Individual- and community-level correlates of cigarette-smoking trajectories from age 13 to 32 in a U.S. population-based sample

Life-Course Associations Between Smoking and Depressive Symptoms. A 30-Year Finnish Follow-up Study

INTRODUCTION

Relatively little is known about whether the association between smoking and depressive symptoms changes with age and how the trajectories of smoking and depressive symptoms are intertwined during the life course. In this population-based study, these associations were examined from young adulthood to middle age.

METHODS

Participants of a Finnish cohort study (N = 1955) were assessed at the ages of 22, 32, 42, and 52 using questionnaires covering daily smoking (yes/no) and the short 13-item Beck Depression Inventory. Longitudinal latent class and longitudinal latent profile analyses were used to identify life course trajectories of smoking and depressive symptoms.

RESULTS

The proportions of daily smokers decreased, while levels of depressive symptoms increased among both females and males from age 22 to 52 years. Smoking was associated with higher levels of depressive symptoms from age 22 to 42 years, while not at 52. Associations among males prevailed when adjusting for education, marital status, and alcohol use. Four life course classes of daily smoking (nonsmokers, decreasing prevalence of smoking, persistent smokers, and increasing prevalence of smoking) and four trajectories of depressive symptoms (low, increasing/moderate, decreasing/moderate, and high) were identified. In males, persistent daily smokers (relative risk ratio (RRR) = 4.5, 95% confidence interval (CI): 2.2 to 9.2) and those in the class with increasing smoking prevalence (RRR = 3.2, 95% CI: 1.1 to 9.1) had an increased risk of belonging to the high depressive symptoms profile. In females these associations were nonsignificant.

CONCLUSIONS

Compared to females, the relationship between smoking and depressive symptoms seems more robust among males during adulthood. Specifically, males smoking persistently from young adulthood to middle age have an increased risk of high depressive symptoms trajectory.

IMPLICATIONS

This population-based cohort with 30 years of follow-up showed that the life course trajectories of daily smoking and depressive symptoms are associated. Persistent daily smokers and those starting late had an increased risk of belonging to the profile with constantly high levels of depressive symptoms during the life course. However, these associations were statistically significant only in males. Actions should be strengthened, especially in males, to prevent smoking initiation, to help smoking cessation, and to identify and treat depression in smokers with significant depressive symptoms.

Trends in age of tobacco use initiation over time in Bangladesh, India and Pakistan: analysis of cross-sectional nationally representative surveys

OBJECTIVE

Tobacco use begins at an early age and typically leads to a long-term addiction. The age of initiation for tobacco use is not well studied in South Asia, where 22% of tobacco smokers and 81% of smokeless tobacco (SLT) users reside.

METHODS

Data from the nationally representative Global Adult Tobacco Surveys in India, Bangladesh and Pakistan were analysed to examine patterns of initiation among smokers and smokeless tobacco users.

RESULTS

Data on 94 651 individuals were analysed, of which 13 396 reported were ever daily smokers and 17 684 were ever SLT users. The proportion of individuals initiating tobacco use before the age of 15 years has increased over time. The rates of SLT initiation among those aged 15-24 years increased markedly in Bangladesh (by 7.8%) and Pakistan (by 37.7%) between 1983 and 1999-2000. Among males, the increase in SLT initiation was higher in individuals aged below 15 years compared with other age groups in India and Bangladesh. Smoking initiation among females aged below 15 years has also significantly increased in India over time. Compared with the initiation of tobacco smoking before the age of 15 years, a greater increase in the proportion of SLT users was observed in urban areas.

CONCLUSION

Our findings indicate that the proportion of youth initiating tobacco (both smoking and smokeless) before the age of 15 years has increased over time in all three countries. Moreover, variations in age at initiation for different types of tobacco products across countries, and by rurality, were noticeable. Younger youths (aged up to 15 years) should therefore be a priority population for tobacco control interventions. Strategies such as raising the legal age of tobacco sale and use to 21 years, and, other measures under WHO Framework Convention on Tobacco Control (FCTC), may prevent underage use and avert lifelong addiction to tobacco products.

Age-gender differences in the relationships between physical and mental health

Previous studies have identified that smoking, exercise and breadth of social interaction mediate the strong associations between physical and mental health. However, these studies have been restricted to older populations, have not explored differences by gender, and have not considered online social interaction. We explore how the effects of four mediators (exercise, smoking, in-person and online social interaction) of the two-way relationships between past and future physical and mental health vary across eight age and gender groups. We use data from a representative sample of the UK population consisting of 175,779 observations on 41,995 adults from Understanding Society (UKHLS) between 2009 and 2019. Within a mediation framework, we estimate the percentage of the total effects that can be explained by the proposed mediating factors. We show that exercise, smoking, in-person and online social interaction are significant mediators of the effect of mental health on future physical health. In-person social interaction is the largest of these, accounting for 2.3% of the total effect. Smoking, in-person and online interaction are significant mediators of the effect of physical health on future mental health. Again, in-person interaction is the largest of these, accounting for 3.0% of the total effect. The percentages of the total effects mediated by each factor differ substantially by age and gender. Seeking to avoid the harmful effects of poor physical health on future mental health should focus on increasing physical activity in older men, and on increasing in-person social interaction in both men and women. Seeking to avoid the harmful effects of poor mental health on future physical health should focus on increasing physical activity and in-person social interaction in older men and women, and on reducing smoking in younger men and women.

Smoking across adolescence and adulthood with cardiovascular risk among American Indian peoples

OBJECTIVE

American Indian peoples (AIs) have high smoking rates and cardiovascular risk factor burden. The present study aimed to (a) investigate latent smoking classes across adolescence and adulthood, (b) investigate adolescent predictors of smoking classes, and (c) assess how smoking class is related to adult cardiovascular risk in a sample of AIs.

