Adolescents' first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences

Distinct populations suppress or escalate intake of cocaine paired with aversive quinine

Background

Only a subset of individuals who encounter drugs of abuse become habitual users. Aversive subjective effects like coughing and unpleasant taste are predictors for continued use. While several preclinical studies have explored self-administration involving aversive cues, none have simultaneously introduced aversion with the initial drug self-administration. We aimed to develop a clinically relevant model by pairing intravenous cocaine with intraoral quinine self-administration from the outset and investigating whether repeated exposure to an aversive stimulus would alter its hedonic value under laboratory conditions.

Methods

Twenty-seven male and female Sprague Dawley rats self-administered intravenous/intraoral (cocaine/quinine) for 2 hr/day over 14 days. This was followed by a 1-day quinine-only extinction session, a 3-day return to self-administration, and an intraoral infusion session to assess quinine taste reactivity (TR).

Results

We identified three distinct groups. The first self-administered very little cocaine, while the second sharply escalated cocaine intake. Both groups had similar aversive TR to quinine, suggesting that the escalating group did not habituate to the aversive cue but pursued drug despite it. We also identified a third group with high initial intake that decreased over time. This decrease predicted high aversive TR, and we argue this group may represent individuals who "overindulge" on their first use and subsequently find self-administration to be aversive.

Conclusions

Our novel model mimics real-world variability in initial interactions with drugs of abuse and yields three distinct groups that differ in self-administration patterns and aversive cue valuation.

Adolescent dual-product users: Acquisition and situational use of cigarettes and cigars

BACKGROUND

Little is known about how adolescents who smoke both cigarettes and cigar products obtain and use these products. This study sought to explore cigarette and cigar acquisition and situational use among high school smokers.

METHODS

Data are drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Analysis was limited to youth who smoke cigarettes as well as cigars, cigarillos, and little cigars (CCLC) in the past month (N = 649). Consumption of both products was calculated and used to create four subtypes of users based on high or low use of each product (Dual High, Dual Low, High CCLC/Low Cigarette, and Low CCLC/High Cigarette users). Current users were asked to identify situations in which they use cigarettes and CCLCs and ways in which they obtain these products. Data were analyzed overall and by user subtype.

RESULTS

Youth reported acquiring cigarettes and CCLC in similar ways, although youth were more likely to take cigarettes from family members than CCLC (11.1% vs. 4.8%). Several differences were observed between cigarettes and CCLC for situational use. While both products are frequently used in social situations (e.g., with friends), cigarettes were more likely to be used in solitary situations (e.g., before bed). Further, significant differences were observed among the four user subtypes.

CONCLUSIONS

Study results highlight important, nuanced differences regarding how young multi-tobacco users obtain and the situational use of such products. Importantly, these findings vary by user subtype, informing future interventions to prevent and reduce smoking among the most vulnerable subgroups of youth.

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:: A Cross-sectional Study

INTRODUCTION

Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them.

METHODS

Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014.

RESULTS

Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only.

CONCLUSIONS

These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.

Socially acquired nicotine self-administration with an aversive flavor cue in adolescent female rats

RATIONALE

Establishing a behavioral model for the effect of social environment on nicotine intake in rodents facilitates the investigation of molecular mechanisms critical for the interaction between social environment and cigarette smoking.

OBJECTIVES

Our main objective was to test the hypothesis that nicotine is the primary reinforcer in the socially acquired nicotine intravenous self-administration (IVSA) model by using an aversive flavor cue.

METHODS

Adolescent female rats were placed in operant conditioning chambers equipped with two lickometers. Operant licking triggered concurrent deliveries of a flavor (i.e., taste and odor) cue containing either quinine or saccharin and an i.v. infusion (30 μg/kg nicotine or saline). An audiovisual cue was provided for some groups of rats. A second rat that did not receive nicotine was placed in the operant conditioning chambers to provide either a neutral or an inducing (i.e., by consuming the flavored solution) social environment. These two rats were separated by a divider that allowed orofacial interactions.

RESULTS

Rats acquired stable nicotine IVSA with either the aversive or the appetitive flavor cue in the inducing social environment, and obtained similar amounts of infusions. The neutral social environment did not support nicotine IVSA with either cue. The audiovisual cue per se did not support nicotine IVSA but enhanced nicotine intake. Nicotine increased the number of concurrent nose pokes by the two rats into the center divider, a measure of social interaction.

CONCLUSIONS

Despite its aversive effects, nicotine is the primary reinforcer for the operant responses in the socially acquired nicotine IVSA model.

Nonprobability and probability-based sampling strategies in sexual science

With few exceptions, much of sexual science builds upon data from opportunistic nonprobability samples of limited generalizability. Although probability-based studies are considered the gold standard in terms of generalizability, they are costly to apply to many of the hard-to-reach populations of interest to sexologists. The present article discusses recent conclusions by sampling experts that have relevance to sexual science that advocates for nonprobability methods. In this regard, we provide an overview of Internet sampling as a useful, cost-efficient, nonprobability sampling method of value to sex researchers conducting modeling work or clinical trials. We also argue that probability-based sampling methods may be more readily applied in sex research with hard-to-reach populations than is typically thought. In this context, we provide three case studies that utilize qualitative and quantitative techniques directed at reducing limitations in applying probability-based sampling to hard-to-reach populations: indigenous Peruvians, African American youth, and urban men who have sex with men (MSM). Recommendations are made with regard to presampling studies, adaptive and disproportionate sampling methods, and strategies that may be utilized in evaluating nonprobability and probability-based sampling methods.

