Reliability of children's self-reported cigarette smoking

Dose-response associations between modifiable lifestyle behaviours and anxiety, depression and psychological distress symptoms in early adolescence

OBJECTIVE

To investigate associations between key modifiable lifestyle behaviours (sleep; physical activity; fruit, vegetable and sugar-sweetened beverage consumption; screen time; alcohol use and tobacco use) and mental health among early adolescents in Australia.

METHODS

Cross-sectional self-report data from 6,640 Year 7 students (M_age:12.7[0.5]; 50.6% male, 48.9% female, 0.5% non-binary) from 71 schools in New South Wales, Queensland and Western Australia were analysed using multivariate linear regression adjusting for sociodemographic factors and school-level clustering.

RESULTS

All examined behaviours were associated with anxiety, depression and psychological distress (p≤0.001), with the lowest mental health symptom scores observed in participants who slept 9.5-10.5 hours per night; consumed three serves of fruit daily; consumed two serves of vegetables daily; never or rarely drank sugar-sweetened beverages; engaged in six days of moderate-to-vigorous physical activity per week; kept daily recreational screen time to 31-60 minutes; had not consumed a full standard alcoholic drink (past six months); or smoked a cigarette (past six months).

CONCLUSIONS

Targeting modifiable risk behaviours offers promising prevention potential to improve adolescent mental health; however, further longitudinal research to determine directionality and behavioural interactions is needed.

IMPLICATIONS FOR PUBLIC HEALTH

While Australian Dietary, Movement and Alcohol Guidelines target physical health, findings indicate similar behaviour thresholds may offer mental health benefits.

Does e-cigarette experimentation increase the transition to daily smoking among young ever-smokers in France?

INTRODUCTION

According to multiple studies, e-cigarette use among adolescents is associated with subsequent smoking initiation. However, little is known about its effect on the transition from smoking initiation to daily smoking.

METHODS

Using retrospective data from a French national representative survey collected in 2017 (n = 39,115), we analyzed the role of ever using e-cigarettes on daily cigarette smoking status at 17 among ever smokers (n = 21,401). Risk-ratios (RR) were computed through modified Poisson regressions with an inverse probability of treatment weighting (IPTW) approach.

RESULTS

Among French adolescents aged 17, 16.8 % declared current e-cigarette use (1.9 % reported daily use) and 34.1 % cigarette smoking (25.1 % reported daily smoking). Among ever-smokers, adolescents who declared having ever used e-cigarettes were less likely than those who did not to transition to daily smoking at 17: RR = 0.62 95 %CI [0.60 - 0.64]. We found similar results for those who experimented with e-cigarettes before initiating smoking, RR = 0.76 95 %CI [0.66 - 0.89].

CONCLUSIONS

Our results found no evidence of an increased risk of transitioning to daily smoking at 17 among ever-smokers who also experimented with e-cigarettes. Further studies should investigate the longer-term role of vaping on future smoking habits with the use of causal inference methods.

Electronic and Combustible Cigarette Use in Adolescence: Links With Adjustment, Delinquency, and Other Substance Use

PURPOSE

The purpose of the study was to identify proximal links between electronic cigarette (e-cigarette) use and numerous indicators of adjustment, delinquency, and other substance use in adolescence, beyond prior levels and confounders.

METHODS

The ongoing Millennium Cohort Study is a nationally representative, intergenerational, longitudinal study of children born 2000-2001 in the United Kingdom followed from birth to age 14 years (n = 11,564 adolescents and their parents). A series of ordinary least squares and logistic regressions compared 14-year-old e-cigarette only users to never users and to combustible/dual users on 10 measures of adjustment (school engagement, well-being, and self-esteem), delinquency (theft, vandalism, disorderly conduct, and graffitiing), and other substance use (frequent alcohol use, heavy drinking, and marijuana use). Controls included each outcome variable measured at age 11 years and prospectively assessed parent and child confounders (e.g., parent education, child externalizing and internalizing behaviors, cognitive test scores, gender, and race/ethnicity).

RESULTS

At age 14 years, e-cigarette only users (approximately 7% of youth) had a higher risk of adolescent adjustment problems, delinquent behavior, and substance use relative to nonusers (75% of youth), but lower risk relative to combustible cigarette/dual users (18% of youth), even after controlling for a host of childhood confounders.

