Defining subgroups of adolescents at risk for experimental and regular smoking

Personality and impulsivity as predictors of tobacco use among emerging adults: A latent class analysis

The tobacco industry markets their products toward emerging adults (18-29), with the goal of increasing use among this age group. To inform prevention efforts, researchers are investigating how specific demographic and psychological traits may predict tobacco initiation and continuation. Participants were 578 incoming university freshmen from the Appalachian region. Participants provided information on demographics, personality traits, impulsivity characteristics, lifetime use of cigarettes and electronic cigarettes (ECIGs), and current use of cigarettes, ECIGs, small cigars/cigarillos, large cigars, smokeless tobacco, and waterpipe. Latent class analysis identified tobacco-use classes and regressions identified psychological predictors of class membership. Participants were Nonusers, Experimenters, and Polytobacco Users. Lower agreeableness and conscientiousness as well as higher extraversion and neuroticism were associated with being Experimenters or Polytobacco Users. Lower impulsivity was associated with being Nonusers. Distinct types of emerging adults belong to each tobacco use class, suggesting that individual differences be incorporated in prevention efforts.

Development and validation of a Brief Diet Quality Assessment Tool in the French-speaking adults from Quebec

Background

The objective of this study was to develop and validate a short, self-administered questionnaire to assess diet quality in clinical settings, using the Alternative Healthy Eating Index (AHEI) as reference.

Methods

A total of 1040 men and women (aged 44.6 ± 14.4 y) completed a validated web-based food frequency questionnaire (webFFQ) and had their height and weight measured (development sample). Participants were categorized arbitrarily according to diet quality (high: AHEI score ≥ 65/110, low: AHEI score < 65/110) based on dietary intake data from the webFFQ. The Brief Diet Quality Assessment Tool was developed using a classification and regression tree (CART) approach and individual answers to the webFFQ among participants considered to have a plausible energy intake (ratio of reported energy intake to basal metabolic rate ≥ 1.2 and < 2.4; n = 1040). A second sample of 3344 older adults (aged 66.5 ± 6.4 y) was used to test the external validity of the Brief Diet Quality Assessment Tool (external validation sample).

Results

The decision tree included sequences of 3 to 6 binary questions, yielding 21 different pathways classifying diet quality as being high or low. In the development sample, the area under the receiver operating characteristic (ROC) curve of the predictive model was 0.92, with sensitivity, specificity and agreement values of 89.5, 83.9 and 87.2%. Compared with individuals having a low-quality diet according to the Brief Diet Quality Assessment Tool (mean AHEI 56.7 ± 11.4), individuals classified as having a high-quality diet (mean AHEI 71.3 ± 11.0) were significantly older, and had lower BMI, percent body fat and waist circumference, and had lower blood pressure, triglycerides, cholesterol/HDL ratio and fasting insulin as well as higher HDL-cholesterol concentrations (all P < 0.05). Similar results were observed in the external validation sample, although overall performance of the Brief Diet Quality Assessment Tool was slightly lower than in the development sample, with an area under the ROC curve of 0.79 and sensitivity, specificity and agreement values of 73.0, 69.0 and 71.3%, respectively.

Conclusion

The CART approach yielded a simple and rapid Brief Diet Quality Assessment Tool that identifies individuals at risk of having a low-quality diet. Further studies are needed to test the performance of this tool in primary care settings.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0821-6) contains supplementary material, which is available to authorized users.

The influence of tobacco retailers on adolescent smoking: prevention and policy implications

BACKGROUND

Smoking rates are higher among adolescents in South Korea than among those in other Asian countries. Researchers have reported associations between the presence of licensed tobacco retailers and adolescent smoking rates. However, few researchers have examined the factors that influence adolescent smoking including those that are intrapersonal, interpersonal or related to the tobacco retailers' environment.

AIM

The purpose of this study was to describe factors related to the students, the licensed tobacco retailers and the schools and how those factors are associated with adolescent smoking outcomes such as tobacco marketing receptivity, lifetime smoking and current smoking.

METHODS

The survey data were gathered from 740 South Korean adolescents, and geographic data for 3488 licensed tobacco retailers were also used. Geographic Information Systems and multilevel modeling were used to describe the variables and determine the factors associated with smoking outcomes in the sample.

RESULTS

The factors that influenced receptivity to tobacco marketing included the presence of peers who smoke and the frequencies of licensed tobacco retailers passed on the way to school. The factors that influenced lifetime smoking included gender, perceived economic status, weekly income, the presence of siblings or peers who smoke and frequencies of licensed tobacco retailers passed on the way to school. The factors that influenced current smoking included gender, weekly income, and the presence of siblings or peers who smoke.

