Youthful smoking: patterns and relationships to alcohol and other drug use

Increasing the prevalence of successful children: The case for community intervention research

This paper makes a case for research on community interventions on child rearing. Sufficient evidence has accumulated about the development of children's problem behavior to justify evaluating efforts to reduce the prevalence of these problems in whole communities. The contextual risk factors for diverse child behavior problems are well understood, and interventions to ameliorate individual risk factors have been developed and evaluated. Because interventions with individual children have proven to be efficacious, it is now appropriate to direct energy toward reducing the prevalence of children with behavior problems. At the same time, existing interventions have limitations. Community interventions may be needed to modify the larger social context for families. This paper enumerates possible components of a community intervention to improve child-rearing outcomes. Existing evidence indicates that communities would benefit from making parent training and family support programs available to parents. Validated methods of identifying and remediating academic and behavioral problems in schools are available, but influencing schools to adopt them remains a problem. Community organizing could mobilize communities to allocate the resources necessary to support such parenting and schooling programs as well as encourage their adoption. Media campaigns could foster community support and directly influence parenting practices. Efforts to modify peer influences to use illicit substances have received empirical support; similar efforts may be relevant to preventing other problems. The development of a science of community interventions on child rearing is hampered by overreliance on randomized control trials. For this reason, two examples of time-series experimental evaluations of community intervention components are described here.

Computerized versus motivational interviewing alcohol interventions: impact on discrepancy, motivation, and drinking

The authors conducted two randomized clinical trials with ethnically diverse samples of college student drinkers in order to determine (a) the relative efficacy of two popular computerized interventions versus a more comprehensive motivational interview approach (BASICS) and (b) the mechanisms of change associated with these interventions. In Study 1, heavy drinking participants recruited from a student health center (N = 74, 59% women, 23% African American) were randomly assigned to receive BASICS or the Alcohol 101 CD-ROM program. BASICS was associated with greater post-session motivation to change and self-ideal and normative discrepancy relative to Alcohol 101, but there were no group differences in the primary drinking outcomes at 1-month follow-up. Pre to post session increases in motivation predicted lower follow-up drinking across both conditions. In Study 2, heavy drinking freshman recruited from a core university course (N = 133, 50% women, 30% African American) were randomly assigned to BASICS, a web-based feedback program (e-CHUG), or assessment-only. BASICS was associated with greater post-session self-ideal discrepancy than e-CHUG, but there were no differences in motivation or normative discrepancy. There was a significant treatment effect on typical weekly and heavy drinking, with participants in BASICS reporting significantly lower follow-up drinking relative to assessment only participants. In Study 2, change in the motivation or discrepancy did not predict drinking outcomes. Across both studies, African American students assigned to BASICS reported medium effect size reductions in drinking whereas African American students assigned to Alcohol 101, e-CHUG, or assessment did not reduce their drinking.

The relationship between traumatic dental injuries and adolescents' development along the life course

Few models have been proposed to explain the aetiology of traumatic dental injuries. Those that have, focus on risk factors at present stage of life. The contribution of risk factors for dental injuries at different stages of life needs to be investigated.

OBJECTIVES

To test the relationship between life course experiences and the occurrence of traumatic dental injuries in adolescents.

METHODS

A cross-sectional survey was used to collect data retrospectively. Out of a total number of 764 eligible 13-year-old-adolescents enrolled in private and public schools located in urban areas in the town of Cianorte, Brazil, 652 (85%) agreed to participate in the study. They were interviewed and examined for traumatic dental injuries by two trained dental epidemiologists using validated criteria. The interviews collected information on socioeconomic circumstances, family related variables, school grade and anthropometric measures (height and weight).

RESULTS

Adolescent boys, those from non-nuclear families, those reporting high levels of paternal punishment and those who were at lower grades at school for their age were more likely to experience dental injuries than girls, adolescents from nuclear families, those reporting low levels of paternal punishment and those who were at higher grades at school.

CONCLUSION

It was concluded that adolescents who experienced adverse psychosocial environments along the life course had more traumatic dental injuries than their counterparts who experienced more favourable environments.