Carbon disulfide mediates socially-acquired nicotine self-administration

The social environment plays a critical role in smoking initiation as well as relapse. We previously reported that rats acquired nicotine self-administration with an olfactogustatory cue only when another rat consuming the same cue was present during self-administration. Because carbon disulfide (CS₂) mediates social learning of food preference in rodents, we hypothesized that socially acquired nicotine self-administration is also mediated by CS₂. We tested this hypothesis by placing female adolescent Sprague-Dawley rats in operant chambers equipped with two lickometers. Licking on the active spout meeting a fixed-ratio 10 schedule triggered the concurrent delivery of an i.v. infusion (saline, or 30 µg/kg nicotine, free base) and an appetitive olfactogustatory cue containing CS₂ (0–500 ppm). Rats that self-administered nicotine with the olfactogustatory cue alone licked less on the active spout than on the inactive spout. Adding CS₂ to the olfactogustatory cue reversed the preference for the spouts. The group that received 500 ppm CS₂ and the olfactogustatory cue obtained a significantly greater number of nicotine infusions than other groups. After extinction training, the original self-administration context reinstated nicotine-seeking behavior in all nicotine groups. In addition, in rats that received the olfactogustatory cue and 500 ppm CS₂ during SA, a social environment where the nicotine-associated olfactory cue is present, induced much stronger drug-seeking behavior compared to a social environment lacking the olfactogustatory cue. These data established that CS₂ is a critical signal that mediates social learning of nicotine self-administration with olfactogustatory cues in rodents. Additionally, these data showed that the social context can further enhance the drug-seeking behavior induced by the drug-taking environment.

Propensity for social interaction predicts nicotine-reinforced behaviors in outbred rats

Social and genetic factors can influence smoking behavior. Using olfactogustatory stimuli as the sensory cue for intravenous nicotine self-administration (SA), we previously showed that social learning of nicotine contingent odor cue prevented rats from developing conditioned taste aversion and allowed them to instead establish stable nicotine SA. We hypothesized that genetic factors influenced socially acquired nicotine SA. A heterogeneous stock (HS; N/NIH) of outbred rats was trained to self-administer nicotine using the social learning protocol. Both male and female HS rats acquired nicotine SA, but females self-administered more nicotine than males. After extinction, the context previously paired with nicotine SA, in conjunction with socially transmitted drug cues, was sufficient to cause reinstatement of drug-seeking behavior. Wide variation in both nicotine intake and reinstatement was observed. Using multiple regression analysis, we found that measures of social interaction were significant predictors of nicotine intake and reinstatement of drug seeking in both males and females. Furthermore, measures of depression were predictors of nicotine intake in both males and females, anxiety was a predictor only in males and response to novelty was a predictor only in females. In males, measures of both depression and anxiety predicted nicotine reinstatement. Together, these data supported the ideas that genetically determined propensities for emotional and social phenotypes are significant determinants for nicotine-reinforced behavior, and that the HS rat is a suitable tool for dissecting genetic mechanisms that may underlie the interaction between social behavior, anxiety, depression and smoking.

Smoking-specific parenting and smoking onset in adolescence: the role of genes from the dopaminergic system (DRD2, DRD4, DAT1 genotypes)

Although only few studies have shown direct links between dopaminergic system genes and smoking onset, this does not rule out the effect of a gene-environment interaction on smoking onset. Therefore, the aim of this study was to examine the associations between smoking-specific parenting (i.e., frequency and quality of communication and house rules) and smoking onset while considering the potential moderating role of dopaminergic system genes (i.e., DRD2, DRD4, and DAT1 genotypes). Data from five annual waves of the 'Family and Health' project were used. At time 1, the sample comprised 365 non-smoking adolescents (200 younger adolescents, mean age = 13.31, SD = .48; 165 older adolescents, mean age = 15.19, SD = .57). Advanced longitudinal analyses were used (i.e., logistic regression analyses, (dual) latent growth curves, and cross-lagged path models). The results showed a direct effect of quality of communication on smoking onset. No direct effects were found for frequency of communication and house rules. Furthermore, no direct and moderating effects of the DRD2, DRD4, or DAT1 genotypes were found. In conclusion, the findings indicated that the effects of smoking-specific parenting on smoking are similar for adolescent carriers and non-carriers of the dopaminergic system genes.

Evidence for truth®: the young adult response to a youth-focused anti-smoking media campaign

BACKGROUND

Previous studies have shown that exposure to truth® and similar countermarketing campaigns is associated with an increase in anti-smoking attitudes and beliefs in those aged 12-17 years and a decrease in youth smoking. However, it is unclear how such campaigns influence young adults aged 18-24 years.

PURPOSE

To examine levels of awareness and the effect of the national truth campaign on smoking-related attitudes, beliefs, and intentions in young adults.

METHODS

Data on respondents, aged 18-24 years, from the Legacy Media Tracking Surveys-eight cross-sectional nationally representative telephone surveys administered from 2000 to 2004-were combined and analyzed in 2009. Logistic regression analyses were used to examine the associations between confirmed awareness of the truth campaign and smoking-related attitudes, beliefs, and intentions. A second set of models was used to examine the association of attitudes and beliefs targeted by the campaign with smoking intentions.