METHOD

A sample of AIs (N = 338) from the National Adolescent to Adult Health Study self-reported on smoking across four assessment waves (W1: 7th-12th grade; W2: 8th-12th grade; W3: ages 18-26; W4: ages 24-32). The socioecological framework for addressing tobacco-related disparities was used to identify potential adolescent (W1) risk and resource factors. C-reactive protein, blood pressure, and lipids were collected at W4. Growth mixture modeling and regressions were used.

RESULTS

Six smoking classes were identified: light smoking (36%), nonsmoking (23%), escalating, adult daily smoking (13%), chronic heavy smoking (12%), escalating, young adult daily smoking (9%), and reducing smoking (7%). Risk factors for being in the chronic heavy smoking class included peer smoking and older age at W1. Compared with the chronic heavy smoking class, AIs in the reducing smoking class lived in in more impoverished neighborhoods during adolescence. Relative to several classes with less smoking, being in the chronic heavy smoking class was associated with higher C-reactive protein and less favorable lipid levels. W1 social support was a resource factor for adult diastolic blood pressure and some lipids.

CONCLUSIONS

Socioecologically informed tobacco interventions have the potential to reduce smoking and cardiovascular risk among AIs, and bolstering social support may be important. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations of attention problems and family context in childhood and adolescence with young adult daily smoking: General and smoking-specific family contexts

BACKGROUND

The potential heterogeneity in daily smoking across young adulthood has been relatively understudied. Relatedly, the unique and joint associations of earlier risk factors with young adults' daily smoking largely remain unknown. To address these gaps, this work identified subgroups of daily smoking trajectories during young adulthood and linked them to earlier attention problems and smoking-specific and general family context.

METHODS

Data came from the Seattle Social Development Project, a longitudinal study following a community sample (N = 808). Participants' daily smoking was measured from ages 21-33. Earlier attention problems were assessed at ages 14-16 and 18. Earlier smoking-specific and general family factors were assessed at ages 10-16 and 18.

RESULTS

Growth mixture models produced four profiles: chronic daily smokers, increasers, decreasers, and no-daily smokers. Results from multinomial logistic regressions revealed that earlier attention problems and smoking-specific family factors may contribute to daily smoking in the early 20 s, whereas earlier general family context provided protection for trajectories of daily smoking characterized by changes in the late 20 s and early 30 s DISCUSSION: Selective prevention strategies that expand people's repertoire of healthy options to address attention problems might be helpful, considering the possibility of using tobacco as means to mitigate attention problems. Our findings also highlight the importance of nurturing earlier general family context, a relatively overlooked dimension in smoking prevention efforts, to facilitate young adult smokers' desistence from daily smoking, particularly those who have attention problems in adolescence.

Intergenerational transmission of parental smoking: when are offspring most vulnerable?

BACKGROUND

Previous literature has showed that the likelihood of smoking is higher among offspring with smoking parents. The aim of this cohort study is to investigate during which smoking initiation stages and at what ages adolescents are more likely to be influenced by parental smoking.

METHODS

This study used the EPITeen Cohort, which recruited 13-year-old adolescents born in 1990, enrolled at schools in Porto, Portugal. Participants (n = 996) were followed across four waves at 13, 17, 21 and 24 years old. We computed the odds ratio (OR) and 95% confidence intervals for the prevalence of the different smoking states (never smoking, experimenter, less than daily smoker, daily smoker and former smoker), and incidence transitions between these states (to smoking experimenter; to less than daily smoker, to daily smoker; to former smoker) as function of age, parental smoking status and their interaction.

RESULTS

Compared with other participants, those with two smoking parents had an increased prevalence of experimentation at 13 years (OR for the interaction at 13 years compared with 24 years = 2.13 [1.50-3.01]) and daily smoking at all ages (OR for parental smoking =1.91 [1.52-2.40]). The latter increase is related to a significantly increased risk to transit from early smoking stages to daily smoking at all ages (OR for parental smoking = 1.83 [1.43-2.34]).

CONCLUSIONS

Parental smoking influences offspring's daily smoking prevalence especially by increasing the risk to transit to daily smoking up to early adulthood. Prevention should focus on parents and parental influences especially among offspring who may transition to daily smokers.

Early to Midlife Smoking Trajectories and Cognitive Function in Middle-Aged US Adults: the CARDIA Study

BACKGROUND

Smoking starts in early adulthood and persists throughout the life course, but the association between these trajectories and midlife cognition remains unclear.

OBJECTIVE

Determine the association between early to midlife smoking trajectories and midlife cognition.

DESIGN

Prospective cohort study.

PARTICIPANTS

Participants were 3364 adults (mean age = 50.1 ± 3.6, 56% female, 46% Black) from the Coronary Artery Risk Development in Young Adults (CARDIA) study: 1638 ever smokers and 1726 never smokers.

MAIN MEASURES

Smoking trajectories were identified in latent class analysis among 1638 ever smokers using smoking measures every 2-5 years from baseline (age 18-30 in 1985-1986) through year 25 (2010-2011). Poor cognition was based on cognitive domain scores ≥ 1 SD below the mean on tests of processing speed (Digit Symbol Substitution Test), executive function (Stroop), and memory (Rey Auditory Verbal Learning Test) at year 25.

RESULTS

Five smoking trajectories emerged over 25 years: quitters (19%), and minimal stable (40%), moderate stable (20%), heavy stable (15%), and heavy declining smokers (5%). Heavy stable smokers showed poor cognition on all 3 domains compared to never smoking (processing speed AOR = 2.22 95% CI 1.53-3.22; executive function AOR = 1.58 95% CI 1.05-2.36; memory AOR = 1.48 95% CI 1.05-2.10). Compared to never smoking, both heavy declining (AOR = 1.95 95% CI 1.06-3.68) and moderate stable smokers (AOR = 1.56 95% CI 1.11-2.19) exhibited slower processing speed, and heavy declining smokers additionally had poor executive function. For minimal stable smokers (processing speed AOR = 1.12 95% CI 0.85-1.51; executive function AOR = 0.97 95% CI 0.71-1.31; memory AOR = 1.21 95% CI 0.94-1.55) and quitters (processing speed AOR = 0.96 95% CI 0.63-1.48; executive function AOR = 0.98 95% CI 0.63-1.52; memory AOR = 0.97 95% CI 0.67-1.39), no association was observed.