Substance use, self-esteem, and depression among Asian American adolescents

The relationship of self-esteem and depression with alcohol, tobacco, and other drug (ATOD) use was tested in a California statewide sample of more than 4,300 Asian American high school students comprising five subgroups: Chinese, Japanese, Korean, Filipino, and Vietnamese. Estimated prevalence rates of alcohol, tobacco, and marijuana use among males and females from these Asian American subgroups are presented. Correlations revealed that cigarette, alcohol, and marijuana use were generally more related to high depression and low self-esteem in females than in males. Logistic regression analysis with only the female subjects investigated whether the relationship between the psychological variables and ATOD use was maintained even after controlling for traditionally important constructs in ATOD use (grade level in school, born in the United States, ethnicity, and ATOD use by friends). These results indicated that for females, depression was significantly related to alcohol and tobacco use, but self-esteem was not. Neither self-esteem nor depression was a significant contributor to marijuana use. Issues related to the application of these results are discussed.

The relative influence of smoking on drinking and drinking on smoking among high school students in a rural tobacco-growing county

PURPOSE

To construct and estimate a model that contains a reciprocal relationship between smoking and drinking and to test whether the gateway drug thesis or the cumulative risk behaviors thesis best fits the data.

METHODS

Data (n = 630) are from a survey of all students (50% female; aged 16.2 years on average; 2.4 grade point average; and 57% residing in homes with both mother and father present) in a rural, tobacco-growing county's two high schools, one public (85%) and one private, in 1993. The survey was conducted by the schools as part of their alcohol and other drugs (AOD) prevention programs and was coordinated by the county AOD Council. Students completed the questionnaires in their homerooms. Endogenous predictors of drinking and smoking include student's perception of adult drug behavior, peer pressure to drink, degree to which their friends' drink, and attitudes toward drinking and smoking. Path coefficients were estimated by using LISREL.

RESULTS

The strong correlation between smoking and drinking resulted from shared causes, rather than from the effects of one type of drug use on the other. Approval of drinking had the strongest association with being a drinker (beta =.57) and with being a smoker (beta =.37). Those who found smoking offensive were less likely to be a smoker (beta = -.25). However, attitude toward smoking was not associated with being a drinker. Having drinking friends increased both the likelihood of being a drinker (beta =.29) and of being a smoker (beta =.23). Peer pressure to drink increased the likelihood of being a smoker (beta =.14) and of being a drinker (beta =.12). Students with lower grade point averages, males, older students, students in public school, and students with family structures other than both parents living in the same household were more likely to be a drinker and were more likely to be a smoker.

CONCLUSIONS

Our results support the cumulative risk behaviors thesis. The link between both high-risk behaviors, smoking and drinking, results from common causes rather than from drinking leading to smoking.

Co-occurrence of alcohol and cigarette use among adolescents

Concurrent use of alcohol and cigarettes among adolescents is a serious public health issue. Trends in concurrent use of alcohol and cigarettes were determined using data from three comparable large statewide samples of 7-12th-grade students in New York State, from surveys conducted in 1983, 1990, and 1994. The prevalence of use of alcohol and cigarettes decreased from 1983 (23%) to 1990 (19%), and increased by 1994 (22%). Logistic regression analysis showed that these trends are highly significant, and that the probability of use of alcohol and cigarettes is higher for females than males, increases with age, and is lower for most ethnic minorities than for Whites. In the 1990s, Blacks, Hispanics, and Asians increased in their probability of concurrent use more than did Whites. Users of both alcohol and cigarettes are at increased risk of personal and social problems, as well as increased risk of delinquency. Drinking and smoking show synergistic effects on illicit drug use and drug problems.

