that smoking prevention programs for adolescents should specifically target White and Hispanic youth and those from families with low socioeconomic status. In addition, these interventions should include ways to increase self-esteem in girls.

Cigarette smoking and adolescents: messages they see and hear

Cigarette smoking is the primary preventable cause of mortality and morbidity in the US. But in the mid-1990s, more than one-third of US teenagers were smokers, despite their awareness of the health risks and negative consequences of tobacco use. In 1996, as part of a three-year qualitative study to explore differences in adolescent smoking by gender and ethnicity, members of the Tobacco Control Network examined messages that teens receive about cigarette smoking. Consisting of 178 focus groups with 1,175 teenagers covering all levels of smoking experience, the study included teens from five ethnic groups, stratified by gender and ethnicity, from urban and rural areas across the US. The authors reviewed the sources and content of messages that teens reported were most influential in their decisions to smoke or not smoke cigarettes. Family and peers, school, television, and movies were the primary sources for both pro- and anti-smoking messages. The authors conclude that a lack of clear, consistent antismoking messages leaves teens vulnerable to the influences of pro-smoking messages from a variety of sources. Interventions need to be culture- and gender-specific. Family-based interventions appear to be needed and efficacious, but resource intensive. Building self-esteem may prove to be a promising intervention.

Psychosocial determinants of the onset and escalation of smoking: cross-sectional and prospective findings in multiethnic middle school samples

PURPOSE

To investigate a broad range of social influence-related and global determinants of smoking to aid in the design of comprehensive multiethnic interventions by testing the most important factors of initiation and escalation of smoking across various subgroups.

METHODS

Cross-sectional (N = 2546) and cohort (N = 736) samples of multiethnic middle school students near a large Southwestern metropolis were surveyed through self-report questionnaires. The confidential questionnaires included information on demographics, risk factors, and smoking behavior and were administered in class by trained data collectors. Multivariable logistic regression analysis was used to examine the statistical significance and strength of the factors.

RESULTS

Those lower in self-esteem and higher in social assertiveness appeared to be most at risk for the onset of smoking, whereas those low in optimism appeared to be the most at risk for the escalation of smoking. Attitudes, friends' norms, parents' norms, perceived behavioral control, and perceived prevalence were consistent predictors of all smoking status outcomes.

CONCLUSIONS

The behavioral-specific determinants of smoking appear to be important predictors of smoking status outcomes in all demographic subgroups. The relationships of the global determinants were more dependent on the smoking outcome variable and subgroup examined. The findings may serve to help facilitate the targeting of comprehensive interventions aimed at reducing adolescent smoking in multiethnic and ethnic group-specific populations.

Tobacco smoking among high school students in Romagna (Italy) and evaluation of a prevention campaign

The aim of this study was to investigate the smoking habits of a sample of second year high school students in Romagna (Northern Italy) by means of an anonymous self-administered questionnaire and the efficiency of a previous health education campaign. A sample of 2,691 16-year-old pupils (74% of the school population of this age) was randomly selected. Of these, 863 (32.1%) had participated in a prevention campaign while attending middle school. 19.1% of the students who had taken part in the campaign were smokers compared to 23.2% of those who had not. The students' smoking habits were found to be influenced by the type of school and by the role models (parents, siblings, friends, teachers). The campaign appears to have had good results, especially in places where it was carried out on a wide scale. Suggestions are made for making such campaigns more efficient.

Associations of family environment and individual factors with tobacco, alcohol, and illicit drug use in adolescents

Despite abundant literature the respective roles of psychosomatic status, personality, health perception, family environment, and sport activity in tobacco, alcohol and illicit drug use have not been well known. To assess their roles, an epidemiological cross-sectional study was conducted in 3294 middle and high school adolescents, 2396 (73%) of whom agreed to participate. The standardized questionnaire was filled out by the teenagers under the supervision of the teachers. Strong associations were found between tobacco, alcohol, and illicit drug use. The prevalence of alcohol use and illicit drug use were respectively 7 and 10 times higher in smokers than in non-smokers. On the whole, the potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception. Mother being a housewife was a protective factor. No marked role was noted for the head of family's socio-occupational category. Personality would be indicators of self-control ability. Indeed, some self-reported personalities (serious, attentive, calm, organized) had protection roles whereas some others (easily irritable, aggressive, worried, clumsy, careless, solitary, etc.) were risk factors (risk-taking or deviant behaviors). Some sports activities were found to be negatively related, but some others related positively with drug use, possibly due to repetitive meetings between the adolescents at risk. Preventive measures may be targeted at these risk factors.

Age of first use of cigarettes among rural and small town elementary school children in Illinois

This study determined age of first use of cigarettes among rural and small town elementary school students. Data were collected from 1,950 elementary school students, grades kindergarten through sixth, attending seven different schools in southern Illinois. Bivariate odds ratios and multivariate logistic regression procedures identified risk factors of cigarette use among this elementary school population. A Duncan multiple-range test revealed no significant difference in cigarette use between grades kindergarten through fifth (average percentage of use for those grades was 4.7%), but use increased significantly to 17.4% in the sixth grade. Predictor variables with the greatest odds ratios were having tried alcohol (OR = 8), having tried chewing tobacco or snuff (OR = 4.4), and being in the sixth grade (OR = 2.2). Healthy People 2010 draft objectives emphasize prevention and reduction of tobacco use among youth. To be effective, tobacco prevention programs must begin in the elementary school years.