Adolescent smoking from a functional perspective: The Berlin-Bremen Study

Do Substance Use and Delinquency have Differential Associations with Adolescents’ Peer Relations?

Despite their potentially serious short- and long-term risks, developmental theorists have argued that risk behaviours may play important constructive roles in adolescent development. The present study hypothesised that adolescent substance use, but not delinquency, would be associated with positive peer relations. Subjects were 491 German adolescents participating in the Bielefeld Longitudinal Youth Survey who completed questionnaires during grades 7, 8, 9, and 10. Measures were adolescents’ self-reported substance use (alcohol, tobacco), delinquency (antisocial acts), and peer relations (peer involvement frequency, perceived peer group closeness, perceived position in the peer group, having a boy- or girlfriend). Repeated measures analyses of variance examined gender and school type differences in risk behaviour and peer relations across four occasions. Within-time, peer relations were positively related to substance use and, in a few cases, positively related to delinquency. As hypothesised, substance use predicted increases in the frequency and intensity of peer relations, but delinquency did not do so consistently. The pattern of results did not differ by gender or school type. The discussion focuses on the meaning of risky behaviours and differences between substance use and delinquency, and argues that prevention efforts must take seriously the positive functions served by risk behaviours.

Psychobiological Theories of Smoking and Smoking Motivation

Abstract. Theories of smoking have been developed about the conditions and causes of smoking as well as for explaining its maintenance. Moreover, factors of smoking motivation have been identified, which describe incentives to smoke and types of smoking behavior. The most frequently reported motives are psychosocial smoking, sensorimotor smoking, indulgent smoking, stimulation smoking, sedation smoking, dependent smoking, and automatic smoking. In the first phase after the start of smoking, psychosocial smoking is the dominating motive, which is best represented by theories of social psychology. Sensorimotor smoking may be best explained by theories of classical and operant conditioning. Indulgent smoking (= smoking for pleasure) may be explained by neurochemical theories and by the neurobiological theories of dependence emphasizing nicotine-induced activation of mesolimbic dopaminergic reinforcement. Stimulation smoking and sedation smoking are related to arousal models. Moreover, sedation smoking is also explained by aspects of reducing negative affect (as claimed by theories of affect regulation) and by biochemical theories emphasizing serotonergic mechanisms in modulating anxiety as well as by theories of dependence. Dependent smoking, which is mostly based on negative reinforcement (suppression of withdrawal symptoms) may be explained by neurochemical theories as well as by neurobiological theories of psychological and physical dependence explaining blunted dopaminergic and serotonergic responsivity as due to desensitization of respective receptors. Also automatic smoking may be explained by processes of habit learning and neurobiological theories of dependence. Finally, personality theories have been applied to all of these smoking motives.

A methodological and substantive review of the evidence that schools cause pupils to smoke

The objectives of this review were to examine whether smoking prevalence varies between schools independently of health promotion programmes and pupil composition, to show which school characteristics are responsible for this variation, and to examine the methodological adequacy of such studies. Searches for published studies were performed on medical, educational and social science databases, relevant articles' reference lists, and citation searches. Any study was included that described inter-school variation in smoking prevalence, or related such variation to school characteristics. A model relating pupil smoking to school, neighbourhood, and pupil characteristics unlikely and likely to be influenced by school was used to examine the adequacy of control of confounding by pupil composition. Data from studies were combined qualitatively considering methodological adequacy to examine the relation of smoking prevalence to school characteristics. Theoretical frameworks underpinning the choice of school characteristics and postulated relationships between these characteristics and smoking prevalence were described. There were large variations in smoking prevalence between ostensibly similar schools. Evidence that pupil composition did not cause this was weak, because all studies had methodological problems, including under control of relevant pupil compositional factors and over control of factors likely to represent the mechanism through which schools influence pupils' smoking. There was little evidence that elements of tobacco control policy other than bans and enforcement deterred smoking. Academic practice and school ethos were related to smoking. Academically selective schools did not influence smoking, once pupil composition was controlled. There was one study on neighbourhood influences, which were unrelated to smoking. Studies frequently offered little or no theoretical justification for associating school characteristics with smoking. Some aspects of school influence pupils' smoking, probably independently of pupil composition. However, under-control and over-control of confounding and lack of theoretical underpinning precludes definitive conclusions on how particular school characteristics influence pupils' smoking.

The influence of school culture on smoking among pupils

School factors and not solely pupil composition probably cause variation in smoking prevalence amongst schools, but there are no theoretical models to explain why. In this paper we propose a hypothesis to explain schools' influence on pupils' smoking and test this using an existing cross-sectional survey of 23,282 pupils from 166 secondary schools in the West Midlands, UK. We hypothesise that school-level educational achievement scores would not be associated with smoking prevalence, but schools providing value-added education given the social background of pupils (authoritative schools) would provide effective support and control, have a relatively strong influence on pupils' lives and be associated with lower than average smoking prevalence. Schools providing value-denuded education (laissez-faire schools) would have a relatively weak influence on pupils' lives and be associated with higher than average smoking prevalence. The school achievement measures were the proportion of pupils achieving 5A-C General Certificates of Secondary Education (5A-Cs) grades and the proportion of half days lost to truancy. Value-added/denuded terms were created by regressing 5A-Cs and truancy on five markers of the social profile of pupils at the school. Authoritative schools achieved better than expected rates on both measures. Laissez-faire schools achieved worse than expected rates on both measures. All other schools were classed as indeterminate. Multilevel logistic regression was used to relate the risk of regular smoking to school culture in both achievement and authoritative/laissez-faire terms, both with and without adjustment for pupil-level risk factors for smoking. As predicted, schools' achievement measures were unrelated to pupils' smoking. The odds ratios (95% confidence intervals) for smoking in authoritative and laissez-faire schools relative to indeterminate schools were 0.80 (0.70-0.91) and 1.16 (1.07-1.27), respectively. Adjustment for pupil-level smoking risk factors had little effect. School culture is an independent risk factor for adolescent smoking. Schools providing effective support and control might protect pupils from smoking.