A substance use prevention framework: considering the social context for African American girls

Shifting patterns of substance use (that is, early initiation, increased marijuana use, narrowing differences in gender use) and the disproportionate socioeconomic obstacles that are related to substance use among ethnically diverse adolescent females create the need to develop ethnic and gender-specific substance use prevention frameworks. This article describes and applies a substance use prevention framework to African American females. Gender socialization and self-efficacy are presented as key concepts, along with the assertion that every substance use prevention framework should examine the influences of specific societal factors (such as racism, sexism, classism, and ageism) on substance use. Rationale and guidelines for designing ethnically sensitive and gender-specific research projects and intervention programs regarding substance use prevention are offered. Public health nurses (PHNs) are uniquely positioned to use this framework in their work with African American adolescent girls, specifically, and in general with other ethnically diverse groups.

Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students

We examined the prevalence of smokeless tobacco use, and its relationship to other risky behaviors in Connecticut school children in grades four through 12 (n=31,861). Less than one per cent of students in grades 4-8, and four per cent of those in grades 9-12, used smokeless tobacco. Eighty-two percent of all users were white males. Among high school males, the prevalences of risk-taking behaviors and feelings of stress and depression were significantly higher among users than non-users. Among high school males, the highest prevalences of risky behaviors and stress indicators were reported by joint users of cigarettes and smokeless tobacco.

Trends in adolescent alcohol and other substance use: relationships to trends in peer, parent, and school influences

The aim of this study is to improve understanding of trends in adolescent substance use by comparing them with trends in peer substance use, school problem behavior, parental disapproval of alcohol and drugs, and exposure to school prevention information. These trends were determined using data from three large comparable representative surveys of 7-12th grade students in New York State conducted in 1983, 1990, and 1994. Analysis of variance was used to test the significance of the trends and to identify meaningful differences in trends by demographic subgroups (gender, grace level, and ethnicity). Adolescent alcohol and substance use declined in the 1980s, then increased from 1990 to 1994. Trends in friend's substance use and school problem behavior paralleled the alcohol and other substance use trends, consistent with their being part of the same adolescent problem behavior syndrome. Parental disapproval also followed a trend consistent with the substance use trends, i.e., parental disapproval increased in the 1980s but then decreased in the 1990s. However, the trend in school prevention influences did not parallel these substance use trends: student exposure to school primary prevention programs continued to increase from 1990 to 1994. Use of alcohol, cigarettes, marijuana, and other illicit drugs from 1990 to 1994, increased fastest among the younger students, despite increased school prevention exposure. Other factors must be sought as possible explanations of the increasing alcohol and substance use among adolescents.

Cigarette smoking among native and foreign-born African Americans

PURPOSE

To examine differences in current smoking status and the number of cigarettes consumed daily between foreign and native-born African Americans, and the impact of demographic and socioeconomic status (SES) factors on smoking behavior.

METHODS

Data were obtained from combining the 1990-1994 National Health Interview Surveys and consisted of 16,738 U.S. born and foreign-born African Americans between 18 and 64 years of age. The statistical analysis included cross-tabulations and weighted multiple logistic regression (MLR) using the Statistical Packages for the Social Sciences (SPSS) and the Survey Data Analysis (SUDAAN) computer programs.

RESULTS

Adjusted MLR analysis revealed that native-born African Americans were more likely (odds ratio (OR) = 2.7, p < 0.001) to be current smokers than foreign-born blacks. Within the native-born group, smoking prevalence decreased with increasing education and income, but these associations were not found for foreign-born blacks. Women in both groups were less likely than men to be current smokers. Statistically significant differences were not found between the two groups in the number of cigarettes smoked per day.

CONCLUSIONS

This analysis of nativity and smoking behavior further demonstrates the social diversity among African Americans and suggests the differential impact of social and cultural factors on smoking behavior within racially classified social groups. In areas where there are substantial numbers of foreign-born blacks, researchers should consider differentiating smoking status by nativity. Though differences in smoking prevalence were apparent for native and foreign-born American Americans, prevention and cessation programs are needed for both groups.

Factors associated with smoking among children and adolescents in Connecticut

INTRODUCTION

The age of smoking initiation has dropped over the past four decades. Since behaviors and attitudes adopted in late childhood or early adolescence predict future smoking, it is important to understand the smoking and other risk-taking behaviors and attitudes of children aged 12 and younger. The goal of the analyses presented here was to describe behavioral and attitudinal factors associated with smoking among elementary school (grades 4-6), middle school (grade 7-8), and high school (grades 9-12) students in Connecticut.