RESULTS

A majority of young adults showed confirmed awareness of the truth campaign. Awareness was associated with roughly half of the anti-smoking attitudes and beliefs, and it was associated marginally with the intention to quit among smokers (p=0.06). Several of the attitudes and beliefs targeted by the campaign were associated with the intention to not smoke (among nonsmokers) and to quit (among smokers).

CONCLUSIONS

Messages contained in youth-focused anti-smoking campaigns may promote attitudinal and behavioral change in young adults. Young adults are at risk for both initiation and establishment of smoking, while also being targeted specifically by the tobacco industry, so it is critical to consider this audience when developing and implementing anti-smoking interventions.

Tobacco use prevalence and factors associated with tobacco use in new U.S. Army personnel

This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.

People Use Self-Control to Risk Personal Harm: An Intra-Interpersonal Dilemma

People will smoke cigarettes, drink alcohol, binge eat, drink coffee, eat chili peppers, fail tests, steal, ingest illicit drugs, engage in violent and sadistic actions including killing, have sex, and seek to become HIV positive for the sake of interpersonal acceptance. The self-control for personal harm model reconceptualizes behaviors that have both urge and control components as demonstrating either successful or failed self-control, depending on the incipient urge. The model underscores the role of expected social rewards as an important incentive for which people sometimes engage in personally risky and aversive behaviors despite feeling that they would rather avoid the behaviors and attendant harm. Research from diverse perspectives converges to show that risky behaviors, which might on the surface appear to be self-control failures, can in fact require self-control exertion.

Psychosocial mediators of a school-based tobacco prevention program in India: results from the first year of project MYTRI

Each day in India, an estimated 5,500 youth initiate tobacco use, contributing to predictions that by 2020, tobacco will account for 13% of all deaths in India. Project MYTRI (Mobilizing Youth for Tobacco-Related Initiatives in India) is a multi-component school-based intervention designed to prevent and reduce tobacco use among adolescents in Delhi and Chennai, India. The intervention was implemented over the 2004-2006 school years and involved 6th and 8th grade students in 32 classrooms. Students participated in peer-led classroom activities involving games, competitions, and other activities intended to target a number of psychosocial risk factors believed to prevent tobacco use among urban Indian youth. To more fully understand how Project MYTRI influenced students' intentions to smoke or chew tobacco, the current study used mediation analysis to investigate whether Project MYTRI altered the psychosocial risk factors as intended, and whether the changes in psychosocial risk factors were, in turn, responsible for altering students' tobacco-use intentions. Multi-level mediation models were estimated using student data from baseline and 1-year follow-up surveys. Results indicated that the psychosocial risk factors Knowledge of Health Effects, Normative Beliefs, Reasons to Use Tobacco, and Perceived Prevalence were significant mediators between the intervention activities and students' tobacco use intentions. Evidence of inconsistent mediation was observed for the Perceived Prevalence factor. These findings, combined with those from qualitative research and the second-year student data, will help to illuminate the impact of Project MYTRI on participating youth.

Substance use, trait measures, and subjective response to nicotine in never-smokers stratified on parental smoking history and sex

INTRODUCTION

Male and female never-smokers stratified on parental history of smoking were tested for possible differences in susceptibility to the hedonic effects of nicotine.

METHODS

We recruited nicotine-exposed never-smokers with two never-smoking biological parents (PH-) or two ever-smoking biological parents (PH+). After completing a baseline assessment battery focusing on conditions or behaviors associated with smoking, participants were tested for subjective and hedonic effects in response to administration of three different nicotine doses (0.0, 0.5, and 1.0 mg) via nasal spray. Physiological and biochemical reactivity also was monitored.

RESULTS

PH+ were significantly more likely to report having experienced a "buzz" upon early smoking experimentation and to have histories of alcohol abuse and alcoholism; they also scored higher on disordered eating. In response to nicotine dosing, PH+ reported an increase in depressed mood, compared with a minimal response in PH-, in keeping with our expectation that nicotine would have more pronounced effects in PH+. Regardless of parental history, women reported experiencing greater anxiety in response to the highest nicotine dose, compared with men.

DISCUSSION

Further exploration in larger samples, using more stringent selection criteria, a wider range of measures, and a less aversive dosing method, may provide a full test of the possible utility of the parental history model for illuminating biobehavioral mechanisms underlying response to nicotine. Also important would be broadening the scope of inquiry to include comparisons with ever-smokers to determine what protected PH+ from becoming smokers, despite the presence of factors that might be expected to decrease resilience and increase susceptibility.

Using MIMIC models to examine the relationship between current smoking and early smoking experiences

INTRODUCTION

The present study expands previous research on early experiences with tobacco by using a Multiple Indicator Multiple Causes (MIMIC) model, which permits combining indicators tapping into pleasant experiences into one latent construct and those indicators of unpleasant experiences into another latent construct.

METHODS

A sample of 458 participants was recruited via newspaper advertisements. Response to early experimentation with cigarettes was assessed using the Early Smoking Experiences questionnaire, in which participants were asked the following question: "The first time you tried cigarettes, did you experience any of the following? (pleasurable and displeasurable sensations [overall], pleasurable rush or buzz, dizziness, relaxation, nausea, cough, difficulty inhaling)." These experiences were rated on a scale ranging from 1 = none to 4 = intense.