CONCLUSIONS

Positive links shown here between e-cigarette use and poor adjustment, delinquency, and other substance use in adolescence, coupled with accumulating evidence that e-cigarettes substantially increase youths' likelihood of combustible smoking, indicate that e-cigarettes are part of an emerging pattern of health-risk behaviors and poor adjustment for some youth.

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.

Gender differences in risk factors for cigarette smoking initiation in childhood

INTRODUCTION

We investigated whether established risk factors for initiating cigarette smoking during adolescence (parents, siblings, friends smoke; home smoking rules, smokers at home, exposure to smoking in cars, academic performance, susceptibility to smoking, depressive symptoms, self-esteem, school connectedness, use of other tobacco products) are associated with initiation in preadolescents, and whether the effects of these factors differ by gender.

METHODS

In spring 2005, baseline data were collected in self-report questionnaires from 1801 5th grade students including 1553 never-smokers (mean age=10.7years), in the longitudinal AdoQuest I Study in Montréal, Canada. Follow-up data were collected in the fall and spring of 6th grade (2005-2006). Poisson regression analyses with robust variance estimated the effects of each risk factor on initiation and additive interactions with gender were computed to assess the excess risk of each risk factor in girls compared to boys.

RESULTS

101 of 1399 participants in the analytic sample (6.7% of boys; 7.7% of girls) initiated smoking during follow-up. After adjustment for age, gender and maternal education, all risk factors except academic performance and school connectedness were statistically significantly associated with initiation. Paternal and sibling smoking were associated with initiation in girls only, and girls with lower self-esteem had a significant excess risk of initiating smoking in 6th grade.

CONCLUSIONS

Risk factors for smoking initiation in preadolescents mirror those in adolescents; their effects do not differ markedly by gender. Preventive programs targeting children should focus on reducing smoking in the social environment and the dangers of poly-tobacco use.

Parental co-viewing and susceptibility for smoking and drinking in adolescents: an experimental pilot study

BACKGROUND AND OBJECTIVES

The current pilot study is the first experiment to examine whether parents are able to diminish the adverse influences of smoking and drinking depicted in movies through co-viewing.

METHODS

For this study, 99 adolescents (M = 12.82 years old; SD = .95; 38.8% boys) watched the 3D version of Titanic in the cinema. Through randomization, adolescents were invited to come with either a parent or a friend. After watching the movie, adolescents filled out a questionnaire that assessed their susceptibility for smoking and drinking and their social images concerning these behaviors.

RESULTS

The findings revealed that adolescents who co-viewed the movie with their parents, compared to with their friends, were at the same or an even higher risk for future smoking or drinking after watching the movie. The findings also indicated that only a few parents communicated about smoking and drinking while watching the movie.

CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE

Simply co-viewing might not be an effective way for parents to blunt the effect of smoking and drinking in movies. In addition to ensuring more caution when advising parents to simply co-view movies, the present findings encourage additional research on the impact of instructive mediation strategies.

Consistency and Recanting of Ever-Smoking Status Reported by Self and Proxy Respondents One Year Apart

The study examined consistency of reports concerning current and prior smoking behaviors. Data came from the 2002-2003 Tobacco Use Supplement to the Current Population Survey, where the current smoking behaviors and smoking history were reported by self- and proxy-respondents on two occasions, one year apart. The ever-smoking status is reported consistently, overall: Kappa coefficient is 0.78 with the corresponding 95% confidence interval given by (0.77, 0.78). One specific type of inconsistency of prior reports was assessed for respondents who were identified as never smokers at the latter assessment and former or current smokers at the earlier assessment. Based on the survey logistic regression that controls for multiple respondent characteristics and survey administration method, the estimated prevalence of such inconsistent self-reports is 9.0%, and prevalence of inconsistent proxy-reports is 5.4%. In addition, prevalence of recanting, i.e., future reporting never smoking for respondents who previously claimed to be a former or a current smoker was assessed. The recanting was shown to be most prevalent with respect to proxy-reports and former smokers: overall prevalence of recanting was estimated to be in the range 13% - 19% for current smokers, and 27% - 46% for former smokers. Our findings indicate that while, unexpectedly, proxy-respondents are more likely to report the ever-smoking status consistently than do self-respondents, the proxies are also more likely to incorrectly report never smoking in the future for smokers especially regarding adolescents and young adults. Therefore, the observed higher level of consistency for proxy-respondents may be due to proxies' incorrect knowledge which leads to consistent yet ambiguous responses.