Parent's socioeconomic status, adolescents' disposable income, and adolescents' smoking status in Massachusetts

OBJECTIVES

This study examined the association between parental socioeconomic status (SES) and adolescent smoking.

METHODS

We conducted telephone interviews with a probability sample of 1308 Massachusetts adolescents aged 12 to 17 years. We used multiple-variable-adjusted logistic regression models.

RESULTS

The risk of adolescent smoking increased by 28% with each step down in parental education and increased by 30% for each step down in parental household income. These associations persisted after adjustment for age, sex, race/ethnicity, and adolescent disposable income. Parental smoking status was a mediator of these associations.

CONCLUSIONS

Parental SES is inversely associated with adolescent smoking. Parental smoking is a mediator but does not fully explain the association.

Association of adolescent cigar use with other high-risk behaviors

OBJECTIVES

To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use.

METHODS

A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires.

RESULTS

The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2-32.3; boys, OR: 21.3; 95% CI: 17.1-26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4. 5-12.4; boys, OR: 13.0; 95% CI: 9.8-17.4), and alcohol (girls, OR: 6. 6; 95% CI: 4.8-9.1; boys, OR: 6.8; 95% CI: 5.3-8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9-16.9; boys, OR: 34.8; 95% CI: 19.4-62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item.

CONCLUSIONS

Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Determinanten des Rauchverhaltens bei Jugendlichen und Transfereffekte eines schulischen Gesundheitsprogrammes

Zusammenfassung. Die vorliegende Studie untersucht Transfereffekte eines schulischen Gesundheitsprogramms zur Prävention von Alkohol- und Medikamentenkonsum auf den Bereich der Rauchprävention. Zur Abschätzung der Programmwirkungen wurden persönliche und soziale Schutz- bzw. Risikofaktoren (Rauchverhalten der Freunde, Eltern und Geschwister; rauchbezogene Instrumentalitäts- und Selbstwirksamkeitserwartungen; Selbstwertgefühl) als zusätzliche Prädiktoren berücksichtigt. Die Evaluation folgt einem quasi-experimentellen Versuchsplan mit 22 Gesamtschulklassen der siebten bis neunten Klassenstufen in einer unstandardisierten und einer standardisierten Interventionsgruppe sowie einer Kontrollgruppe. Für 357 Schüler (189 Mädchen und 168 Jungen; Alter: 13 bis 18 Jahre) liegen vollständige Daten zu Prätest, Posttest und Follow-up vor. Die mittels logistischer Regressionen ermittelten Ergebnisse zeigen, daß aus primärpräventiver Sicht das Rauchverhalten der engsten Freunde und die rauchbezogenen Wirksamkeits- bzw. Instrumentalitätserwartungen entscheidend dafür sind, ob nicht rauchende Jugendliche mit dem Rauchen beginnen oder nicht, während die Intervention keine zusätzlichen Effekte erzielte. Eine sekundärpräventive Wirkung des Gesundheitsprogramms ergab sich in der standardisierten Interventionsgruppe, in der bedeutsam mehr Jugendliche mit dem Rauchen aufhörten als in der unstandardisierten Interventionsgruppe und der Kontrollgruppe. Einflüsse der persönlichen und sozialen Faktoren gab es hier hingegen nicht. Die Befunde werden diskutiert im Hinblick auf unterschiedliche Risikogruppen, Präventionsziele und psychosoziale Determinanten für den Beginn und die Einstellung des Rauchverhaltens.

Why children start smoking cigarettes: predictors of onset

We review findings from 27 prospective studies of the onset of cigarette smoking conducted since 1980. Almost 300 measures of predictors of smoking onset were examined, and 74% of them provided multivariate support for predictors of onset derived from theory and previous empirical findings. Expected relationships were strongly supported for (a) socioeconomic status, with students with compromised status being more likely to try smoking; (b) social bonding variables, particularly peer and school bonding, with less support for family bonding; (c) social learning variables, especially peer smoking and approval, prevalence estimates, and offers/availability, with less consistent support for parent smoking and approval; (d) refusal skills self efficacy; (e) knowledge, attitudes and intentions, with the expected stronger predictions from intentions than from attitudes than from knowledge; and (f) broad indicators of self-esteem. The few investigators who analyzed their data separately by age, gender, or ethnicity found many differences by these factors, though there were too few of them to detect any pattern with confidence. Though the 27 studies are far from perfect, we believe that they confirm the importance of many well-accepted predictors and raise some questions about others. In particular, family smoking, bonding and approval each received unexpectedly low support. It is not clear whether this lack of support reflects reality as it has always been, is due to a changing reality, reflects developmental changes, either in the age of subjects or the stage of onset, or is due to poor measurement and too few tests. Future prospective studies need to be theory-driven, use measures of known reliability and validity, report analyses of scale properties, and use statistical methods appropriate to the hypotheses or theories under study. Finally, we encourage more investigations of the potentially different predictors of transitions to experimental or regular cigarette smoking. This will require multi-wave studies and careful measurement of changes in smoking behavior.