RESULTS

The MIMIC model revealed that current smoking status and age of initial experimentation with cigarettes were significantly associated with both early pleasant and unpleasant experiences (p < .05). African Americans were less likely than Whites to have early unpleasant experiences (p < .05). No association was found between race and early pleasant experiences.

DISCUSSION

Our findings are consistent with the inferences that pleasant experiences in response to early experimentation with smoking lead to regular smoking and that positive experiences play a stronger role than negative experiences in the transition to regular smoking. Our study also demonstrates that the MIMIC model is pertinent and practicable in nicotine and smoking research. We recommend it as a useful tool for identifying endophenotypes related to nicotine dependence and tobacco use latent constructs.

Characterizing early cigarette use episodes in novice smokers

Retrospective self-report data indicate that early cigarette use episodes may be important predictors of smoking. Unfortunately, recall of early experiences are confounded with current smoking. The current study is the first to examine early cigarette use episodes (EUEs) prospectively in novice smokers (less than 15 lifetime cigarettes). Smoking amount, context and subjective experiences for up to five of the first cigarette episodes during their first year of college were collected using weekly internet-based questionnaires and structured interviews. Data were obtained on 538 EUEs from 163 students. EUEs generally occurred within a social/party context; over 90% of EUEs occurred when participants were with other people who were smoking and over 65% occurred while participants were drinking alcohol. Subjective effects across episodes were reported as generally mild and factor analysis yielded Positive, Negative and Sensory/Peripheral effects scales. Subjective effects were related to the amount smoked and inhalation, whereas EUE context, including alcohol use and social context, was not. This study demonstrates that it is possible to study EUEs in college students within days or weeks of their occurrence and that most of these occur in social settings with the concurrent use of alcohol.

Adolescent smoking networks: the effects of influence and selection on future smoking

Peer influence and peer selection have both been linked to the smoking behavior of adolescents. The present investigation uses social network analysis methodology to explore the simultaneous effects of both processes on adolescent smoking and smoking susceptibility over two time periods. Results suggest the effects of friendship selection in 6th grade on smoking behavior in 7th grade were primarily direct. Selecting smokers as friends in 6th grade predicted both smoking and smoking susceptibility in 7th grade, and selecting susceptibles predicted future friendship selection and peer influence. Influence processes were indirectly related to smoking. Smokers' influence in 6th grade predicts the selection of smokers as friends in 7th grade. Smokers' influence also demonstrated a protective effect when ties were not reciprocated.

The Myth of Peer Influence in Adolescent Smoking Initiation

The widespread belief that peer influence is the primary cause of adolescent smoking initiation is examined and called into question. Correlational and longitudinal studies purporting to demonstrate peer influence are analyzed, and their limitations described. Qualitative interview studies of adolescent smoking initiation are presented as depicting the more complex role of the peer context. Finally, a new model of the role of peers in smoking initiation is offered, with an emphasis on how adolescents' characteristics lead to the selection of their friends, who then provide a peer context that may or may not support smoking.

Mediators and moderators of magazine advertisement effects on adolescent cigarette smoking

The purpose of the present study is to examine the relation between magazine advertising for cigarettes and adolescent cigarette smoking. Participants (242 adolescents) reported their frequency of reading 46 magazines and their attention to cigarette ads. Recognition of cigarette ads, passive peer pressure (i.e., normative beliefs), and the smoker image also were assessed. Results indicate that exposure to cigarette advertising and recognition of ads augment the effect of passive peer pressure on smoking. In addition, a positive smoker image was associated with attention to advertising and mediated the relation between attention and smoking. It is suggested that the effect of magazine ads on adolescents should be considered in policymaking on cigarette advertising.

Seasonal variations in the initiation of smoking among adolescents

Numerous studies have identified a variety of reasons that youths give for starting smoking. Few efforts have been made, however, to identify seasonal variations in initiation. This study was an attempt to fill that void. We examined data from 342 youths participating in a mandated smoking education and cessation program in Texas. Data were collected based on responses to questions in participant workbooks, including an item asking participants about the month in which they started smoking. A total of 47% of the participants indicated that they started smoking in May through August (chi2 = 91.42, df = 3). Post-hoc analyses indicated that significantly more youths than expected began smoking in May and June, whereas significantly fewer youths than expected began smoking in September and November. Unsupervised time out of school during the first months of summer vacation is a period of increased danger for smoking initiation. The significantly lower rates during September seem to be related to the beginning of school.

Immediate hedonic response to smoking lapses: relationship to smoking relapse, and effects of nicotine replacement therapy

OBJECTIVE AND RATIONALE

Smoking lapses represent an important juncture between smoking cessation and relapse. Nicotine replacement therapy (NRT) has been shown to decrease the risk of progression from lapse to relapse. We hypothesized that this effect might be mediated via decreases in reinforcement from smoking lapses.

METHOD

We assessed 169 subjects who lapsed during treatment in a double-blind placebo-controlled study of high-dose (35 mg) nicotine patch. Following their first lapse, using an electronic diary, subjects recorded the amount they smoked, and rated the pleasantness and satisfaction ("hedonic rating") and the aversiveness of smoking. Subjects were then followed and assessed for further lapses and relapses.