Smoking-specific communication and children's smoking onset: an extension of the theory of planned behaviour

The aim of this study was to test whether maternal smoking-specific communication and parental smoking related to smoking cognitions (i.e. attitude, self-efficacy and social norm) derived from the Theory of Planned Behaviour in association with smoking onset during preadolescence. A total of 1478 pairs of mothers and children participated (mean age: 10.11; standard deviation = 0.78). Structural equation models in Mplus were used to examine whether smoking-specific communication influences children's smoking cognitions, which in turn, affect smoking onset. A positive association was found between pro-smoking attitudes and smoking onset. Smoking-specific communication and parental smoking were related to smoking cognitions. Specifically, frequency of communication was negatively associated with pro-smoking attitudes, social norms of mother and best friend. Quality of communication related negatively to pro-smoking attitudes and positively to self-efficacy and norms of friends. Parental smoking was positively associated with pro-smoking attitudes and norms of mother and (best) friends. Additionally, more frequent communication and higher levels of parental smoking were associated with higher smoking onset. In conclusion, smoking-specific communication and parental smoking were associated with smoking cognitions and smoking onset. Already during preadolescence, parents contribute to shaping the smoking cognitions of their children, which may be predictive of smoking later in life.

The relation between smoking-specific parenting and smoking trajectories of adolescents: how are changes in parenting related to changes in smoking?

In this study, we tested to what extent smoking-specific parenting and changes in parenting are related to adolescents' smoking trajectories. Data were used from a four-wave prospective study including 428 adolescents (aged M = 15.2; SD = 0.60). Latent Class Growth Analyses were conducted to identify trajectories. Multinomial Logistic Regression Analyses were executed to examine the relations between parenting and class membership. Longitudinal cross-lagged models were tested to examine causal predominance between parenting and smoking. Four trajectories were found, consisting of Non-smokers, Increasers, Stable smokers and Decreasers. Quality of parental smoking-specific communication was strongly related to the membership in different trajectories. Along with the cross-lagged associations demonstrating that the quality of communication was predominantly related to future smoking rather than vice versa, these findings indicate that parents who talked about smoking in a constructive and respectful manner were more likely to have non-smoking children. In contrast, parents who talked often about smoking-related issues and increased these discussions over time were more likely to have smoking children; cross-lagged associations indicated that these findings could be best explained by children changing their parents. Having a non-smoking agreement was related to a lower risk in becoming a regular smoker.

Test-retest reliability of selected items of Health Behaviour in School-aged Children (HBSC) survey questionnaire in Beijing, China

BACKGROUND

Children's health and health behaviour are essential for their development and it is important to obtain abundant and accurate information to understand young people's health and health behaviour. The Health Behaviour in School-aged Children (HBSC) study is among the first large-scale international surveys on adolescent health through self-report questionnaires. So far, more than 40 countries in Europe and North America have been involved in the HBSC study. The purpose of this study is to assess the test-retest reliability of selected items in the Chinese version of the HBSC survey questionnaire in a sample of adolescents in Beijing, China.

METHODS

A sample of 95 male and female students aged 11 or 15 years old participated in a test and retest with a three weeks interval. Student Identity numbers of respondents were utilized to permit matching of test-retest questionnaires. 23 items concerning physical activity, sedentary behaviour, sleep and substance use were evaluated by using the percentage of response shifts and the single measure Intraclass Correlation Coefficients (ICC) with 95% confidence interval (CI) for all respondents and stratified by gender and age. Items on substance use were only evaluated for school children aged 15 years old.

RESULTS

The percentage of no response shift between test and retest varied from 32% for the item on computer use at weekends to 92% for the three items on smoking. Of all the 23 items evaluated, 6 items (26%) showed a moderate reliability, 12 items (52%) displayed a substantial reliability and 4 items (17%) indicated almost perfect reliability. No gender and age group difference of the test-retest reliability was found except for a few items on sedentary behaviour.

