Prospective social-psychological factors of adolescent smoking progression

Using a classification tree modeling approach to predict cigarette use among adolescents in the United States

Objective: The purpose of this study was to screen pertinent variables to identify ordered relations that provide easily interpretable and accurate predictions of the probability of cigarette use among adolescents using a classification tree modeling approach. Methods: This cross-sectional study included a national sample of 3717 U.S. adolescents aged between 12 and 20 years old from the 2016 National Survey on Drug Use and Health. Results: The results indicated that age was the most influential variable, followed by depression, race/ethnicity, family income, gender, and alcohol abuse and dependence. Additionally, several interaction emerged that identified higher and lower cigarette use profiles: youth who were between 18 and 20 years old and self-identified as non-Hispanic White, Native American/Alaska Native, and "Other" racial/ethnic group and African American, Asian, and Latinx adolescents, with depressive symptoms were at higher risk of cigarette use; while youth who reported lower family incomes, were 16-17 years old, who identified as African American, Asian, and Latinx, were also likely to report lower use of cigarettes when they reported lower depressive symptom scores. Discussion: These results are discussed relative to practice implications.

Predictors of smoking behaviour among indigenous Sami adolescents and non-indigenous peers in North Norway

Aims: A study was undertaken to examine predictors of smoking behaviour among indigenous Sami adolescents and non-indigenous peers in North Norway, and to examine for ethnic-specific predictors. Methods: This is a cross-sectional and longitudinal school-based and postal questionnaire study initially including 2,718 10th to 12th grade students (response rate (RR): 85%) in 1994—95 (T1). At the three-year follow-up (T2), in 1997 — 98, 1,405 were included (RR: 57%). Indigenous Sami contributed 23% (599/324) of the total samples. Logistic regression was used to examine the influence of sociodemographic and psychosocial predictors on smoking behaviour. Results: The proportions of regular smokers were 33% (729) and 35% (401) at T1 and T2, respectively, while 19% (153) had initiated current smoking during the study period. Substance use, externalizing problems, sexual activity and vocational training (p≤0.01) predicted regular smoking both cross-sectionally and prospectively. Among non-smokers at T1, age and frequent alcohol intoxication predicted current smoking prospectively (p≤0.01). Frequent intoxication predicted all stages of smoking (p≤0.001). Ethnicity did not predict smoking in this study. Laestadian Christian affiliation increased the prevalence of experimental smoking at T1 but only for Sami students. Conclusions: Youth smoking behaviour was strongly associated with risk-taking behaviours, indicating that a broader focus on health-compromising behaviours in anti-smoking campaigns is needed. The findings indicate little need for culturally sensitive anti-smoking campaigns specially designed for indigenous Sami youth, as the main predictors (risk-taking behaviours) were similar across ethnic groups.

Cognitive Dysfunction, Affective States, and Vulnerability to Nicotine Addiction: A Multifactorial Perspective

Although smoking prevalence has declined in recent years, certain subpopulations continue to smoke at disproportionately high rates and show resistance to cessation treatments. Individuals showing cognitive and affective impairments, including emotional distress and deficits in attention, memory, and inhibitory control, particularly in the context of psychiatric conditions, such as attention-deficit hyperactivity disorder, schizophrenia, and mood disorders, are at higher risk for tobacco addiction. Nicotine has been shown to improve cognitive and emotional processing in some conditions, including during tobacco abstinence. Self-medication of cognitive deficits or negative affect has been proposed to underlie high rates of tobacco smoking among people with psychiatric disorders. However, pre-existing cognitive and mood disorders may also influence the development and maintenance of nicotine dependence, by biasing nicotine-induced alterations in information processing and associative learning, decision-making, and inhibitory control. Here, we discuss the potential forms of contribution of cognitive and affective deficits to nicotine addiction-related processes, by reviewing major clinical and preclinical studies investigating either the procognitive and therapeutic action of nicotine or the putative primary role of cognitive and emotional impairments in addiction-like features.

The Role of Depression in the Uptake and Maintenance of Cigarette Smoking

Cigarette smoking and depression both account for significant morbidity, mortality, and economic burden. The prevalence of both smoking and depression increase across mid-to-late adolescence and show high rates of comorbidity. While little is known about why smoking is disproportionately higher among depressed adolescents than adolescents without depression, emerging research has begun to offer some initial insights. The high rates of comorbidity between depression and smoking emphasize the importance of identifying intervention targets to inform smoking prevention efforts for this high-risk group. Interventions during adolescence may lessen the prevalence of depression-prone adult smokers. Depression is over-represented among adult smokers and contributes to lower smoking cessation rates. Negative mood management and pharmacotherapy have been the central focus of smoking cessation interventions for depression-prone populations to date. Converging lines of research highlight novel smoking cessation targets such as the maintenance of positive mood and reward regulation. Smoking cessation research in depression-prone smokers is critical to identify efficacious treatments that will ultimately decrease the excess smoking burden for this population.