RESULTS

Subjects who smoked more during the first lapse had greater risk of progression [second lapse: hazard ratio (HR)=1.16, confidence interval (CI)=1.01-1.32; relapse: HR=1.22, CI=0.97-1.54]. Subjects with higher hedonic ratings of the first lapse also had a greater risk of progression to the second lapse (HR=1.08, CI=1.02-1.14) and to relapse (HR=1.26, CI=1.11-1.41). Aversive ratings had no bearing on progression. As expected, active treatment reduced the risk of both a second lapse (HR=0.54, CI=0.39-0.78) and a relapse (HR=0.22, CI=0.11-0.45). Importantly, however, NRT had no effect on hedonic ratings, amount smoked during the first lapse, or aversive ratings.

CONCLUSIONS

Hedonic response to an initial lapse predicted progression to relapse, but this did not mediate the effect of NRT on progression.

Knowledge about tobacco and subsequent use of cigarettes and smokeless tobacco among Swedish adolescents

PURPOSE

To investigate whether knowledge of the risks and properties of tobacco among adolescents influences their future use of cigarettes and smokeless tobacco in different directions.

METHODS

A prospective cohort study of 2581 adolescents whose knowledge of tobacco was assessed in the sixth grade by means of a multi-item scale. Tobacco use was assessed by annual surveys up to the ninth grade.

RESULTS

Knowledge level was not associated with future use. Items dealing with addictive properties of nicotine were prospectively associated with smokeless tobacco ("snus") use only.

CONCLUSIONS

A high level of knowledge of the risks associated with tobacco is not a predictor of future nonuse or of a shift to smokeless tobacco rather than cigarettes. Attitudes and expectations may determine knowledge rather than vice versa.

An examination of early smoking experiences and smoking status in a national cross-sectional sample

AIMS

To extend previous work showing lightheadedness from and liking for smoking to be associated with continued smoking while controlling for demographics and social influences that can also contribute to progression to established smoking.

DESIGN AND SETTING

Random digit dialing telephone survey conduced on 3383 never smokers, non-smokers, former smokers and current smokers in the continental United States.

MEASUREMENTS

Demographic information (sex, race, age, education level), smoking history, reactions to early experiences with smoking (lightheadedness, liking), whether parents, siblings or friends smoked when respondent was a teenager.

FINDINGS

Lightheadedness and liking interacted-those who liked smoking (regardless of lightheadedness) were very likely to progress to established smoking, while non-likers who experienced lightheadedness were more likely than non-likers who did not experience lightheadedness to progress. These results held even after adjusting for demographic (sex, age, race, education) and social influences (parents, siblings and friends smoking).

CONCLUSIONS

Lightheadedness from early smoking appears to be associated with having smoked 100 cigarettes only among those who report not liking early smoking. Overall, this study supports the literature suggesting that early experiences, particularly liking smoking, are associated with becoming a regular smoker.

Friends in the 'hood: Should peer-based health promotion programs target nonschool friendship networks?

PURPOSE

To examine the characteristics of inner city African-American adolescents nonschool-based and school-based friendship networks and to explore the influence of these networks on health risk behavior.

METHODS

We assessed close friendships networks in a probability sample of inner city African-American youth living in a single neighborhood and describe the networks and health risk behavior of network members. The initial probability sample was obtained via telephone (Random Digit Dialing [RDD] sampling) and followed up with in-person interviews with telephone respondents (seeds). Subsequently, seeds' friends were recruited and completed an in-person interview.

RESULTS

A majority of friendship networks included some nonschool friends (57%) and 24% of networks were composed exclusively of nonschool friends. As expected, youth were more likely to spend time with school-based friends on weekdays. On weekends, youth were equally likely to spend time with both school and nonschool networks. Youth in the same friendship group tended to engage in similar behaviors. Health risk behaviors were high regardless of whether networks were nonschool based, mixed, or school based.

CONCLUSIONS

The high proportion of nonschool friendships suggests that out-of-school networks may be an important influence in this population. Youth spend time with their friends, regardless of network type, on weekends, and weekends are a high-risk period for health-damaging behaviors. Levels of experience with health risk behaviors suggest that both school and nonschool environments require intervention. Future social influence prevention efforts that are broad-based are likely to have maximal impact.

Validation of retrospective reports of early experiences with smoking

Initial sensitivity to the pharmacological effects of a drug may affect patterns of future use and dependence for a wide variety of drugs. Retrospective reports of sensations experienced upon early experimentation, however, may be limited by recall bias based on time elapsed and subsequent experiences. To validate reports of early experiences with nicotine, we studied 34 smokers who had contributed retrospective data on early experiences with smoking. Half had reported experiencing a buzz from smoking their first cigarette (the "yes" group), the other half had not (the "no" group). To simulate initial sensitivity to nicotine, we asked participants to remain abstinent from smoking for 5 days to allow for the dissipation of tolerance. They then participated in a laboratory session in which they were reexposed to nicotine in an unfamiliar form (nicotine nasal spray) and asked to indicate pleasurable responses by depressing a foot pedal if and when they experienced a "pleasurable buzz." Smokers in the "yes" group were marginally more likely to be male. The two groups did not differ significantly on age or race. The "yes" group smoked significantly more cigarettes/day than the "no" group. When the two groups were compared for response to nasal spray following 5 days' abstinence, smokers in the "yes" group were marginally more likely to have signaled experiencing at least one pleasurable buzz and rated "pleasurable sensation from spray" on a 100-mm visual analogue scale administered 10 min after nicotine dosing significantly higher than were those in the "no" group. To the extent that several days' abstinence can serve as a model for initial sensitivity to nicotine, our findings validate retrospective reports of pleasurable sensations upon early smoking experimentation.