CONCLUSIONS

The overall findings of this study suggest that most selected indicators in the HBSC survey questionnaire have satisfactory test-retest reliability for the students in Beijing. Further test-retest studies in a large and diverse sample, as well as validity studies, should be considered for the future Chinese HBSC study.

Preventing smoking in young people: a systematic review of the impact of access interventions

AIMS

To examine existing evidence on the effectiveness of interventions that are designed to prevent the illegal sale of tobacco to young people. The review considers specific sub-questions related to the factors that might influence effectiveness, any differential effects for different sub-populations of youth, and barriers and facilitators to implementation.

METHODS

A review of studies on the impact of interventions on young people under the age of 18 was conducted. It included interventions that were designed to prevent the illegal sale of tobacco to children and young people. The review was conducted in July 2007, and included 20 papers on access restriction studies. The quality of the papers was assessed and the relevant data was extracted.

RESULTS

The evidence obtained from the review indicates that access restriction interventions may produce significant reductions in the rate of illegal tobacco sales to youth. However, lack of enforcement and the ability of youth to acquire cigarettes from social sources may undermine the effectiveness of these interventions.

CONCLUSIONS

When access interventions are applied in a comprehensive manner, they can affect young people's access to tobacco. However, further research is required to examine the effects of access restriction interventions on young people's smoking behaviour.

Do smoking attitudes predict behaviour? A longitudinal study on the bi-directional relations between adolescents' smoking attitudes and behaviours

AIMS

Prevention and intervention programmes focus frequently upon retaining or creating negative attitudes towards smoking in an effort to prevent adolescents from smoking. As the focus upon attitudes is central in these programmes it is essential to know whether smoking attitudes actually precede smoking behaviour or, conversely, are affected by it. Therefore, in the present study we examined to what extent bi-directional relations existed between smoking attitudes and behaviour.

DESIGN

Data were used from the three annual waves of the 'Family and Health' project.

SETTING

Participants were asked to complete questionnaires individually at their homes.

PARTICIPANTS

Addresses of families consisting of two parents and two adolescents were obtained from the records of 22 municipalities in the Netherlands. At baseline, 428 families participated with a response rate of 94% at the third measurement.

MEASUREMENTS

Self-reports were used to assess adolescents' smoking attitudes and behaviour. Associations between smoking attitudes and behaviour were tested using structural equation modelling.

FINDINGS

Findings revealed that smoking attitudes did not predict smoking consistently over time. However, past smoking affected subsequent attitudes moderately, suggesting that adolescents who started to smoke developed less negative attitudes towards smoking.

CONCLUSIONS

The current findings imply that smoking behaviour predominantly shapes smoking-related attitudes, rather than vice versa. Focusing merely on smoking attitudes is probably not enough to prevent adolescents from smoking.

Adolescent environmental tobacco smoke exposure predicts academic achievement test failure

PURPOSE

Research has linked prenatal tobacco exposure to neurocognitive and behavioral problems that can disrupt learning and school performance in childhood. Less is known about its effects on academic achievement in adolescence when controlling for known confounding factors (e.g., environmental tobacco smoke [ETS]). We hypothesized that prenatal tobacco exposure would decrease the likelihood of passing academic achievement tests taken at 16 and 18 years of age.

METHODS

This study was a longitudinal analysis of birth cohort data including 6,380 pregnant women and offspring from the 1958 National Child Development Study (NCDS). Academic pass/fail performance was measured on British standardized achievement tests ("Ordinary Level" [O-Level] and Advanced Level: [A-Level]). Prenatal tobacco exposure plus controlling variables (ETS, teen offspring smoking and gender, maternal age at pregnancy, maternal smoking before pregnancy, and socioeconomic status) were included in regression models predicting O- and A-Level test failure.

RESULTS

Significant predictors of test failure in the O-Level model included exposure to maternal (OR = 0.71, p < .0001) and paternal (OR = 0.70, p < .0001) ETS, as well as teen smoking, female gender, and lower SES. Prenatal tobacco exposure did not influence failure. Similar factors emerged in the A-Level model except that male gender contributed to likelihood of failure. Prenatal exposure remained nonsignificant.