The long arm of adolescence: school health behavioral environments, tobacco and alcohol co-use, and the 5HTTLPR gene

Although sociologists, demographers, and others have thoroughly studied contextual and life course influences on tobacco and alcohol use in adolescence and young adulthood, far less attention has been paid to the determinants of tobacco and alcohol co-use. This is important to remedy because co-use has a nonadditive effect on long-term health. In this article, we use nationally representative, longitudinal data from adolescents and young adults to examine patterns of joint tobacco and alcohol use behaviors across the life course. Importantly, we describe how these trajectories are linked to respondents' high school's joint profile of tobacco and alcohol use, measured two ways: as the proportion of tobacco and alcohol co-users, and as the "excess proportion" above that expected based on the marginal probabilities of smoking and drinking in that school. Joint tobacco and alcohol use is associated with both measures, emphasizing the "long arm" of adolescent contexts. Furthermore, we extend previous research to assess whether there is a gene-environment interaction between this school-level measure, 5HTTLPR, and tobacco and alcohol co-use, as suggested by recent work analyzing drinking and smoking separately. We find evidence of such a pattern but conclude that it is likely to be due to population stratification or other forms of confounding.

Peer influence and selection processes in adolescent smoking behavior: a comparative study

INTRODUCTION

Adolescent smoking studies find evidence of active peer influence and selection processes. However, studies have shown that these processes operate differently depending on context. This study uses SIENA to model coevolutionary processes between smoking and changes in friendship ties, comparing two high schools in which data were collected in identical fashion to explore influence and selection mechanisms with respect to current smoking, and smoking levels.

METHODS

This is a longitudinal survey with 2 waves of data. In-home surveys were conducted with students from 2 large high schools in the United States: a West Coast school, and a Midwestern school. Participants were consented students in 10th and 11th grades at the first wave of data collection. The primary measures were self-reported smoking behavior and friendship nominations.

RESULTS

There is evidence of influence and selection in both schools for adolescents' smoking status (1 = any smoking) and for level of smoking.

CONCLUSIONS

These models reflect great similarities in influence and selection processes across schools for different smoking behaviors. However, smoking prevalence may impact the exact mechanisms by which influence and selection operate. Researchers should consider smoking interventions with independent modules addressing different selection and influence processes, implemented based on contextual factors such as the prevalence of smoking.

Cigarette smoking and mood disorders in U.S. adolescents: sex-specific associations with symptoms, diagnoses, impairment and health services use

OBJECTIVE

To report sex-specific associations between cigarette smoking and DSM-IV disorders, symptoms, and mental health services use related to depression and anxiety in a nationally representative sample of U.S. adolescents.

METHODS

Data on two samples were drawn from the 1999-2004 National Health and Nutrition Examination Surveys to examine the association of ever smoking (versus never smoking) with depression (n=1884 12-15 year-olds) and anxiety (n=6336 12-19 year-olds). Sex-specific associations between smoking and DSM-IV diagnoses, subthreshold and severe disorder, symptoms, impairment and mental health services use were assessed using logistic regression modeling.

RESULTS

Rates of DSM-IV depression and anxiety were increased in adolescent female ever smokers as compared to never smokers (OR=3.9, 95% CI: 1.3-11.3 and OR=10.6, 95% CI: 3.1-37.0, respectively). Females also showed statistically significant increases in severe disorder, subthreshold disorder, all symptoms of major depressive disorder, most symptoms of panic disorder, and increases in severe impairment, especially those related to schoolwork and teachers. Male adolescents showed smaller variations in depression and anxiety by smoking status, but were more likely to seek mental health services.

CONCLUSIONS

Smoking prevention efforts may benefit from specifically targeting female youth who show signs of depression or anxiety diagnoses through a school-based program, while greater benefits with males may be evident through programs integrated into mental health services.

Resisting Smoking When a Best Friend Smokes: Do Intrapersonal and Contextual Factors Matter?

This longitudinal study examines individual differences in the tendency to initiate (N = 4,612) and escalate (N = 2,837) smoking when adolescents gain a best friend who smokes. Potential moderating factors include self-esteem, depression, problem behavior, school and family bonds, and household access to cigarettes. In addition to acquiring a smoking best friend, initiation was predicted by trouble at school, household access, poorer grades and delinquency, whereas escalation was predicted by depressive symptoms. There was little evidence that the examined individual difference factors moderate the association between gaining a smoking best friend and increased adolescent smoking. Results point to the challenges of identifying factors that may lead adolescents to be more or less susceptible to the influence of pro-smoking friends.

Nicotine-induced plasma corticosterone is attenuated by social interactions in male and female adolescent rats

Most smokers begin smoking during adolescence, a period during which social reward is highly influential. Initial exposure to nicotine can produce anxiogenic effects that may be influenced by social context. This study examined play behavior and plasma corticosterone following nicotine administration (0.6 mg/kg, s.c.) in both male and female adolescent (PND39) Sprague-Dawley rats in either isolate or social contexts. In blood samples collected immediately following the 15-min test session, nicotine increased plasma corticosterone relative to saline in both male and female isolate rats, but failed to do so in both males and females placed together in same-sex pairs. Nicotine also attenuated several indices of play behavior including nape attacks, pins and social contact. In isolate rats, nicotine selectively increased locomotor activity in females; however, when administered to social pairs, nicotine decreased locomotion in both sexes. These findings suggest that the presence of a social partner may decrease the initial negative, stress-activating effects of nicotine, perhaps leading to increased nicotine reward.

Tobacco use in youth with mental illnesses

Despite an abundance of literature documenting the prevalence and dangers of youth tobacco use, there is a relative dearth of literature in the area of effective cessation treatments for youth (Fiore et al. in Clinical tobacco guideline: treating tobacco use and dependence, 2008). Additionally, although it has been widely accepted that mental illness is highly correlated with tobacco use and dependence, little research has been done to support prevention and cessation efforts for youth with mental illnesses. This paper summarizes the literature on tobacco use and cessation in youth, with a focus on describing the existing knowledge base for youth with mental illnesses.