CONCLUSIONS

The association between early to midlife smoking trajectories and midlife cognition was dose-dependent. Results underscore the cognitive health risk of moderate and heavy smoking and the potential benefits of quitting on cognition, even in midlife.

Profiles of Nicotine and Cannabis Exposure among Young Adults with Asthma

There is a paucity of data on nicotine and cannabis use among young adults (YAs) with asthma. This study aimed to do the following among YAs with asthma: (1) describe YAs' active and passive exposure to nicotine and cannabis; (2) identify latent classes of active use of nicotine and cannabis; and (3) explore predictors of class membership (i.e., demographics, parental and friend use of nicotine and cannabis, and hours of environmental exposure to tobacco smoke, e-cigarette vapor, and marijuana smoke). YAs with asthma (N = 178) self-reported on nicotine and cannabis exposure and the included covariates. Latent class analysis was used to identify latent classes of lifetime nicotine and cannabis use. High rates of nicotine and cannabis use among YAs with asthma were found: 37% reporting a lifetime history of using both nicotine and cannabis. Regarding past year use, 25% had smoked cigarettes, 40% had used e-cigarettes, and 35% had used cannabis. Five classes of lifetime use were identified. The largest class was a non-user class (53%); the other four classes indicate concerning patterns of nicotine and cannabis use. The most consistent predictor of being in a class characterized by more nicotine and cannabis exposure (versus being in the non-user class) was past week exposure to cannabis smoke. This is the first study to identify classes of lifetime nicotine and cannabis use, and examine predictors of class membership, among YAs with asthma. There is a critical need to address environmental and active tobacco and marijuana exposure among YAs with asthma.

Adolescent depression symptoms and e-cigarette progression

BACKGROUND

Depression symptoms are associated with the initiation of cigarette smoking and progression to regular use. Whether similar relationships exist between depression symptoms and adolescent e-cigarette progression has not been firmly established.

METHODS

This prospective longitudinal survey study measured the relationship between depression symptoms and e-cigarette use among 1822 adolescents from four public high schools outside of Philadelphia, PA. Adolescents completed in-classroom surveys at wave 1 (fall 2016, 9th grade) and 6-month intervals for the following 36 months (fall 2019, 12th grade). E-cigarette use, depression symptoms, and potential covariates were measured at each wave. A latent growth curve model was used to assess the longitudinal relationship between e-cigarette use and depression symptoms.

RESULTS

Baseline depressive symptoms had a significant effect on e-cigarette use trend (b = 0.01, z = 4.29, p < 0.0001) while holding other variables constant. A standard deviation increase in depressive symptoms at baseline was associated with a 0.25 standard deviation increase in the rate of e-cigarette progression across the following 36 months. By contrast, the path from baseline e-cigarette use to depressive symptoms trend was not significant (p = 0.74).

CONCLUSIONS

The present study provides new evidence for the effects of depression symptoms on adolescent e-cigarette progression. Greater depressive symptoms at age 14 years old were associated with a faster rate of e-cigarette escalation. However, e-cigarette use was not related to the development of depression symptoms over time. It will be important to examine whether adolescents with elevated depression symptoms respond similarly to e-cigarette prevention campaigns as adolescents in general.

Evaluation of neighborhood deprivation and store characteristics in relation to tobacco retail outlet sales violations

INTRODUCTION

Regulations of the sale of tobacco products to minors have been effective at reducing adolescent tobacco use overall. However, these efforts may not be uniformly enforced in all areas, creating uneven protection against adolescent smoking. Knowledge regarding factors associated with tobacco retail outlet (TRO) violations could help inform better enforcement strategies.

METHODS

In this study, we used Bayesian index regression models to determine if tobacco sales to minors violations across Virginia (2012-2021) were related to store characteristics and neighborhood deprivation and identify geographic areas at significantly elevated risk for violations after adjusting for these factors.

RESULTS

Results show that there were multiple factors associated with a higher likelihood of tobacco sales violations. Store type was an important factor, as grocery stores and pharmacies had significantly lowered likelihood of violations compared with convenience stores. Being located near another TRO was significantly associated with increased risk of sales to a minor. Neighborhood deprivation was also positively associated with TRO sales violations. Further, there were statistically higher likelihood of sales violations occurring in specific areas (e.g., southwest and southeast) of the state that were not explained by neighborhood deprivation and store attributes.

CONCLUSIONS

Together, results highlight the need to better understand where and why TRO sales violations are occurring in order to improve efforts aimed at monitoring and remediating TRO sales violations.

Interparental Relationship Adjustment, Parenting, and Offspring's Cigarette Smoking at the 10-Year Follow-up

Familial influences on children's cigarette smoking have been established, yet little is known about whether these influences in childhood relate to offspring's smoking behavior in adolescence. Drawing on prior work showing that children's emotional and behavioral problems (i.e., internalizing and externalizing behavior problems) are influenced by both interparental and parent-child relationships, we examined whether children's emotional and behavioral problems would further predict their smoking behavior in adolescence. Two hundred and twenty-one families were followed from early childhood (M_age  = 4.05 years) to the 10-year follow-up. Interparental relationship adjustment and disagreement, dysfunctional parenting, and children's emotional and behavioral problems were reported by both mothers and fathers. Adolescents' self-reported cigarette smoking status was assessed along with other demographic variables. Using structural equation modeling, the hypothesis was only supported based on mothers' reports, suggesting that early couple relationship adjustment and parenting relate to children's emotional and behavioral problems, which associate with smoking behavior in adolescence. When the hypothesized model was tested with emotional and behavioral problems separately, only behavioral problems were related to adolescent smoking for both parents. Findings from this study support models of family environment and children's behavioral problems, providing evidence of the long-term links with adolescent cigarette smoking behaviors. Further family-focused research and preventive work, for instance, testing the combination of partner support and parent training, are needed.