Characterization of the smoking habit among high school students in Syria

OBJECTIVES

To establish an accurate estimate of the prevalence of smoking among high school students in Aleppo-Syria and to characterize the smoking habit in this age group.

DESIGN

A cross-sectional survey was performed, in which a self-administered questionnaire was distributed to 10th, 11th and 12th graders.

SUBJECTS

A sample of 1587 students (784 males; mean age 16 years, and 803 females; mean age 15.9 years) was studied. This sample was drawn from 16 schools randomly selected from a total of 73 schools in the city.

RESULTS

The prevalence of current smoking was 15.9% for males and 6.6% for females. The prevalence of daily smoking was 2.4% for males and 0.5% for females. Almost all smoking categories increased with age and grade. Forty seven percent of male daily smokers were heavy smokers. Peer influence was evident in all stages of the smoking process, especially for males. Parental smoking was also an important associated factor. The combination of parental and siblings smoking was the strongest predictor of the smoking status of the surveyed (OR: 4.4; 95% CI: 2.7-7). Thirty eight percent of male smokers and 47.2% of female smokers smoke out of boredom. Fifty one percent of male smokers were introduced to smoking by a friend. Forty percent of male smokers buy their cigarettes, while 56.6% of female smokers obtain their cigarettes from home. Logistic regression analyses showed that parental and siblings smoking were the most important predictors of ever trying to smoke or current smoking among male and female students.

CONCLUSIONS

Our study shows that smoking is more frequent in male than female students. Parental and sibling smoking are the most important factors associated with smoking in this population, and peer influence is important particularly in the smoking-initiation stage. Pattern of smoking and associated factors differed substantially between males and females in this study.

Stage of change, decisional balance, and temptations for smoking: measurement and validation in a large, school-based population of adolescents

Developing interventions for reducing adolescent smoking rates based on the Transtheoretical Model (TTM) requires the development of quality measures of the key constructs of the model. The goal of this investigation was to evaluate the psychometric properties of measures of Stage of Change, Decisional Balance and Situational Temptation for both smokers and nonsmokers and to test if the predicted relationships between these constructs were confirmed in a large (N=2808) sample of adolescents. A correlated three factor model (Social Pros, Coping Pros and Cons) provided an excellent fit to the 12-item Decisional Balance inventory for both smokers (CFI=0.957) and nonsmokers (CFI=0.963). A hierarchical four factor model (negative affect, positive social, habit strength and weight control) provided an excellent fit to the eight-item Situational Temptations inventory for smokers (CFI=0.969). A hierarchical five-factor model (same four as smokers plus Curiosity) provided an excellent fit to the 10-item Situational Temptations inventory for nonsmokers (CFI=0.943). The relationships between both the Decisional Balance and temptation scales and the Stages of Change were verified for both smokers and nonsmokers. The measures for adolescents are similar to but not the same as the measures of these constructs for adults.

The social context of experimenting with cigarettes: American Indian "start stories"

Smoking rates among American Indians are higher than any other racial or ethnic group. Focus groups were conducted with 140 American Indian middle school students who were not living on reservations to explore the social context of smoking initiation. Most teens smoked their first cigarettes with friends, siblings or cousins, usually out of curiosity, or in response to peer encouragement. There was no indication of any link between smoking initiation and use of tobacco in traditional ceremonies. Overall, the social context for these teens was very similar to the social context of other teens in the United States.

Spit (smokeless) tobacco use by high school baseball athletes in California

OBJECTIVE

To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California.

DESIGN

This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use.

RESULTS

Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user.

CONCLUSION

The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified.

Initial tobacco use episodes in children and adolescents: current knowledge, future directions

Approximately three-quarters of adult tobacco users report that their first tobacco use occurred between ages 11 and 17, while many adults who do not regularly use tobacco report that they experimented with it as adolescents. Surprisingly little is known about the effects of these initial tobacco use episodes and their influence on adult tobacco use patterns. In particular, understanding the role that nicotine plays in these early tobacco use experiences may be important in understanding the development of regular tobacco use and concomitant nicotine dependence. One goal of this review is to summarize current knowledge regarding the effects of initial tobacco use episodes in adolescents and to discuss nicotine exposure in initial tobacco use episodes. Another goal is to outline a research agenda designed to learn more about initial tobacco use episodes and the effects of nicotine in children. An ethical rationale and some potential methods for this research agenda are presented.

Cigarette use by adolescents: attitude-behavior relationships

Structural equation models were used to test the effectiveness of various theories in predicting cigarette smoking among adolescents. Maximum-likelihood estimation, as implemented in LISREL for Windows 8.12, was used to compare the theory of reasoned action (TRA), the theory of planned behavior, and a modified version of the theory of reasoned action incorporating past behavior. Respondents consisted of 225 high school students who were questioned in 1994 about their attitudes, subjective norms, perceived behavioral control, past behavior, intentions, and actual behavior relating to the use of cigarettes. Results indicated that the modification of the TRA incorporating past behavior provided a marginally better fit than the other models. For this group of high school students, attitudes toward smoking, past behavior in relation to smoking, and perceptions of what significant others think they should do were significant predictors of their intentions to smoke. Intentions, together with past behavior, predicted their actual behavior. The models used in the present research show that this behavior can be explained with reference to a small number of key variables which are useful for furthering our understanding of the structure of adolescent smoking.