METHODS

We have used data from 8 years (1988-1996) of an anonymous, self-administered health risk appraisal survey given to children and adolescents in self-selected public and private schools. We compared the proportion of smokers and nonsmokers who reported various behaviors and attitudes and compared them with the chi-square test.

RESULTS

Fifteen percent (n = 4,884) of the total population (n = 31, 861) were current smokers. At all grade levels, current smokers were more likely than nonsmokers to engage in risk-taking behaviors, and to report more stress and depression. Indicators of risk-taking and stress were also associated with the intent to smoke among children in grades 4-6.

CONCLUSIONS

Smoking occurs within the context of other risk-taking behavior and psychological distress, among both children and older adolescents. Our data provide support for the idea of early identification and targeting of children at high risk of smoking in elementary school, possibly as early as grade four.

Contributions of the social context to the development of adolescent substance use: a multivariate latent growth modeling approach

This article demonstrates a latent growth curve methodology for analyzing longitudinal data of adolescent substance use. Hypotheses concerning the form of growth in alcohol, cigarette, and marijuana use, and covariates influencing the form of growth, were tested. Participants were male and female adolescents (n = 664) assessed at three time points. A common trajectory existed across the developmental period with significant increases in all three substances. Second-order multivariate extensions of the basic latent growth modeling framework suggested that associations among the individual differences parameters, representing growth or change in the various substance use behaviors, could be adequately modeled by a higher-order substance use construct. Inept parental monitoring, parent-child conflict, peer deviance, academic failure, gender, and age, were significant predictors of initial levels and the trajectory of substance use.

Psychosocial and pharmacologic explanations of nicotine's "gateway drug" function

Research has shown that adolescent users of tobacco are much more likely to progress to use of illicit drugs than are nonusers of tobacco. This article suggests potential psychosocial reasons for the progression based on principles of learning theory, Theory of Reasoned Action, Health Belief Model, and Cognitive Dissonance. In addition, a neuropharmacologic causal mechanism is discussed. The existence of tobacco's gateway function has important implications in the nation's efforts to reduce illicit drug use and adolescent smoking.

A Comparative Analysis of Cigarette, Alcohol, and Illicit Drug Use among an Ethnically Diverse Sample of Hispanic, African American, and Non-Hispanic White Adolescents

Longitudinal findings are presented on lifetime, past year, and magnitude of use of cigarettes, alcohol, and illicit drugs among non-Hispanic White (NHW), African-American, Cuban, Nicaraguan, Colombian, and Puerto Rican adolescent boys. The T-3 sample included 5,370 adolescents of whom 3,403 were Hispanic. About one-half the Hispanic sample was foreign born. Significant increases in lifetime use and magnitude of use of all three substances were found over the three data collection periods for all six groups. NHW and Hispanic adolescents had higher substance use rates than African-Americans. Most differences were not significant for NHW and Hispanic subgroups. Foreign-born Hispanics reported positive relationships between length of time in country and substance use. Significant relationships were found in two instances. Length of time in country was related to lifetime use of all substances for Cubans and for past year use of alcohol and illicit drugs. It was also significantly related to lifetime and past year use of alcohol and for lifetime illicit drug use among Nicaraguans. Although substance use did not vary greatly for different Hispanic groups, the authors suggest caution be used in offering generalizations, especially among young groups with diverse nativity and immigration histories.