Parents, Peers, and Trajectories of Cigarette Smoking: A Group-Based Approach

This study examines the independent, relative, and additive associations between both parent and peer role models and longitudinal patterns of smoking across adolescence and early adulthood. An analysis of data from the National Longitudinal Study of Adolescent to Adult Health (N=10,166) reveals at least four distinct trajectories of smoking across ages 13-35: (1) non-smokers; (2) late peak (almost 10 cigarettes per day around age 30); (3) an early peak group that reached roughly 10 cigarettes per day around age 20 and declined; and (4) a high group that increased during adolescence and early adulthood and then remained high. Parent and peer smoking behaviors were associated with trajectory group membership net of controls for sociodemographic characteristics, parental SES, parent-child relations, and the availability of cigarettes in the family home. Parents and peers appear to have at least some independent associations net of each other, but their combined effects are powerful.

Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels

INTRODUCTION

Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories.

AIMS AND METHODS

We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban).

RESULTS

About 64.5% were female and 65.0% were white. From age 18 to 26, 27%-31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use.

CONCLUSION

Distinct prevention and intervention efforts may be needed to address the trajectories identified.

IMPLICATIONS

Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.

Latent Trajectories and Profiles of Commercial Cigarette Smoking Frequency From Adolescence to Young Adulthood Among North American Indigenous People

INTRODUCTION

North American Indigenous people (ie, American Indian/Alaska Native and Canadian First Nations) have the highest rates of commercial cigarette smoking, yet little is known about long-term trajectories of use among this population. The purpose of this study is to examine heterogeneous trajectories and profiles of Indigenous cigarette use frequency from early adolescence (mean age: 11.1 years) to young adulthood (mean age: 26.3 years).

AIMS AND METHODS

Data come from a nine-wave prospective longitudinal study spanning early adolescence through young adulthood among Indigenous people in the Upper Midwest of the United States and Canada (N = 706). Smoking frequency was examined at each wave, and latent class growth analysis was used to examine heterogeneous patterns. Early adolescent and young adult demographics and smoking-related characteristics were examined across these latent trajectory groups.

RESULTS

In young adulthood, 52% of participants smoked daily/near-daily, and an additional 10% smoked weekly or monthly. Four latent trajectory groups emerged: low/non-smokers (35.2%) who had low probabilities of smoking across the study; occasional smokers (17.2%) who had moderate probabilities of smoking throughout adolescence and declining probabilities of smoking into young adulthood; mid-adolescent onset smokers (21.6%) who showed patterns of smoking onset around mid-adolescence and escalated to daily use in young adulthood; and early-adolescent onset smokers (25.9%) who showed patterns of onset in early adolescence and escalated to stable daily use by late adolescence.

CONCLUSIONS

The findings suggest multiple critical periods of smoking risk, as well as a general profile of diverse smoking frequency patterns, which can inform targeted intervention and treatment programming.

IMPLICATIONS

Nearly two-thirds (62%) of this sample of Indigenous people were current smokers by early adulthood (mean age = 26.3 years), which is substantially higher than national rates in the United States and Canada. Moreover, in all but one trajectory group, smoking prevalence consistently increased over time, suggesting these rates may continue to rise into adulthood. The longitudinal mixture modeling approach used in this study shows that smoking patterns are heterogeneous, and implications for public health policy likely vary across these diverse patterns characterized by timing of onset of use, escalation in frequency of use, and stability/change over time.

Youth Perceptions of Parental Involvement and Monitoring, Discrepancies With Parental Perceptions, and Their Associations With First Cigarette Use in Black and White Girls

OBJECTIVE

Low parental involvement and monitoring are risk factors for adolescent cigarette use. Assessments of parental involvement and monitoring by youth and parents may capture an additional source of risk: differences in perceptions of these parenting behaviors. This study tested for unique contributions of youth-reported parental involvement and monitoring and youth-parent discrepancies in reporting to first cigarette use in girls.

METHOD

Data were drawn from interviews at ages 8-17 with 1,869 girls (57.3% Black, 42.7% White) and their primary caregivers (94% mothers) in the Pittsburgh Girls Study. Cox proportional hazards regression analyses were conducted to predict first cigarette use as a function of girls' reports of parental involvement and monitoring, magnitude and direction of youth-parent reporting discrepancies, and the interaction between them, adjusting for neighborhood, socioeconomic, and individual level factors.

RESULTS

High magnitude of discrepancy in parental involvement reports (hazard ratio [HR] = 1.14, 95% confidence interval [CI] [1.03, 1.26]) and lower perceived parental involvement by girls (HR = 1.14, CI [1.03, 1.27]) were associated with an elevated risk for first cigarette use. Girls' reports of low parental monitoring also predicted first cigarette use (HR = 1.14, CI [1.06, 1.21]).

CONCLUSIONS

Girls whose parents have limited awareness of their whereabouts and friends (i.e., low monitoring) are at an elevated risk for trying cigarettes, but parent-daughter differences in perceived awareness do not affect risk. By contrast, girls who perceive a lower degree of parental involvement than their parents do are at increased risk. Monitoring is one component of parenting that may reduce smoking risk; shared perspectives on the parent's level of involvement are similarly important.

Influence of gender on initiation of tobacco and nicotine containing product use among U.S. Air Force trainees

Military personnel are a subgroup of young adults at risk for tobacco and nicotine containing product (TNCP) use. This study of US Air Force (USAF) trainees who were never users of TNCPs examined gender, peer tobacco use, and tobacco use intentions as predictors of TNCP initiation after Basic Military Training (BMT). We used a longitudinal cohort assessment study design with baseline and 1-year surveys completed (2011-2016) among 2393 USAF trainees: 73% men, 95% aged 18-25 years, 36% racial minorities. Overall, initiation of any TNCP use at 1-year was 23% (20% women, 24% men). From a multivariable multinomial logistic regression model predicting TNCP use at 1-year follow-up, significant 2-way interactions were detected between gender and number of close friends using tobacco before BMT (p = 0.015), and between gender and tobacco use intentions (p < 0.0001). Women reporting almost all or many close friends used tobacco were more likely to report TNCP use compared to women with none (Odds ratio [OR] = 5.8, 95% CI 2.5-13.5, Bonferroni corrected p < 0.0001). Having close friends using tobacco had little influence on TNCP use among men. Men with tobacco use intentions were more likely to report TNCP use compared to men having no intentions (OR = 8.0, 95% CI: 4.7-13.6, Bonferroni corrected p < 0.001), but tobacco use intentions had little influence among women. In this sample of USAF trainees, the study provides novel prospective findings on TNCP initiation, and how men and women are influenced differently by peer tobacco use and tobacco use intentions. Gender-specific prevention efforts focused on uptake of TNCPs appear warranted.