Declining alternative reinforcers link depression to young adult smoking

AIMS

Young adulthood represents a period of continued smoking progression and the establishment of regular and long-term smoking practices. Our understanding of the psychological processes that facilitate and solidify regular smoking patterns in this developmental period is limited. We sought to evaluate the role of depression symptoms in young adult smoking uptake and to evaluate whether non-smoking related alternative reinforcers was a mechanism by which depression symptoms influence smoking.

PARTICIPANTS

The sample was composed of 834 young adults who participated in a longitudinal study of smoking adoption (aged 18-22 years).

DESIGN AND MEASUREMENTS

In this prospective cohort study, smoking, depression, alternative reinforcers and several covariates were measured annually via telephone from emerging adulthood (age 18) to young adulthood (age 22).

FINDINGS

Results of a parallel processes latent growth curve model showed that depression symptoms level (baseline age 18) had a significant negative effect on substitute alternative reinforcers trend (β = -0.01, Z = -3.17, P=0.002) and that substitute reinforcers trend had a significant negative effect on smoking trend (β = -0.62, Z = -2.99, P = 0.003). An assessment of indirect effects revealed that depression symptoms level had a significant positive indirect effect on smoking trend through substitute alternative reinforcers trend (β = 0.01, Z = 2.09, P = 0.04, 99% CI = 0.001, 0.02), such that greater depression symptoms at baseline predicted decreases in substitute reinforcers across time which in turn predicted increases in smoking uptake/rate from emerging to young adulthood.

CONCLUSIONS

Depressive symptoms in emerging adulthood appear to influence smoking uptake and smoking rate through reductions in alternative reinforcers. This suggests that increasing involvement in alternative reinforcers may prevent smoking uptake and escalation in smoking rate.

Substance use and common child mental health problems: examining longitudinal associations in a British sample

AIMS

To examine the longitudinal associations in both directions between mental health and substance use in adolescence.

DESIGN

Three-year longitudinal cohort.

SETTING

Britain (nationally representative sample).

PARTICIPANTS

3607 youths aged 11-16 years at baseline.

MEASUREMENTS

Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs.

FINDINGS

Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose-response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up.

CONCLUSIONS

Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems. A dose-response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventions rather than targeting individuals only at the negative extreme.

Cognitive susceptibility to smoking: Two paths to experimenting among Mexican origin youth

Cognitive susceptibility to smoking, defined as the lack of a firm commitment not to smoke in the future or if offered a cigarette by a friend, begins in childhood and is an early phase in the transition from never to ever smoking. Our objectives were to examine susceptibility to smoking and other psychosocial risk factors for experimentation with cigarettes among Mexican origin adolescents and to determine whether susceptibility status moderates the relationship between established risk factors for experimentation with cigarettes and future experimentation. We examined susceptibility and several psychosocial factors associated with susceptibility as baseline predictors of experimentation after 3 years of follow-up among 964 Mexican origin girls and boys between 11 and 13 years of age from the Houston metropolitan area. Participants were recruited between May 2005 and October 2006 and reported that they had never experimented with cigarettes at baseline. Baseline susceptibility and experimentation rates were 23% and 9%, respectively, whereas the follow-up experimentation rate, among those who had not experimented at baseline, was 22%. Susceptible adolescents at baseline were 2.6 times more likely to have experimented with cigarettes by follow-up. Baseline susceptibility moderated the relationship between experimentation at follow-up and the psychosocial risk factors assessed at baseline. Susceptibility is a valid and strong marker for the transition to experimentation for Mexican origin adolescents. Our results suggest that tailoring primary prevention programs by a youth's susceptibility status may increase the efficacy of prevention efforts among Mexican origin youth.

Potential effects of active parental consent: Enrolling teen smokers into a school-based cessation program

INTRODUCTION

Research on effective teen smoking cessation interventions is critical to reducing the tobacco-related disease burden and risk of lifetime negative health outcomes for youth. However, informed consent procedures requiring active parental consent may restrict or influence teen participation in critical teen cessation programs.

METHODS

Not On Tobacco (N-O-T) is a teen smoking cessation intervention that has been implemented under both active parental consent and passive parental consent conditions. The present study determined if there are differences in characteristics of youth enrolled under each condition. Data were available for active consent (n = 968) and passive consent (n = 4,924) participants aged 14-18 who completed the N-O-T program between 1998 and 2006 across several states.

RESULTS

Participants enrolled under active consent conditions were more likely to be older, White/non-Hispanic, live in father-only or grandparent-headed household, start smoking at an earlier age, smoke more on weekdays, have previous unsuccessful quit attempts, and have siblings and friends who smoke. Additional differences were found between active and passive consent conditions in motivation to quit smoking, confidence in quitting, and stage of change.

DISCUSSION

Results highlight important differences between youth who enroll in a smoking cessation program under active and passive consent conditions, often a distinguishing feature of research and non-research implementation.

Adolescent smoking and depression: evidence for self-medication and peer smoking mediation

AIMS

The nature of the relationship between adolescent smoking and depression is unclear and the mechanisms that account for the comorbidity have received little investigation. The present study sought to clarify the temporal precedence for smoking and depression and to determine whether these variables are linked indirectly through peer smoking.

PARTICIPANTS

The sample was composed of 1093 adolescents participating in a longitudinal study of the behavioral predictors of smoking adoption.