The health behaviour of northern Finnish men in adolescence and adulthood

The aim of the study was to produce data about health behaviour among men born in Northern Finland in 1966. A particular concern was to find out how well health behaviour in adolescence predicts health behaviour in adulthood. The family questionnaire on health and development was submitted in 1980 when the subjects were 14 years of age. The response rate was 97%. The second questionnaire survey was carried out 10 years later with 2500 respondents. The final response rate was 60%. The results indicated that health behaviour in adolescence predicted health behaviour in adulthood as far as smoking and physical exercise were concerned. Over half (65%) of those who were non-smokers in their youth did not smoke as adults. Similarly the majority (71%) of those who had taken physical exercise at least once a week in their youth continued to do so in adulthood. Most of the subjects (85%) used alcohol in adulthood. A good family situation was connected with healthy habits. In the case of drinking, however, the subjects whose fathers belonged to social classes I-II used alcohol to a somewhat greater extent than others. It is important to conceive of health behaviour as an element connected with a person's life situation. Health research should be incorporated into cultural research and should have closer co-operation with other disciplines.

Social influence predictors of alcohol use among New York Latino youth

We examined demographic and social influence predictors of adolescent drinking among New York City Latino adolescents, including specific Latino subgroups (i.e., Puerto Rican, Dominican, Colombian, and Ecuadorian). Sixth- and seventh-grade students (N = 3129) who identified themselves as Latino or Hispanic on the survey questionnaire comprised our Latino sample. The survey included self-reported frequency of alcohol use, demographic items, and measures of social influences for drinking. Logistic-regression analyses revealed that social influences (how many friends drink, attitudes of parents and friends toward respondent's drinking) are strong predictors of current drinking (defined as drinking at least once a month) for the overall sample of Latino youth, as well as for Puerto Rican youth and Dominican youth. Findings are discussed in terms of their implications for prevention.

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.

Adolescent cigarette consumption: the influence of attitudes and peer drug use

Predictors of tobacco consumption were investigated with path analytic techniques using household survey data from 1,093 teenagers aged 13-17. When current smokers are compared to past or never smokers, pro-tobacco attitudes are always the most important predictor variable followed by friends' use of marijuana and own use of marijuana, suggesting that pro-tobacco attitudes are responsible for maintaining tobacco consumption. We infer that peer illicit drug use has the greatest effect in taking up smoking because it is the most important predictor of past smoker status compared to never smoking and it does not appear as such an important predictor of current use compared to never smoker status. Pro-tobacco attitudes are a consequence of smoking rather than an influence upon taking up smoking.

Gender differences in substance use among Mexican American school-age children

This study identified differences in gender between and among fourth, fifth, and sixth grade Mexican American students for use of four specific "minor" substances: cigarettes, beer, wine/liquor, and marijuana. Minor substances are believed to serve as a "gateway" to more intense and frequent use of minor and major substances. Students (N = 2,216; males 52% and females 48%) were surveyed to ascertain information pertaining to their substance use. The chi-square statistic found significant gender differences at the fourth and fifth grade for use of minor substances. Patterns of initiation of minor substance use by gender and grade are discussed in the context of substance use stage theory. Overall, results support the need for further research emphasizing within group variations in the substance use of singular ethnic groups.

Smoking: a special need?

The smoking behaviour of 665 children aged 12-15 years with special educational needs was compared with that of a control group of 842 children in mainstream education. Each child was interviewed using a structured questionnaire and reported smoking behaviour was validated against scores on a carbon monoxide monitor. We identified as the most at risk group children with emotional and behavioural disorders. They had the highest smoking rates and were the heaviest smokers. In contrast, children with learning difficulties had slightly lower smoking rates than those of the control. There were significant associations between the children's smoking behaviour and the smoking behaviour of siblings and 'other adults' in the household, belonging to single parent families, low self-esteem and large friendship groups. The reported smoking rates of the families of both groups of special needs children was found to be considerably higher than that in the control group or in the general population.

Like parent like child? Associations between drinking and smoking behaviour of parents and their children

This paper examines the association between the smoking and drinking behaviours of parents and their adolescent children, and the effect of gender and social class upon this association. It is based on data collected from a cohort of young people and their parents, resident in the west of Scotland. Both social class and parental smoking behaviour were independently associated with young people's smoking, with young people from lower social class households or whose parents smoked being most likely to smoke. Social class and gender were independently associated with young people's drinking, with males and young people from non-manual households being most likely to drink. Parental drinking behaviour was associated positively with young people's drinking only in non-manual classes and among daughters. We conclude that it is important to take social class and gender into account since it may influence whether or not there is an association between the behaviour of young people and that of their parents, and it may influence young people's behaviour in addition to influences from parental behaviour.