Social capital and peer influence of tobacco consumption: a cross-sectional study among household heads in rural Uttar Pradesh, India

OBJECTIVE

Having the world's second-largest tobacco-consuming population, tobacco control is a priority agenda of the Indian Government. Yet, there is no evidence of how peer influence and nature of social relationships-defined as social capital-affect tobacco use. This study aimed to explore the role of social capital and peer influence on tobacco consumption among household heads in rural Uttar Pradesh (UP), India.

DESIGN AND SETTING

This study was embedded within the baseline evaluation of Project Samuday. A cross-sectional multistage cluster survey was implemented in six census blocks of Hardoi and Sitapur districts of UP from June to August 2017. Self-reported tobacco consumption status of randomly selected 6218 household heads (≥18 years; men vs women=5312 vs 906) was assessed from 346 rural communities. Peer influence of tobacco use was measured by the non-self cluster proportion of tobacco consumption among respondents. Community engagement, social support, trust and social cohesion were separately measured as unique facets of social capital both at individual and community levels using the Shortened Adapted Social Capital Assessment Tool in India (SASCAT-I). The explanatory power of covariates was assessed using gender-stratified generalised estimating equations (GEE) with robust-variance estimator.

RESULT

Tobacco consumption patterns were starkly different for men and women (71% vs 14%). The peer influence only affected men (adjusted odds ratio (AOR)=1.10, 95% CI: 1.05 to 1.16, p<0.01), whereas women were more likely to consume tobacco if they were more engaged with community organisations (AOR=1.33, 95% CI=1.07 to 1.66, p<0.01).

CONCLUSION

Gender alters the way social engagement affects tobacco use in rural India. Countering peer influence on Indian men should be prioritised as a tobacco control strategy. Moreover, as gender mainstreaming is a critical egalitarian agenda in India, further research is needed to understand how social engagement affects tobacco consumption behaviours among women.

Alcohol trajectories among biracial black subgroups: Testing the intermediate substance use hypothesis

OBJECTIVE

This study tests the intermediate biracial substance use hypothesis, which suggests that the prevalence of substance use among biracial individuals fall intermediate to their corresponding mononoracial counterparts. Using National Longitudinal Study of Adolescent and Adult Health (Add Health) data, we examine alcohol-use trajectories of a de-aggregated sample of biracial Black youth and compare them with the trajectories of the corresponding monoracial counterparts.

METHOD

The sample consists of 9421 adolescents and young adults who self-identified as 1 of 4 monoracial groups (i.e., Black, White, Hispanic, American Indian) or 1 of 3 biracial Black groups (i.e., Black-American Indian, Black-Hispanic, and Black-White). Study hypotheses are tested using latent growth curve modeling for first use, number of drinks, and binge drinking.

RESULTS

We found partial support for the intermediate substance use hypothesis, with the alcohol use rates of biracial Blacks more closely resembling the non-Black corresponding group than the monoracial Black group. Black-American Indians face particularly high risk of problematic drinking.

CONCLUSIONS

These findings demonstrate the need for additional research clarifying the onset and maintenance of alcohol use and misuse among biracial individuals and subgroups.

Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults

This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking (n = 658, 73.7%), declining smoking (n = 20, 2.2%), moderate/stable smoking (n = 114, 12.8%), high/stable smoking (n = 79, 8.9%), and escalating smoking (n = 22, 2.5%); and in YA Cohort: nonsmoking (n = 1,215, 81.5%), slowly declining smoking (n = 52, 3.5%), rapidly declining smoking (n = 50, 3.4%), stable smoking (n = 139, 9%), and escalating smoking (n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.

Risk factors associated with early smoking onset in two large birth cohorts

We use prospective data from the ongoing British Cohort Study (BCS) and Millennium Cohort Study (MCS) to: 1) document changes in the prevalence of childhood smoking onset; 2) assess whether broad historic shifts in key risk factors, such as maternal education, parental smoking, and peer childhood smoking, explain observed cohort changes in childhood smoking; and 3) evaluate whether inequalities in onset have narrowed or widened during this period. The children in these two studies were born 31 years apart (i.e., BCS in 1970; MCS in 2001), and were followed from infancy through early adolescence (n = 23,506 children). Our outcome variable is child self-reports of smoking (ages 10, 11). Early life risk factors were assessed via parent reports in infancy and age 5. Findings reveal that the odds of childhood smoking were over 12 times greater among children born in 1970 versus 2001. The decline in childhood smoking by cohort was partly explained by increases in maternal education, decreases in mothers' and fathers' smoking, and declines in the number of children whose friends smoked. Results also show that childhood smoking is now more linked to early life disadvantages, as MCS children were especially likely to smoke if their mother had low education or used cigarettes, or if the child had a friend who smoked. Although the prevalence of child and adult smoking has dropped dramatically in the past three decades, policy efforts should focus on the increased social inequality resulting from the concentration of early life cigarette use among disadvantaged children.