Smokeless tobacco and cigarettes: differential attitudes and behavioral intentions of young adolescents toward a hypothetical new peer

Examined adolescents' perceptions of cigarette smokers and smokeless tobacco users. Participants were 562 middle school students in rural Florida who viewed 1 of 6 videotapes of a hypothetical peer (i.e., actor) who would soon be attending their school. The videotapes differed only as a function of sex (boy or girl) and tobacco condition (no tobacco, cigarette, smokeless tobacco). After viewing the videotape, participants completed 2 measures designed to assess attitudes and behavioral intentions toward the peer. Results indicated that (a) the actor in the no-tobacco condition was rated more favorably than actors in the other two conditions, although the actor in the smokeless-tobacco condition was rated more favorably than the actor in the cigarette condition; (b) girls viewed the actor in smokeless-tobacco condition more favorably than did boys; (c) compared to nonsmokers, adolescents with a cigarette use history provided more favorable ratings for the actor in the cigarette condition. Taken together, results suggest that different types of tobacco use may have a different impact on social image within the young adolescent population.

Self-initiated quitting among adolescent smokers

OBJECTIVES

This paper reviews the literature regarding predictors of adolescent self-initiated smoking cessation and investigates self-initiated smoking cessation among a large sample of alternative high school youth in southern California. Youth transfer to alternative schools because of academic or behavioral problems, and they are at relatively high risk for cigarette smoking.

METHODS

Several demographic (e.g., gender), behavioral (e.g., level of smoking), and psychosocial (e.g., risk-taking) predictors of adolescent smoking cessation were investigated. The alternative high school cohort provided a sufficient sample size of quitters (defined as no use in the past 30 days, measured after a 1-year period) to permit a prospective examination of adolescent smoking cessation.

RESULTS

Although nine demographic, behavioral, or psychosocial variables discriminated among quitters and nonquitters in univariate analyses, only level of baseline smoking, smoking intention, and perceived stress were predictors in a final multivariable model.

CONCLUSIONS

Based on the literature review and findings among the cohort, smoking cessation programs for adolescents should include counteraction of problem-prone attitudes, support of wellness attitudes, provision of motivation to quit strategies, and assistance with overcoming withdrawal symptoms.

Stages of acquisition and cessation for adolescent smoking: an empirical integration

Adolescent cigarette smoking acquisition and cessation were integrated into a single nine-stages-of-change continuum using the transtheoretical model of change framework. Findings in a high school student sample (n > 700) showed that a few of the never smokers were planning to try smoking, and half of the current smokers were contemplating quitting. More than half of former smokers were long-term quitters. The high pros of smoking scores assessing coping benefits of cigarettes were related to smoking acquisition and the high con (disadvantages) scores to long-term abstinence. Never smokers were most tempted to try smoking when they anticipated that smoking would help reduce negative and increase positive mood. Current and former smokers were tempted due to peer cigarette offers and negative mood. These temptations were significantly reduced among ex-smokers.

Physiological sensations of initial smoking in the development of regular smoking behavior

This study examined the relationships between adolescents' physiological sensations of smoking during initiation and early experience. For a national sample of a birth cohort of 2,043 adolescents, ages 15 to 22 years at the follow-up, variables of interest included measures of smoking behavior and physiological sensations reported from the initial smoking experience. Analysis showed that adolescents experimenting with smoking were more likely to become regular smokers over three years if they indicated that they felt relaxed, felt dizzy, did not feel sick, and did not cough during the initial smoking experience. Antismoking interventions may impede the transition to regular smoking by helping adolescents interpret the physiological sensations as negative and unhealthy.

Continuation high schools: youth at risk for drug abuse

Students at alternative high schools may be at substantial risk for drug abuse. The present article provides a general overview of the drug use-related context of continuation high schools in southern California. A total of 144 students and ninety-six staff were interviewed from twenty continuation high schools. The interview data revealed that continuation school students show high levels of substance use. However, only 20 percent of the students report that they received any drug abuse prevention programming. Also, students at continuation high schools aspired to a productive life after high school including continued education. Thus, these youth may still be amenable to preventive educational interventions which deter them from drug use and help them to fulfill their future goals.

The report of the Surgeon General: preventing tobacco use among young people

This year's surgeon general's report on smoking and health is the first such report to focus on young people. From extensive data that indicate that tobacco use is a pediatric epidemic, the report reached six major conclusions: (1) Nearly all first use of tobacco occurs by age 18. (2) Most adolescent smokers are addicted to nicotine. (3) Tobacco is often the first drug used by young people who subsequently use illegal drugs. (4) There are identified psychosocial risk factors for the onset of tobacco use. (5) Cigarette advertising also appears to increase young people's risk of smoking. (6) Communitywide efforts have successfully reduced adolescent use of tobacco. This commentary restates each of the six conclusions, summarizes the data that support each, and then considers the implications of the conclusions for public health action.

Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents

Past studies which examined correlates of smokeless tobacco or cigarette use have investigated use of one tobacco product regardless of use of the other product. Thus, the etiology of exclusive use of the two tobacco products is not clear. The present study investigated the relationship of problem-prone-related variables to exclusive versus overlapping use of smokeless tobacco and cigarettes. Two samples of southern California male students (eighth-grade and high school) were divided into groups according to their tobacco use status: neither product, cigarettes only, smokeless tobacco only, or both tobacco products. Generally, triers and monthly users of both tobacco products reported a higher risk-taking preference, greater susceptibility to peer social influence to use tobacco products, and greater likelihood to have tried marijuana and alcohol than did subjects who were not users of either tobacco product. Adolescents who used either product, but not both, reported similar scores on most of the variables examined, which fell in between combined or nonuse categories. These results suggest that the number of tobacco products used, not the specific product, is associated with problem-prone attributes.

Project towards no tobacco use: 1-year behavior outcomes

OBJECTIVES

We present 1-year follow-up data from a school-based tobacco use prevention project designed to test the effectiveness of three main components of social influence programs. The components teach refusal skills, awareness of social misperceptions about tobacco use, and misconceptions about physical consequences.

METHODS

Four different curricula were developed and tested in a randomized experiment involving 48 junior high schools. The outcome variables examined were changes in initial and weekly cigarette and smokeless tobacco use 1 year after the intervention.

RESULTS

Analyses indicated that each of the component programs were effective in decreasing both the initial and the weekly use of cigarettes except for the curriculum in which refusal skills were taught. Also, each curriculum was effective in decreasing the initial use of smokeless tobacco except for the one aimed at correcting social misperceptions. Only the combined curriculum showed an effect on the weekly use of smokeless tobacco.

CONCLUSIONS

The combined intervention was the most effective overall in reducing the initial and weekly use of cigarettes and smokeless tobacco. This suggests that different reasons for use exist and need to be counteracted simultaneously. However, since single programs were also effective in reducing all but weekly smokeless tobacco use, any of these components may be worthwhile prevention tools.

Naturalistic observation of adolescent tobacco use

A naturalistic observation study of adolescent tobacco use was conducted to corroborate previous studies which used self-report questionnaire or structured interview methods to study this problem behavior. Several findings converged with previous accounts of adolescent tobacco use. For example, most use occurred in small groups. However, other findings diverged somewhat from previous research in that an unexpectedly low number of offers of tobacco was observed, nonusers were present in smoking groups, and solitary smoking was common. These data suggest that direct, normative social pressure to use tobacco may not be as frequent as more subtle informational social influence, at least in high school adolescent tobacco use groups.

Which lesson components mediate refusal assertion skill improvement in school-based adolescent tobacco use prevention?

Any of three components of current school-based refusal assertion training might mediate improvement of seventh grade students' ability to refuse tobacco use offers: 1) teaching students knowledge of ways to say "no," 2) engaging students in the practice of refusal assertion, or 3) motivating students to perform refusal assertion in a socially skilled way. A 3-condition true field experimental "component study" of the differential effects of these three components yielded improvement in role-played behavioral skill to refuse tobacco offers that was evident in both the Knowledge and Practice conditions but not in the Motivation condition. In these same two conditions, skills training led to a significant decrease in students' intention to use smokeless tobacco in the future but not cigarettes. A focus on engaging students in Knowledge and Practice components of refusal assertion training appears warranted.

Refusal assertion versus conversational skill role-play competence: relevance to prevention of tobacco use

Conversational and refusal assertion skills of 768 seventh grade youth were assessed through ratings of global (for example, effectiveness) and non-verbal (for example, eye contact) behaviour performed in two role-play scenarios. The ratings were completed after each scenario by the subjects themselves, as well as by classmate and trained adult observers. Use of the Hays and Hayashi multitrait scaling method to interpret these data revealed two results. First, the items used to measure role-play behaviour did not achieve sufficient internal consistency to create global and non-verbal composites. Second, inter-rater agreement and discriminant validity were obtained only for ratings of the global effectiveness of each of the two social skills. Next, a series of multiple regression analyses indicated that an index of the global effectiveness of refusal assertion skill, but not of conversational skill, was predictive of intention to use tobacco. Those who were relatively unskillful at refusing offers were more likely to intend to use tobacco. Analyses exploring relations of trained observer ratings of the effectiveness of both role-play types, trained observer ratings of the other global and non-verbal items, and subjects' intention to use tobacco indicated that only a hesitant voice pattern was both negatively predictive of effective refusal assertion and positively predictive of intention to use tobacco in the future. In other words, those who are hesitant when they refuse a tobacco offer are the ones most likely to report an intention to use tobacco in the future. The consistency of this last finding in the tobacco use prevention literature is discussed.

Availability of tobacco products at stores located near public schools

The nearby store is an obvious major site where adolescents obtain tobacco products. We investigated availability of tobacco products to adolescents at those stores located closest to public junior high and high schools by using 3 novel methods: (1) interviewing store personnel; (2) recording types and location of tobacco products, promotional items, and the legal age warning signs within stores; and (3) observing purchasing behavior. Store personnel were interviewed at randomly selected Southern California stores (n = 36) and Illinois stores (n = 12). Results showed that store personnel used tobacco at twice the rate of the general public, and that they often use tobacco while working at the store. Promotional advertisements were present at many stores, while tobacco use legal age signs were posted at few stores. Approximately 50% of the store personnel admitted that they would sell to minors, and many reported that they had seen teenagers using tobacco near the stores. Several apparently illegal purchases were observed. Tobacco use prevention program and policy implications are discussed.