Ethnicity and psychosocial factors in alcohol and tobacco use in adolescence

Research on ethnic group differences has suggested that (a) adolescents from various groups differ on a number of dimensions that have been related to risk for substance use initiation, and (b) adolescents of different groups choose different substances. However, there is little consensus regarding the reasons for such differences. There is an especially high rate of alcohol use among Hispanic adolescents, and Hispanics are at high risk for alcohol abuse. In light of ethnic group differences in both substance use and the precursors of substance use in adolescence, this study examined differences among black, Anglo, Puerto Rican, and Dominican adolescents in the relation between cigarette and alcohol use and psychosocial functioning. Comparisons between the Puerto Rican and Dominican subjects were of special interest due to preexisting differences between these groups that may be attributed to acculturation. Results provided evidence of the importance of acculturation in modifying psychosocial vulnerability, especially for alcohol use, with the Dominican group at highest risk.

Patterns of cigarette and smokeless tobacco use among children and adolescents

Although cigarette and smokeless tobacco use are recognized as major problems among school-age youth, few nationwide or statewide data exist on the prevalence and patterns of use. To determine the patterns of tobacco use among children and adolescents in Missouri, self-report information was obtained from a representative sample of 5,431 students in grades 5, 8, and 12. Both cigarette smoking and smokeless tobacco use were more common among males than females for each grade level except the 12th, where 30% of females and 28% of males had smoked during the previous week. Smoking prevalence was considerably lower among blacks than whites. Smokeless tobacco use was rare among both blacks and females. Smokeless tobacco use was more common than cigarette smoking in rural areas, where 17% of 8th-grade males and 31% of 12th-grade males had used smokeless tobacco during the previous week. The mean age at first use of cigarettes was slightly lower in the rural than the urban area, whereas the mean age of initial smokeless tobacco use was more than a year earlier in the rural area. Data regarding the perceived difficulty of quitting smoking and quit rates suggested that adolescent females have more difficulty quitting smoking than males. Male smokeless tobacco users appeared to be more addicted than male cigarette smokers. Smokeless tobacco brand preference indicated that users may switch to progressively stronger types of smokeless tobacco as they get older and a nicotine tolerance is developed. The current study emphasizes the urgent need for carefully targeted tobacco prevention and cessation efforts among school-age youth.

Alcohol or tobacco research versus alcohol and tobacco research

Despite the frequent co-occurrence of tobacco and alcohol use, little is known about relationships between alcohol and nicotine. This paper reviews similarities and differences between tobacco and alcohol use, offers speculation about why a marriage of the two fields has been so long in coming, and discusses the multiple scientific and therapeutic benefits that could derive from the study of individuals who use both drugs.

Involvement of tobacco in alcoholism and illicit drug use

Survey data from the United States indicate that tobacco use is associated with the initiation of use of other addicting substances, and that increasing levels of tobacco use are associated with increasing levels of use of other psychoactive substances. Furthermore, factors affecting initiation, abstinence, and relapse to the use of tobacco, alcohol, and opioids are similar in nature. In addition, there are similarities in the addictive process underlying the use of these substances. Taken together, these data suggest that tobacco use is involved, possibly more than by simple association, in the use of other substances containing psychoactive chemicals. In the present paper we discuss the involvement of tobacco in the use of alcohol, opioids, cocaine, and other substances, as well as some of the implications of these observations for researchers and clinicians. One such implication is that it may be possible to use tobacco and nicotine as models for phenomena of interest to other substance use researchers. For example, drug abuse treatment and prevention strategies could be explored using tobacco use as a target behavior, and biological phenomena such as the development of tolerance and physical dependence may be more readily studied with nicotine than with many other drugs. Certain pharmacologic differences across substances are also discussed in light of their implications for development of treatment and drug control policies.