Is Social Support a Cause or Consequence of Depression? A Longitudinal Study of Adolescents

A large body of literature has examined the relations between social support and depression. However, the exact nature and direction of these relations are not well understood. This study explored the relations between specific types of social support (peer support and teacher support) and depression. Adolescents (ages 11 to 17) for the first time (N = 2453) participated in a two-wave, 6-month longitudinal study. Structural equation modeling was used to test a social causation model (deficits in social support increase the likelihood of depression), interpersonal theories of depression (depression leads to social erosion), and a reciprocal influence model. Depression influenced peer support significantly and negatively. By contrast, the social causation model was not supported. These results held for males and females. Findings suggested that depression resulted in social support erosion. However, the effect was specific to perceived peer support but not to perceived teacher support.

Adolescent Nicotine Exposure Induces Dysregulation of Mesocorticolimbic Activity States and Depressive and Anxiety-like Prefrontal Cortical Molecular Phenotypes Persisting into Adulthood

Considerable evidence demonstrates strong comorbidity between nicotine dependence and mood and anxiety disorders. Nevertheless, the neurobiological mechanisms linking adolescent nicotine exposure to mood and anxiety disorders are not known. Disturbances in the mesocorticolimbic dopamine (DA) system, comprising the prefrontal cortex (PFC), ventral tegmental area (VTA), and nucleus accumbens (NAc), are correlates of mood and anxiety-related symptoms and this circuitry is strongly influenced by acute or chronic nicotine exposure. Using a combination of behavioral pharmacology, in vivo neuronal electrophysiology and molecular analyses, we examined and compared the effects of chronic nicotine exposure in rats during adolescence versus adulthood to characterize the mechanisms by which adolescent nicotine may selectively confer increased risk of developing mood and anxiety-related symptoms in later life. We report that exposure to nicotine, selectively during adolescence, induces profound and long-lasting neuronal, molecular and behavioral disturbances involving PFC DA D1R and downstream extracellular-signal-related kinase 1-2 (ERK 1-2) signaling. Remarkably, adolescent nicotine induced a persistent state of hyperactive DA activity in the ventral tegmental area (VTA) concomitant with hyperactive neuronal activity states in the PFC. Our findings identify several unique neuronal and molecular biomarkers that may serve as functional risk mechanisms for the long-lasting neuropsychiatric effects of adolescent smoking behaviors.

Cigarette use trajectories in young adults: Analyses of predictors across system levels

BACKGROUND

Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time.

METHODS

We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression).

RESULTS

We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005).

CONCLUSIONS

Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention.

Thirty-day smoking in adolescence is a strong predictor of smoking in young adulthood

Thirty-day smoking, although a widely used measure of adolescent smoking (age 12-16), has been questioned as an accurate measure of young adult (age 26-30) smoking behavior, particularly when critiquing studies linking use of e-cigarettes with subsequent cigarette smoking. We used logistic regression to test two measures of 30-day adolescent smoking as predictors of young adult smoking in the National Longitudinal Survey of Youth 1997. Adjusting for psychosocial covariates, compared to those who smoked zero days in the past 30 days in adolescence, odds of any past-30-day smoking in young adulthood ranged from 2.85 (95% CI: 1.85-4.37) for those who smoked 1 day to 4.81 (3.50-6.59) for those who smoked daily as adolescents, and adjusted odds of daily smoking in young adulthood ranged from 1.99 (1.24-3.18) to 4.69 (3.42-6.43). Compared with adolescent never smokers, adjusted odds of any past-30-day smoking in young adulthood among adolescent former smokers was 2.11 (1.77-2.53), and among adolescent current smokers, ranged from 3.03 (2.22-4.14) for those who smoked 1-5 cigarettes per month to 8.19 (5.80-11.55) for those who smoked daily. Adjusted odds of daily smoking in young adulthood were 2.49 (2.12-2.91) for adolescent former smokers and, among adolescent current smokers, ranged from 2.54 (1.92-3.37) for those who smoked 1-5 cigarettes per month to 8.65 (6.06-12.35) for those who smoked daily. There is a strong dose-response relationship between 30-day smoking in adolescence-even a single day in the month-and 30-day and daily smoking in young adulthood.

The 'state' of tobacco: Perceptions of tobacco among Appalachian youth in Kentucky

INTRODUCTION

In Appalachia, youth tobacco-use rates remain higher than the U.S. national average. Past research has indicated that several factors are related to high rates of tobacco use among Appalachian youth (e.g. low socioeconomic status, rural lifestyles). Of the Appalachian states, Kentucky has one of the highest rates of youth tobacco use. The aim of this study was to explore views of tobacco among Kentucky youth living in Appalachian counties.

METHODS

In Fall 2014 - Spring 2015, focus group interviews were conducted with middle and high school students (N=109) in Appalachian counties in Kentucky. Each focus group session included open-ended questions and was conducted by trained facilitators. Focus group transcriptions and field notes were analyzed for themes.

RESULTS

Study participants described an entrenched culture of tobacco. Three themes exemplified this culture. First, adult behavior served to enable youth tobacco use (e.g. teachers ignoring dip use in class, adults smoking with youth). Second, tobacco is easily accessible to youth (e.g. restrictions on youth sales are often ignored, family members provide). Third, symbols of tobacco are prevalent (e.g. festivals celebrating tobacco heritage, tobacco barns, and tobacco marketing logos).

CONCLUSIONS

Youth participants described a deeply rooted tobacco culture, which they believed was unlikely to change. Additional studies and health education efforts are needed in these rural communities. Further, stricter enforcement of tobacco sales and marketing restrictions may be helpful in protecting this vulnerable population.

Discontinuous Patterns of Cigarette Smoking From Ages 18 to 50 in the United States: A Repeated-Measures Latent Class Analysis

INTRODUCTION

Effective cigarette smoking prevention and intervention programming is enhanced by accurate understanding of developmental smoking pathways across the life span. This study investigated within-person patterns of cigarette smoking from ages 18 to 50 among a US national sample of high school graduates, focusing on identifying ages of particular importance for smoking involvement change.

AIMS AND METHODS

Using data from approximately 15,000 individuals participating in the longitudinal Monitoring the Future study, trichotomous measures of past 30-day smoking obtained at 11 time points were modeled using repeated-measures latent class analyses. Sex differences in latent class structure and membership were examined.