DESIGN AND MEASUREMENTS

In this prospective cohort study, smoking, depression, peer smoking and other covariates were measured annually from mid-adolescence (9th grade; age 14) to late adolescence (12th grade, age 18).

FINDINGS

Parallel processes latent growth curve models supported a bidirectional relationship between adolescent smoking and depression, where higher depression symptoms in mid-adolescence (age 14) predicted adolescent smoking progression from mid- to late adolescence (ages 14-18). A significant indirect effect indicated that higher depression symptoms across time predicted an increase in the number of smoking peers, which in turn predicted smoking progression from mid-adolescence to late adolescence. In addition, smoking progression predicted a deceleration of depression symptoms from mid- to late adolescence. A significant indirect effect indicated that greater smoking at baseline predicted a deceleration in the number of smoking peers across time, which predicted a deceleration in depression symptoms from mid-adolescence to late adolescence.

CONCLUSIONS

The current study provides the first evidence of bidirectional self-medication processes in the relationship between adolescent smoking and depression and highlights peer smoking as one explanation for the comorbidity.

Is image everything? The role of self-image in the relationship between family functioning and substance use among Hispanic adolescents

This cross-sectional self-report study examined (1) whether family functioning (Family Functioning in Adolescence Questionnaire, FFAQ) and self-image (Piers-Harris Children's Self-Concept Scale) have independent associations with smoking and alcohol use and (2) whether self-image mediates the relationship between family functioning, smoking, and alcohol use among 1,598 Hispanic males and females in grades 7 through 12 in Los Angeles County, California, in 2001. The findings supported the main effects and, to some degree, the mediational effects that were hypothesized. Limitations and implications for this study are discussed, and directions for future research are suggested. This study was funded by the California Tobacco Related Disease Research Program.

Beyond quitting: predictors of teen smoking cessation, reduction and acceleration following a school-based intervention

There remains a great need for effective, cost-efficient, and acceptable youth smoking cessation interventions. Unfortunately, only a few interventions have been demonstrated to increase quit rates among youth smokers, and little is known about how elements of cessation interventions and participants' psychosocial characteristics and smoking histories interact to influence program outcomes. Additionally, few studies have examined how these variables lead to complete smoking abstinence, reduction or acceleration over the course of a structured cessation intervention. Data for the present investigation were drawn from a sample of teen smokers (n=5892) who voluntarily participated in either a controlled study or field study (i.e., no control group) of the American Lung Association's Not On Tobacco (N-O-T) program between 1998 and 2006 in five states. Results suggest that those who reduce smoking (but do not achieve full abstinence) are similar to those who quit on most measures except stage of change. Furthermore, it was found that those who increased smoking were heavier smokers at baseline, more addicted, were more likely to have parents, siblings, and significant others who smoked and reported less confidence in and less motivation for quitting than did those who quit or reduced smoking. Finally, a path model demonstrated how peers, siblings and romantic partners affected tobacco use and cessation outcomes differently for males and females. Implications for interventions are discussed.

Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins

AIMS

To explore the developmental relationships between early-onset depressive disorders and later use of addictive substances.

DESIGN, SETTING AND PARTICIPANTS

A sample of 1545 adolescent twins was drawn from a prospective, longitudinal study of Finnish adolescent twins with baseline assessments at age 14 years and follow-up at age 17.5 years.

MEASUREMENTS

At baseline, DSM-IV diagnoses were assessed with a professionally administered adolescent version of Semi-Structured Assessment for Genetics of Alcoholism (C-SSAGA-A). At follow-up, substance use outcomes were assessed via self-reported questionnaire.

FINDINGS

Early-onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49-3.50, P < 0.001], smokeless tobacco use (OR = 2.00, 95% CI 1.32-3.04, P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95-11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04-3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18-2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within-family analysis of depression-discordant co-twins (analyses that control for shared genetic and familial background factors), early-onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5.

CONCLUSIONS

Our results suggest important predictive associations between early-onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.

A profile of teen smokers who volunteered to participate in school-based smoking intervention

OBJECTIVES

Although a number of population-based studies have examined the characteristics of teens who attempt to quit smoking, few have identified the characteristics of youth who participate in structured cessation interventions, particularly those with demonstrated effectiveness. The purpose of the present study is to describe the sociodemographic and smoking-related characteristics of teen smokers who participated in the American Lung Association's Not On Tobacco (N-O-T) program, spanning eight years. N-O-T is the most widely used teen smoking cessation program in the nation.

METHODS

Drawn from multiple statewide N-O-T studies, this investigation examined data from 5,892 teen smokers ages 14-19 who enrolled in N-O-T between 1998-2006. We demonstrate similarities and differences between N-O-T findings and existing data from representative samples of US teen smokers where available and relevant.

RESULTS

N-O-T teens started smoking earlier, were more likely to be poly-tobacco users, were more dependent on nicotine, had made more previous attempts to quit, and were more deeply embedded in smoking contexts than comparative samples of teen smokers. Additionally, N-O-T teens were moderately ready to quit smoking, believed important people in their lives would support their quit efforts, yet had deficits in their confidence with quitting.

CONCLUSION

This profile of N-O-T teens can guide efforts for targeted recruitment strategies to enhance intervention reach for teen smoking cessation. Findings provide guidance for marketing and recruitment efforts of intensive, school-based cessation interventions among established teen smokers, particularly those who want to quit. Study results may shed light upon who is and is not enrolling in N-O-T.