CONCLUSIONS

Our model suggests that adolescent exposure to ETS, not prenatal tobacco exposure, predicted failure on both O- and A-Level achievement tests when controlling for other factors known to influence achievement. Although this study has limitations, results bolster growing evidence of academic-related ETS consequences in adolescence.

Maternal smoking during late pregnancy and offspring smoking behaviour

We explored the influence of maternal smoking during late pregnancy on the likelihood of smoking among offspring in adolescence and adulthood, using birth cohort data collected in the United Kingdom as part of the 1958 National Child Development Study. Longitudinal analysis indicated that maternal smoking during late pregnancy was associated with an increased likelihood of being a non-smoker at 16-year, 23-year and 33-year follow-up. This association differed between male and female offspring, with women showing no significant association and men showing an increased likelihood of being a non-smoker. There did not appear to be any association between maternal smoking during late pregnancy and cigarette consumption among offspring who reported smoking for either sex. These results are inconsistent with some previous reports that maternal smoking during pregnancy increases the likelihood of smoking among female offspring, although the observation of a moderating effect of sex on smoking behaviour is consistent with several previous reports. We discuss possible mechanisms for this association, and suggest factors that may account for the observed sex differences in this association, and the discrepancy between our results and some previous reports.

Reliability of self-reports of cigarette use in novice smokers

This analysis reports the 3-month test-retest reliability of self-reports of cigarette use in novice smokers, and identifies factors associated with adequate recall. Participants included 63 novice smokers (mean age 14.1 years) from the McGill University Study on the Natural History of Nicotine Dependence in Teens. We compared data for three cigarette use indicators obtained in a 1-month recall of smoking, to data obtained for that same month, 3 months later. Forty-three participants (68.3%) smoked infrequently; 12.7%, 6.4%, and 12.7% were monthly, weekly, and daily smokers, respectively. Test-retest reliability for the cigarette use frequency and intensity indicators was good (kappa=0.78 and 0.75, respectively); it was lower for total number of cigarettes smoked per month (ICC=0.64). Older age was independently associated with adequate recall for all three indicators. These data suggest that novice smokers recall the frequency and intensity of their cigarette use reliably after 3 months, and that older adolescents have better recall than younger adolescents.

Lies, damned lies and statistics? Reliability and personal accounts of smoking among young people

Smoking remains a major problem among young people in Europe. However, within the research community examining the issue, debate continues about the best way of assessing the extent of that problem. Questions have been raised about the extent to which existing techniques for generating statistical representations of patterns of youth smoking can address a range of problems connected with identifying, accounting for and correcting unreliable self-report smoking data. Using empirical data from the UK Liverpool Longitudinal Smoking Study (LLSS), this paper argues that self-report measures of smoking, treated in isolation from participants' personal accounts, can disguise problems with the reliability and validity of a given study. Using longitudinal qualitative and quantitative data in dialogue, two main factors contributing to unreliable data are discussed: (a) participants' access to and familiarity with frameworks of everyday cultural knowledge about the practice of smoking, and (b) participants' retrospective revision of events in line with their current goals, aspirations and self-understandings. The conclusion drawn is that research has to employ multiple methods, minimally incorporating some personal contribution from participants, to explore the complex character of the problem of smoking and to avoid the difficulties posed by the models of smoking behaviour embodied within stand-alone statistical research.

Toward reducing youth exposure to tobacco messages: examining the breadth of brand and nonbrand communications

Young people cannot escape prosmoking messages in today's society. From magazine advertisements to billboards to promotional products to storefronts, the pervasive landscape of tobacco-related communications is unavoidable. Despite increased restrictions on tobacco advertising and promotion in recent decades, including the 1998 Master Settlement Agreement (MSA), tobacco companies continue to employ an extensive array of marketing communications practices that can reach youth. Moreover, minors encounter tobacco messages not only from branded sources (those paid for by the tobacco firms), but also through nonbranded sources, such as smoking portrayals on television and in films and prosmoking websites. In this article, we critically examine the myriad and far-reaching tobacco messages that young people face. Although tobacco company marketing that can reach minors has undergone much research and public scrutiny, the combined impact of those messages along with nonbrand messages that positively portray smoking has received much less attention. Since all messages communicate, not just branded ones, it is important to examine the breadth of tobacco communications to which young people are exposed. We close by offering recommendations both for reducing youth exposure to protobacco communications and enhancing anti-youth-smoking efforts.