RESULTS

Twelve latent classes were identified: three characterized by consistent smoking patterns across age (no smoking; smoking < pack per day; smoking pack + per day); three showing uptake to a higher category of smoking across age; four reflecting successful quit behavior by age 50; and two defined by discontinuous shifts between smoking categories. The same latent class structure was found for both males and females, but membership probabilities differed between sexes. Although evidence of increases or decreases in smoking behavior was observed at virtually all ages through 35, 21/22 and 29/30 appeared to be particularly key for smoking category change within class.

CONCLUSIONS

This examination of latent classes of cigarette smoking among a national US longitudinal sample of high school graduates from ages 18 to 50 identified unique patterns and critical ages of susceptibility to change in smoking category within class. Such information may be of particular use in developing effective smoking prevention and intervention programming.

IMPLICATIONS

This study examined cigarette smoking among a national longitudinal US sample of high school graduates from ages 18 to 50 and identified distinct latent classes characterized by patterns of movement between no cigarette use, light-to-moderate smoking, and the conventional definition of heavy smoking at 11 time points via repeated-measures latent class analysis. Membership probabilities for each smoking class were estimated, and critical ages of susceptibility to change in smoking behaviors were identified.

The longitudinal, bidirectional relationships between parent reports of child secondhand smoke exposure and child smoking trajectories

This study examines the longitudinal relationships between child smoking and secondhand smoke exposure (SHSe). Participants were 222 parent-child dyads. The parents smoked, had a child with (48%) or without asthma, and were enrolled in a smoking/health intervention. Parent-reported child SHSe was measured at baseline and 4, 6, and 12-month follow-ups; self-reported child smoking was assessed at these points and at 2-months. A parallel process growth model was used. Baseline child SHSe and smoking were correlated (r = 0.30). Changes in child SHSe and child smoking moved in tandem as evidenced by a correlation between the linear slopes of child smoking and SHSe (r = 0.32), and a correlation between the linear slope of child smoking and the quadratic slope of child SHSe (r = - 0.44). Results may inform interventions with the potential to reduce child SHSe and smoking among children at increased risk due to their exposure to parental smoking.

Trajectories of Cigarette Smoking From Teens to Young Adulthood: 2000 to 2013

PURPOSE

To identify trajectories of smoking behaviors of a cohort of youth followed through young adulthood from 2000 to 2013.

DESIGN

The Minnesota Adolescent Community Cohort study, a population-based cohort study.

SETTING

Nationwide, originating in the Midwestern United States.

PARTICIPANTS

Cohort of youth surveyed for 14 years beginning at ages 12 to 16 (N = 4241 at baseline; 59% recruitment rate).

MEASURES

Main variable of interest was the number of days smoked in the past 30 days. Also included time-varying and time-invariant covariates.

ANALYSIS

We utilized growth mixture modeling to group individuals into trajectories over time.

RESULTS

We identified 5 distinct trajectories: nonsmokers (59.5%), early-onset regular smokers (14.2%), occasional smokers (11.5%), late-onset regular smokers (9.4%), and quitters (5.3%). Adjusted models showed that early- and late-onset regular smokers (compared to nonsmokers) had lower odds of attending or graduating from a 4-year college ( P < .05). Participants in all smoking classes compared to nonsmokers had greater odds of having more close friends who smoked ( P < .05).

CONCLUSION

Our results show that individuals in their teens through young adulthood can be classified into 5 smoking trajectories. More people in this age range remained abstainers than found in most previous studies; however, a sizable group was identified as regular smokers by the time they reached young adulthood. Interventions targeted at teens, including those that address social and environmental influences, are clearly still needed to prevent escalation of smoking as they move toward young adulthood.

Beyond experimentation: Five trajectories of cigarette smoking in a longitudinal sample of youth

The first goal of this study was to identify the most appropriate measure of cigarette smoking for identifying unique smoking trajectories among adolescents; the second goal was to describe the resulting trajectories and their characteristics. Using 15 annual waves of smoking data in the National Longitudinal Survey of Youth 1997 (NLSY97), we conducted an exploratory latent class growth analysis to determine the best of four outcome variables for yearly smoking (cigarettes per day on days smoked, days smoked per month, mean cigarettes per day, and total cigarettes per month) among individuals aged 12 to 30 (n = 8,791). Days smoked per month was the best outcome variable for identifying unique longitudinal trajectories of smoking and characteristics of these trajectories that could be used to target different types of smokers for prevention and cessation. Objective statistics were used to identify four trajectories in addition to never smokers (34.1%): experimenters (13.6%), quitters (8.1%), early established smokers (39.0%), and late escalators (5.2%). We identified a quitter and late escalator class not identified in the only other comparable latent class growth analysis. Logistic regressions were used to identify the characteristics of individuals in each trajectory. Compared with never smokers, all trajectories except late escalators were less likely to be black; experimenters were more likely to be out of school and unemployed and drink alcohol in adolescence; quitters were more likely to have a mother with a high school degree/GED or higher (versus none) and to use substances in adolescence and less likely to have ever married as a young adult; early established smokers were more likely to have a mother with a high school diploma or GED, be out of school and unemployed, not live with both parents, have used substances, be depressed, and have peers who smoked in adolescence and to have children as young adults and less likely to be Hispanic and to have ever married as young adults; and late escalators were more likely to be Hispanic, drink alcohol, and break rules in adolescence and less likely to have ever married as young adults. Because of the number of waves of data analyzed, this analysis provided a clearer temporal depiction of smoking behavior and more easily distinguishable smoking trajectories than previous analyses. Tobacco control interventions need to move beyond youth-focused approaches to reach all smokers.

The Association of Cigarette Smoking With Depression and Anxiety: A Systematic Review

BACKGROUND

Many studies report a positive association between smoking and mental illness. However, the literature remains mixed regarding the direction of this association. We therefore conducted a systematic review evaluating the association of smoking and depression and/or anxiety in longitudinal studies.