Changes in the influence of parents' and close friends' smoking on adolescent smoking transitions

This paper examined changes in the influence of parents' and close friends' smoking on smoking transitions occurring over the course of adolescence, using a large (N=6,006) longitudinal study. The three grade periods were 5th to 7th (ages 10-12), 7th to 9th (ages 12-14), and 9th to 12th grade (ages 14-17). Smoking transitions examined were: (1) never to trying, (2) trying to monthly, and (3) monthly to daily. Results showed that the influence of parents' smoking was substantial for all three transitions during most of the grade periods and, for the transition from monthly to daily smoking, increased (p=.006) during adolescence. In contrast, the influence of close friends' smoking was strongest for the transition to trying smoking and did not significantly change (all p>.05) for any of the smoking transitions as the adolescent became older. In conclusion, the influence of close friends' smoking on smoking transitions might be stable during adolescence whereas the influence of parents' smoking on the transition to daily smoking might markedly increase across adolescence.

Psychological symptoms and physical health and health behaviours in adolescents: a prospective 2-year study in East London

AIMS

To examine whether physical health and health-risk behaviours in young people are risk factors for psychological distress and depressive symptoms over a 2-year period.

DESIGN/SETTING

A 2-year, prospective epidemiological cohort study in East London.

PARTICIPANTS

A total of 1615 adolescents from the Research with East London Adolescents: Community Health Survey (RELACHS)-a representative cohort of young people aged 11-12 and 13-14 years at baseline, followed-up after 2 years.

MEASUREMENTS

Psychological distress and depressive symptoms identified by the self-report Strengths and Difficulties Questionnaire and the Short Moods and Feelings Questionnaire at baseline and follow-up. Data on overweight/obesity, general health, long-standing illness, physical activity, smoking, alcohol use and drug use were collected from questionnaires completed by the adolescents at baseline and follow-up.

FINDINGS

At follow-up, 10.1% of males and 12.9% of females reported psychological distress; 20% of males and 33.7% of females reported depressive symptoms. Having tried drugs or engaged in two or more health-risk behaviours (smoking, alcohol use or drug use) at baseline predicted psychological distress and depressive symptoms at follow-up. Smoking on its own, long-standing illness, obesity/overweight and activity levels were not associated with later psychological health. Risk of poor psychological health at follow-up was associated strongly with psychological health at baseline.

CONCLUSIONS

Psychological health at baseline was the strongest predictor of psychological health at follow-up. Engaging in two or more health-risk behaviours moderately increased the risk of poor psychological health, suggesting that prevention strategies targeting co-occuring substance use may reduce burden of disease.

Challenges to the peer influence paradigm: results for 12-13 year olds from six European countries from the European Smoking Prevention Framework Approach study

OBJECTIVE

To examine whether smoking onset in young adolescents is predicted by peer or parental smoking.

DESIGN

Longitudinal design with one pretest and one follow-up at 12 months.

SETTING

Schools in Finland, Denmark, the Netherlands, the United Kingdom, Spain and Portugal.

PARTICIPANTS

7102 randomly selected adolescents from six countries. Mean age was 12.78 years.

MAIN OUTCOME MEASURES

Smoking behaviour of adolescents, peers and parents.

RESULTS

No support was found for peer smoking as an important predictor of smoking onset in most countries. Support was found for the selection paradigm, implying that adolescents choose friends with similar smoking behaviour. Support for the impact of parents on adolescent behaviour and the choice of friends was also found.

CONCLUSIONS

Smoking uptake in this age cohort may be more strongly influenced by personal and parental influences than initially believed. Hence, social inoculation programmes teaching youngsters to resist the pressures to smoke may be less appropriate if youngsters have a positive attitude towards smoking, associate smoking with various advantages and look for peers with similar values. For this group attitudes towards smoking may thus guide future friend selection.

Adolescents' perspectives on addiction: Qualitative study

Given that the adolescence period is one of the most crucial stages of development during one's lifetime and adolescents are prone to engage in behaviors which may negatively impact their health, it is very important to have a clear and transparent understanding of adolescents' health needs and problems. A content analysis with a qualitative approach was conducted and 41 healthy adolescents were interviewed. The results of this study revealed the following themes: addiction causes and prevalence; unhealthy friendship and communication and increased rates of cigarette smoking; alcohol and drugs; barriers to and factors in addiction and health; family and addiction. The findings showed worrying attitudes of adolescents to addiction and its prevalence are alarming. It is concluded that exploring adolescents' perspectives is not only important but is useful for maintaining a healthy society, and thus policy makers should develop effective prevention and intervention programs based on these themes.

The influence of smoking imagery on the smoking intentions of young people: testing a media interpretation model

PURPOSE

To assess a theoretical model of adolescents' exposure to films, perceptions of smoking imagery in film, and smoking intentions.

METHODS

A structured questionnaire was completed by 3041 Year 8 (aged 12 years) and Year 12 (aged 16 years) students from 25 schools in Auckland, New Zealand. The survey assessed the relationships among exposure to films, attitudes about smoking imagery, perceptions of smoking prevalence and its acceptability, and expectations of smoking in the future. Measures included exposure to films, perceived pervasiveness of, and nonchalant attitudes about smoking imagery, identification of positive smoker stereotypes in films, perceived smoking prevalence, judgment of smoking acceptability, and smoking expectations. Path analytic techniques, using multiple regression analyses, were used to test the pattern of associations identified by the media interpretation model.