Can parents who smoke socialise their children against smoking? Results from the Smoke-free Kids intervention trial

OBJECTIVE

To evaluate Smoke-free Kids, a new home based programme to assist parents who smoke in socializing their children against smoking.

DESIGN

Two year randomised controlled trial.

PARTICIPANTS

At baseline, 887 adult smokers who had an abstinent child in the third grade (ages 7-8 years); 671 adults and children were retained through the 24 month follow up.

INTERVENTION

Programme modules, newsletters, incentives, support calls.

OUTCOMES

Anti-smoking socialisation; susceptibility to smoking.

RESULTS

Of 327 parents randomised to treatment, 210 obtained adequate treatment by using at least three of five core modules. Programme efficacy analyses, which compared these parents with controls (n = 344), showed that exposure to adequate treatment predicted significantly higher levels in nearly all categories of anti-smoking socialisation three months post-intervention. Two years post-baseline, children of parents who reported adequate treatment scored significantly higher than controls on attributes that reduce susceptibility to smoking, and they scored significantly lower than controls on attributes that raise susceptibility to smoking. Programme effectiveness analyses compared all parents randomised to treatment (n = 327) with controls (n = 344). Treatment effects were evident for several socialisation outcomes; however, these effects were smaller and less consistent than those from the efficacy analyses. Similarly, although treated children scored higher than controls on attributes that reduce susceptibility and lower than controls on attributes that raise susceptibility, several of these between-group differences were not significant.

CONCLUSIONS

Given adequate exposure to the Smoke-free Kids programme, significant beneficial effects were observed on anti-smoking socialisation in households where parents smoke cigarettes, and significant beneficial effects were observed on children's susceptibility to smoking after two years. Improving programme acceptance and utilisation is necessary before programme effectiveness can be demonstrated.

Self-reported school difficulties and tobacco use among fourth- to seventh-grade students

This study examined the relationship between academic and behavioral difficulties at school, and tobacco use in students. Participants included 1,219 students in fourth to seventh grade at the time of enrollment. Interviews were repeated eight months later with 85% of baseline participants. Telephone interviews assessed use of cigarettes, cigars, and chewing tobacco; students also were asked if they liked school, how often they got in trouble at school, and how well they were doing in school. At baseline, students reporting school difficulties were 1.4-5.6 times more likely to report a lifetime history of cigarette, cigar, and chewing tobacco use relative to students who did not report these difficulties. Average to below-average academic performance at baseline was predictive of new cigarette use at the eight-month follow-up (Relative Risk = 3.35; 95% Confidence Interval = [1.36, 8.22]). Self-reported school difficulties are associated with lifetime use of all major forms of tobacco and are predictive of future cigarette use in fourth- to seventh-grade students.

Estimating Multi-Level Discrete-Time Hazard Models Using Cross-Sectional Data: Neighborhood Effects on the Onset of Adolescent Cigarette Use

Investigating the effects of social context (e.g., neighborhood or school context) on the timing of behaviors (such as cigarette use initiation) requires both multi-level modeling and eventhistory analysis, and often requires the construction of a retrospective person-period data set from cross-sectional data. In this article we describe procedures for constructing such a data set and discuss modeling strategies for estimating multi-level discrete-time event history models. We show that the estimation of two-level discrete-time models involves three distinct modeling assumptions (the assumptions that individual- and neighborhood-level covariates have the same effect at all time points and the assumption that the baseline logithazard curves in each neighborhood are parallel) and discuss methods of relaxing and empirically testing each of these assumptions. Estimation can be simplified in some cases if we additionally assume that the shape of the baseline logit-hazard curve in each neighborhood can be approximated by a simple functional form. The methods described here are applicable to a wide variety of questions where the dependent variable of interest is either onset or cessation. Here we apply these methods to the analysis of cigarette use initiation in a sample of 1,979 11- to 18-year-olds drawn from 79 neighborhoods of Chicago. We find that the racial composition of a neighborhood accounts for roughly half of the difference in age of smoking initiation between Black and White teenagers. Specifically, we find that living in a neighborhood with a large percentage of Black residents is associated with a lower hazard of adolescent cigarette use initiation than is living in neighborhoods with few Black residents.

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

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