METHODS

Studies were identified by searching PubMed, Scopus, and Web of Science and were included if they: (1) used human participants, (2) were longitudinal, (3) reported primary data, (4) had smoking as an exposure and depression and/or anxiety as an outcome, or (5) had depression and/or anxiety as the exposure and smoking as an outcome.

RESULTS

Outcomes from 148 studies were categorized into: smoking onset, smoking status, smoking heaviness, tobacco dependence, and smoking trajectory. The results for each category varied substantially, with evidence for positive associations in both directions (smoking to later mental health and mental health to later smoking) as well as null findings. Overall, nearly half the studies reported that baseline depression/anxiety was associated with some type of later smoking behavior, while over a third found evidence that a smoking exposure was associated with later depression/anxiety. However, there were few studies directly supporting a bidirectional model of smoking and anxiety, and very few studies reporting null results.

CONCLUSIONS

The literature on the prospective association between smoking and depression and anxiety is inconsistent in terms of the direction of association most strongly supported. This suggests the need for future studies that employ different methodologies, such as Mendelian randomization (MR), which will allow us to draw stronger causal inferences.

IMPLICATIONS

We systematically reviewed longitudinal studies on the association of different aspects of smoking behavior with depression and anxiety. The results varied considerably, with evidence for smoking both associated with subsequent depression and anxiety, and vice versa. Few studies supported a bidirectional relationship, or reported null results, and no clear patterns by gender, ethnicity, clinical status, length to follow-up, or diagnostic test. Suggesting that despite advantages of longitudinal studies, they cannot alone provide strong evidence of causality. Therefore, future studies investigating this association should employ different methods allowing for stronger causal inferences to be made, such as MR.

Similarities and differences in alcohol trajectories: Testing the catch-up effect among biracial black subgroups

Using National Longitudinal Study of Adolescent and Adult Health (Add Health) data, we examine the alcohol-use trajectories of monoracial Black youth and biracial Black-White, Black-Hispanic, and Black-American Indian youth to assess how their trajectories differ from the alcohol-use trajectories of White youth over time. The sample consists of 9421 adolescents and young adults who self-identified as White, Black, Black-American Indian, Black-Hispanic, or Black-White. Study hypotheses are tested using latent growth curve modeling. Results indicate that a catch-up effect exists, but only for Black-American Indians whose alcohol-use rates approach the higher rates of Whites at age 29. Black-American Indians face particularly high risk of problematic drinking over the life course. Additional research is needed to understand causal factors of alcohol-use among biracial individuals particularly Black-American Indians who may be at higher risk for alcohol misuse.

Proactive telephone counseling for adolescent smokers: Comparing regular smokers with infrequent and occasional smokers on treatment receptivity, engagement, and outcomes

BACKGROUND

Adolescent smoking cessation efforts to date have tended to focus on regular smokers. Consequently, infrequent and occasional smokers' receptivity and response to smoking cessation interventions is unknown. To address this gap, this study examines data from the Hutchinson Study of High School Smoking-a randomized trial that examined the effectiveness of a telephone-delivered smoking cessation intervention for a large, population-based cohort of adolescent smokers proactively recruited in an educational setting.

METHODS

The study population included 1837 proactively identified high school smokers. Intervention receptivity, engagement, and outcomes were examined among adolescent infrequent (1-4days/month) and occasional (5-19days/month) smokers and compared with regular smokers (20 or more days/month).

RESULTS

With regard to treatment receptivity, intervention recruitment did not differ by smoking frequency. For engagement, intervention completion rates were higher for infrequent smokers (80.5%) compared with occasional (63.8%) and regular smokers (61.5%, p<0.01). Intervention effect sizes were not statistically different across groups.

CONCLUSIONS

Adolescent infrequent and occasional smokers are at least as receptive to a proactively delivered smoking cessation intervention as regular smokers and can benefit just as much from it. Including these adolescent smokers in cessation programs and research-with the goal of interrupting progression of smoking before young adulthood-should help reduce the high smoking prevalence among young adults.

Family and housing instability: Longitudinal impact on adolescent emotional and behavioral well-being

This study investigated the longitudinal effects of family structure changes and housing instability in adolescence on functioning in the transition to adulthood. A model examined the influence of household composition changes and mobility in context of ethnic differences and sociodemographic risks. Data from the National Longitudinal Study of Adolescent Health measured household and residential changes over a 12-month period among a nationally representative sample of adolescents. Assessments in young adulthood measured rates of depression, criminal activity, and smoking. Findings suggested housing mobility in adolescence predicted poorer functioning across outcomes in young adulthood, and youth living in multigenerational homes exhibited greater likelihood to be arrested than adolescents in single-generation homes. However, neither family structure changes nor its interaction with residential instability or ethnicity related to young adult outcomes. Findings emphasized the unique influence of housing mobility in the context of dynamic household compositions.

Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: race and gender differences

PURPOSE

This study examined the influence of Attention Deficit Hyperactivity Disorder (ADHD) symptoms severity and directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) on trajectories of the probability of current (past month) smoking and the number of cigarettes smoked from age 13 to 32. Racial and gender differences in the relationship of ADHD symptoms and smoking trajectories were also assessed.

METHODS

A subsample of 9719 youth (54.5% female) was drawn from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Cohort sequential design and zero-inflated Poisson (ZIP) latent growth modeling were used to estimate the relationship between ADHD directionality and severity on smoking development.

RESULTS

ADHD severity's effect on the likelihood of ever smoking cigarettes at the intercept (age 13) had a greater impact on White males than other groups. ADHD severity also had a stronger influence on the initial number of cigarettes smoked at age 13 among Hispanic participants. The relationships between ADHD directionality (hyperactive-impulsive symptoms relative to inattentive symptoms) and a higher number of cigarettes smoked at the intercept were stronger among Hispanic males than others. Gender differences manifested only among Whites.

CONCLUSION

ADHD severity and directionality had unique effects on smoking trajectories. Our results also highlight that the risk of ADHD symptoms may differ by race and gender.