RESULTS

Hierarchical regression analyses revealed that film exposure predicted higher levels of perceived smoking prevalence, perceived imagery pervasiveness, and nonchalant attitudes about smoking imagery. Nonchalant attitudes, identification of positive smoker stereotypes, and perceived smoking prevalence predicted judgments of smoking acceptability. Acceptability judgments, identification of positive stereotypes, and perceived smoking prevalence were all positively associated with smoking expectations. The media interpretation model accounted for 24% of the variance in smoking expectations within the total sample.

CONCLUSIONS

Smoking imagery in film may play a role in the development of smoking intentions through inflating the perception of smoking prevalence and presenting socially attractive images.

Parental prompts as risk factors for adolescent trial smoking: results of a prospective cohort study

Our earlier cross-sectional research suggested that smoking parents, particularly Latino parents, engage in behaviors that may prompt their children to smoke (e.g., request their child to start the parent's cigarette in his/her own mouth). This prospective study of 478 adolescent never-smokers, mostly Latino, suggests that parental prompts to smoke were not significantly related to smoking initiation among adolescents over a 1-year period.

Influence and selection processes in friendships and adolescent smoking behaviour: the role of parental smoking

Concerning the role of parental smoking on development of adolescent smoking, most studies have exclusively focused on the direct effects of parents' smoking on youths' smoking. However, parental smoking may also play an indirect role by affecting youths' susceptibility to peer influences and by affecting friendship selection. Data were from a three-wave short-term longitudinal study of 1595 adolescents. Findings showed high similarities in smoking between reciprocal friends. Additionally, friend's smoking and parents' smoking were moderately related to adolescent smoking onset, but parents' smoking did not moderate the prospective association between best friend's smoking and adolescent smoking. Finally, parental smoking seemed to affect the selection of new friends: In particular, adolescents with smoking parents were most likely to become affiliated with smoking friends. There was no evidence that parental smoking affected termination of friendships.

Developmental trajectories of cigarette smoking and their correlates from early adolescence to young adulthood

Smoking initiation typically occurs in adolescence and increases over time into emerging adulthood. Thus adolescence and emerging adulthood compose a critical time period for prevention and intervention efforts. To inform these efforts, this study used latent growth mixture modeling to identify 6 smoking trajectories from ages 13 to 23 among 5,914 individuals: nonsmokers (28%), stable highs (6%), early increasers (10%), late increasers (10%), decreasers (6%), and triers (40%). By age 23, the trajectories merged into 2 distinct groups of low- and high-frequency and their standing on age 23 outcomes reflected this grouping. Consideration of these results can help researchers identify at-risk individuals before their smoking becomes too problematic, providing an opportunity for intervention and possible prevention of nicotine dependence.

[Some emotional repercussions of adolescent pregnancy in Rio de Janeiro, Brazil (1999-2001)]

This study analyzed the association between early pregnancy and negative emotional repercussions for adolescents, according to socio-demographic and psychosocial variables. The study interviewed 1,228 adolescents in maternity hospitals in the City of Rio de Janeiro. Emotional repercussions were evaluated with negative self-assessment variables, showing little or no expectation towards the future, as well as psychological distress. The chi2 test and odds ratio were used to analyze the data. Adolescents who reported a negative reaction by the family felt less valued (OR 1.8), with little expectation towards the future (OR 2.3), and presented major psychological distress (OR 1.5). Those not enrolled in school when they became pregnant also showed worse self-esteem (OR 1.9) and fewer expectations towards the future (OR 2.2). Greater psychological distress was inversely related to frequency of prenatal care (0.7). The article concludes that family support, regardless of original social conditions, was identified as the principal factor for minimizing negative emotional repercussions of pregnancy during adolescence.

From adolescence to young adulthood: racial/ethnic disparities in smoking

OBJECTIVES

We used data gathered from 6259 youths between the ages of 13 and 23 years to compare trends in smoking among 4 racial/ethnic groups.

METHODS

We weighted trend data to represent baseline respondent characteristics and evaluated these data with linear contrasts derived from multiple regression analyses.

RESULTS

Although African Americans exhibited higher initiation rates than Whites, they exhibited consistently lower rates of regular smoking than both Whites and Hispanics. This seeming anomaly was explained by African Americans' lower rates of transition to regular smoking and greater tendency to quit. Racial/ethnic disparities were accounted for by differences in pro-smoking influences.

CONCLUSIONS

Reducing racial/ethnic disparities in smoking may require reducing differences in the psychosocial factors that encourage smoking.

Socioeconomic disparities in cancer-risk behaviors in adolescence: baseline results from the Health and Behaviour in Teenagers Study (HABITS)

BACKGROUND

This study explores the association between socioeconomic deprivation and five factors associated with long-term risk of cancer, in adolescents.

METHODS

BMI, fat intake, fruit and vegetable intake, smoking, and exercise were assessed in 4320 students ages 11 to 12, from 36 schools, in the first year of a 5-year longitudinal study of the development of health behaviors (HABITS study). Neighborhood socioeconomic deprivation for each student's area of residence was matched to their postcode (zip code). We used multiple logistic regression analyses to investigate the relationship between risky behaviors and socioeconomic circumstances.

RESULTS

Univariate analyses showed boys and girls from more deprived neighborhoods were more likely to have tried smoking, to eat a high fat diet, and to be overweight. Girls living in more deprived areas were also less likely to eat five servings of fruit and vegetables or to exercise at the weekend. Most differences persisted after controlling for ethnicity. A clear deprivation gradient emerged for each risk factor, indicating the linear nature of the relationship.

CONCLUSIONS

This study demonstrates the influence of deprivation on engaging in cancer-risk health behaviors. These patterns may set young people from more socioeconomically deprived social environments on a trajectory leading to increased cancer mortality in adult life.

Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study

OBJECTIVE

Smoking among people who have asthma may be a serious health problem. We studied the prevalence of smoking and the relations between smoking and asthma, symptoms, medicine, and gender differences among adolescents with asthma.

METHODS

A national cross-sectional study on health and lifestyles was performed in 1996-1997 using a computerized questionnaire in upper secondary schools in Denmark. We included 1887 pupils with asthma (defined as self-reported asthma diagnosed by a physician) and 20 688 controls. Smoking was categorized as daily, occasional, ex-smokers, and never smoked. We adjusted for age, gender, parents' job and smoking, family type, body mass index, and exercise habits.

RESULTS

In total, 37.7% smoked currently and 16.5% smoked daily; more girls than boys smoked. More pupils with asthma than without smoked daily (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.04-1.33), they smoked significantly more cigarettes daily (10.3 vs 9.6), and more were heavy smokers (> or =15 cigarettes daily; adjusted OR: 1.47; 95% CI:1.14-1.91). Furthermore, nearly twice as many pupils who had asthma with symptoms but were not using medicine smoked as pupils who had asthma without symptoms and were using medicine (adjusted OR: 1.84; 95% CI: 0.99-3.41). More boys with asthma than without started smoking before 14 years of age (adjusted OR: 1.75; 95% CI: 1.09-2.81). However, more pupils with asthma had tried to quit (adjusted OR: 1.26; 95% CI: 0.99-1.60). Pupils with and without asthma were occasional smokers and ex-smokers at a similar prevalence.

CONCLUSIONS

More pupils with asthma than without smoked daily, and they also smoked more cigarettes per day. This is a major health concern, as adolescents have a high smoking prevalence in Denmark.

An ecological approach to understanding youth smoking trajectories: problems and prospects

Non-random patterns of aggregate youth smoking rates and trajectories across communities suggest that individual-level characteristics cannot account fully for the behavior in question. Instead, at least part of the explanation must lie somewhere within the community context. Such community-level contextual effects can impact directly both group and individual-level behavior (e.g. main effects), and they can also condition the effects of individual-level factors on individual behaviors (e.g. moderating effects). This paper reviews previous research examining community-level contextual effects regarding smoking and substance use more generally and identifies important limitations of this extant work, thus defining an agenda for future empirical studies. Next, the (in)compatibility of previous empirical findings with current theoretical models is discussed. In offering an alternative to these existing models, the paper concludes with presentation and discussion of a multi-level, integrated model of adolescent smoking trajectories. In this model, community/institutional forces are presumed to impact smoking above and beyond individual-level main effects. These posited community-level forces are broad and varied, representing school characteristics, neighborhood demographic characteristics, religious culture, media influence, economic context, health services and so on. In addition to exhibiting contextual main effects, the effects of community in the proposed multilevel model can be mediated by community-level processes, including the processes of control and socialization discussed herein. Also, community-level characteristics may interact in producing certain tobacco-use outcomes and, perhaps most importantly, they may moderate or condition the effects of interindividual differences on smoking.

Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking

This transdisciplinary review of the literature addresses the questions, Do stress and negative affect (NA) promote smoking? and Does smoking genuinely relieve stress and NA? Drawing on both human and animal literatures, the authors examine these questions across three developmental stages of smoking--initiation, maintenance, and relapse. Methodological and conceptual distinctions relating to within- and between-subjects levels of analyses are emphasized throughout the review. Potential mechanisms underlying links between stress and NA and smoking are also reviewed. Relative to direct-effect explanations, the authors argue that contextual mediator-moderator approaches hold greater potential for elucidating complex associations between NA and stress and smoking. The authors conclude with recommendations for research initiatives that draw on more sophisticated theories and methodologies.

Nicotinic acetylcholine receptors as targets for antidepressants

While the monoamine deficiency hypothesis of depression is still most commonly used to explain the actions of antidepressant drugs, a growing body of evidence has accumulated that is not adequately explained by the hypothesis. This article draws attention to contributions from another apparently common pharmacological property of antidepressant medications--the inhibition of nicotinic acetylcholine receptors (nAChR). Evidence is presented suggesting the hypercholinergic neurotransmission, which is associated with depressed mood states, may be mediated through excessive neuronal nicotinic receptor activation and that the therapeutic actions of many antidepressants may be, in part, mediated through inhibition of these receptors. In support of this hypothesis, preliminary evidence is presented suggesting that the potent, centrally acting nAChR antagonist, mecamylamine, which is devoid of monoamine reuptake inhibition, may reduce symptoms of depression and mood instability in patients with comorbid depression and bipolar disorder. If this hypothesis is supported by further preclinical and clinical research, nicotinic acetylcholine receptor antagonists may represent a novel class of therapeutic agents for treating mood disorders.

Psychosocial determinants of smoking in Swiss adolescents with special reference to school stress and social capital in schools

OBJECTIVES

To identify the major psychosocial determinants of smoking in adolescents and the school influence on these determinants.

METHODS

Cross-sectional questionnaire survey in 8th grade (age 14.8 years, n = 459) of 14 schools. Logistic regression with smoking as the dependent, and psychosocial indicators as independent variables. Total climate score for each school computed as the sum of scores of five school-related indicators. Linear regression analysis on aggregate data (school level), controlling for gender, ethnicity, and social class.

RESULTS

Five out of 15 tested psychosocial indicators were identified as independent protective factors. The prevalence of smoking decreased steeply with an increasing number of protective factors. In the regression analysis on the aggregate level the mean number of protective factors per school and the prevalence of smoking were significantly related to the school climate score (R2 = 0.650, p < 0.001, and R2 = 0.456, p < 0.001).

CONCLUSIONS

Provided a causal interpretation of the cross-sectional statistical associations is correct, efforts to improve the general climate in schools appear as a promising strategy to enhance individual protective factors. Longitudinal evaluative studies are needed to prove the effectiveness of such a strategy.

Nicotine-induced conditioned place preference in adolescent and adult rats

About 1 million American adolescents start smoking every year. Adolescents may be unusually sensitive to certain consequences of nicotine, demonstrating, for instance, significantly higher rates of dependence than adults at the same level of nicotine use. To explore whether adolescents may be more sensitive to rewarding properties of nicotine than adults, the present study used an animal model to assess the rewarding effects of a low nicotine dose (0.6 mg/kg) in a conditioned place preference (CPP) paradigm. Locomotor activity during conditioning and testing was also evaluated. Nicotine was observed to induce place preference conditioning in adolescent Sprague-Dawley rats, whereas the training dose of 0.6 mg/kg failed to produce convincing place preference in their adult counterparts. Age differences were also apparent in terms of nicotine influences on motor activity, with adults being more sensitive to nicotine-suppressant effects and only adolescents showing an emergence of nicotine-stimulatory effects upon repeated exposures. An increased predisposition to stimulatory nicotine effects during adolescence may contribute to age-specific rewarding properties of the drug as revealed using the CPP paradigm in this experiment. Increased sensitivity to stimulatory and rewarding effects during adolescence could potentially contribute to the high rate of nicotine use and dependence among human adolescents.

Psychosocial determinants of the onset and escalation of smoking: cross-sectional and prospective findings in multiethnic middle school samples

PURPOSE

To investigate a broad range of social influence-related and global determinants of smoking to aid in the design of comprehensive multiethnic interventions by testing the most important factors of initiation and escalation of smoking across various subgroups.

METHODS

Cross-sectional (N = 2546) and cohort (N = 736) samples of multiethnic middle school students near a large Southwestern metropolis were surveyed through self-report questionnaires. The confidential questionnaires included information on demographics, risk factors, and smoking behavior and were administered in class by trained data collectors. Multivariable logistic regression analysis was used to examine the statistical significance and strength of the factors.

RESULTS

Those lower in self-esteem and higher in social assertiveness appeared to be most at risk for the onset of smoking, whereas those low in optimism appeared to be the most at risk for the escalation of smoking. Attitudes, friends' norms, parents' norms, perceived behavioral control, and perceived prevalence were consistent predictors of all smoking status outcomes.

CONCLUSIONS

The behavioral-specific determinants of smoking appear to be important predictors of smoking status outcomes in all demographic subgroups. The relationships of the global determinants were more dependent on the smoking outcome variable and subgroup examined. The findings may serve to help facilitate the targeting of comprehensive interventions aimed at reducing adolescent smoking in multiethnic and ethnic group-specific populations.

Depressive symptoms and cigarette smoking among teens

CONTEXT

Although several risk factors for tobacco use have been implicated in the development of depression, smoking progression has typically been viewed as a consequence of depression. The results of limited longitudinal studies are controversial.

OBJECTIVE

To assess the nature and direction of the relationship between cigarette smoking and depression among teens.

DESIGN

Prospective analysis of baseline and 1-year follow-up data from the National Longitudinal Study of Adolescent Health.

SETTING

In-home teen and parent interviews.

PARTICIPANTS

Two samples were identified. For the first sample, 8704 adolescents who were not depressed at baseline based on CES-D scores were identified for analyses of the effects of cigarette smoking on development of high depressive symptomatology. Baseline smoking status, which could vary in this group, was the predictor of interest in these analyses. For the second sample, 6947 teens who had not smoked cigarettes in the 30 days before the baseline survey (noncurrent smokers) were identified for analyses on the effect of high depressive symptoms on subsequent moderate to heavy cigarette use at 1 year of follow-up. Baseline high depressive symptomatology based on CES-D score was the predictor of interest in this sample.

MAIN OUTCOME MEASURES

Among the nondepressed, developing high depressive symptoms at 1 year of follow-up. Among noncurrent smokers, smoking at least 1 pack per week at 1 year of follow-up.

RESULTS

For the nondepressed, multivariate modeling revealed that current cigarette smoking was the strongest predictor of developing high depressive symptoms in all models (final model odds ratio [OR]: 3.90; 95% confidence interval [CI]: 1.85,8.20). For noncurrent smokers, although in bivariate analyses, baseline high depressive symptoms increased the risk of heavy smoking nearly threefold, multivariate modeling revealed that baseline high depressive symptoms were not predictive of heavy smoking when controlling for other determinants of smoking in teens. Previous experimentation with smoking was the strongest predictor of becoming a heavy smoker (OR: 3.04; 95% CI: 1.93,4.88).

CONCLUSIONS

In contrast to common dictum, depression does not seem to be an antecedent to heavy cigarette use among teens. However, current cigarette use is a powerful determinant of developing high depressive symptoms.