CONCLUSIONS

These factors will guide adolescent tobacco prevention programs and policies.

IMPLICATIONS FOR NURSING PRACTICE AND HEALTH POLICY

The study's implications for nursing practice and health policy are that school nurses and public health nurses need to be encouraged to use retailer-related factors in adolescent smoking-prevention programs. There is also a need for zoning and licensing regulations to restrict licensed tobacco retailers in areas that adolescents frequent, including schools.

Stress and Multiple Substance Use Behaviors Among Hispanic Adolescents

Hispanic adolescents reported a higher annual prevalence of use of nearly all major drugs compared to non-Hispanic White and African American adolescents. Cultural or minority stressors, such as those related to the acculturation process, discrimination, immigration, poverty, and community violence, have been implicated in these outcomes. Unfortunately, few studies have examined how these stressors may have a differential or additive effect when considered simultaneously. The current study examined the relation between stress and multiple substance use behaviors in a sample of Hispanic adolescents (n = 1036), age 11-19 years old. Latent class analysis identified subgroups of Hispanic adolescents based on combinations of substance use behaviors. General linear models were used to examine mean differences by class among the eight domains of stress. Fit statistics revealed a six-class structure: no substance use risk, predominately alcohol use, low polysubstance use, high polysubstance use, illicit drug use, and predominately marijuana use. Differences in stress across the six classes were identified for four of the eight domains: family economic, acculturation gap, community and gang, and family and drug stress. The effect sizes revealed the largest mean differences in stress between the no substance use group and the two polysubstance use groups and between the no risk group and alcohol use group. The findings from this study support the use of interventions that target stress to affect multiple substance use behaviors in Hispanic adolescents.

Association between adolescent tobacco, alcohol and illicit drug use and individual and environmental resilience protective factors

OBJECTIVES

Research suggests that individual and environmental resilience protective factors may be associated with adolescent substance use; however, the associations between a broad range of such factors and use of various types of substances have not been examined. The study aimed to determine the association between a comprehensive range of adolescent individual and environmental resilience protective factors and measures of tobacco, alcohol and illicit substance use.

DESIGN

Cross-sectional study.

SETTING

32 Australian secondary schools.

PARTICIPANTS

Grade 7-10 students (aged 11-17 years).

MEASURES

Data regarding 14 student individual and environmental resilience protective factors and seven substance use measures (tobacco, alcohol, marijuana, other illicit drug use) were obtained via an online self-report survey. Adjusted multivariate logistic regression analyses examined the association between all student resilience protective factors and seven substance use measures.

RESULTS

Inverse univariate associations were found for 94 of 98 relationships examined (n=10 092). Multivariate analyses found: consistent inverse associations between 2 of 14 protective factors and all substance use measures ('goals and aspirations', 'prosocial peers'); inverse associations between 4 protective factors with multiple substance use measures ('home support' (5 of 7), 'school support' (3 of 7), 'self-awareness' (2 of 7), 'community meaningful participation' (2 of 7)); positive associations between 2 resilience protective factors with multiple measures of substance use ('community support' (3 of 7), 'peer caring relationships' (5 of 7)) and 6 protective factors not to be associated with any substance use measure.

CONCLUSIONS

Despite individual relationships between the majority of resilience protective factors and substance use types, the protective benefit of such factors for adolescent substance use was limited to only a small number of such factors when considered collectively. Such results suggest that interventions seeking to reduce adolescent substance use may need to target specific protective factors to address specific types of substance use.

TRIAL REGISTRATION NUMBER

ACTRN12611000606987, Results.

Smoking behaviors and intentions among adolescents in rural China: the application of the Theory of Planned Behavior and the role of social influence

INTRODUCTION

This study investigated the associations between the variables of the theory of planned behavior (TPB), influence of significant others, and smoking intentions and behaviors among adolescents living in rural southern China.

METHODS

A cross-sectional study was conducted among 2609 students in two junior high schools in rural Shantou, Guangdong province, using a self-administered questionnaire. Logistic regression models were fitted to estimate univariate and adjusted odds ratios and corresponding 95% confidence intervals.

RESULTS

Multivariate analyses showed that having favorable attitudes towards smoking on psychological and social aspects, perceived behavioral control, and having most friends who were current smokers were significantly associated with smoking intentions in the next six months and in the next five years. Having most family members who were current smokers was also significantly related to smoking intention in the next five years. Having favorable attitudes towards smoking on psychological aspect and negative attitudes on physical aspect, perceived support from friends on smoking, and having most friends and senior relatives being current smokers were significantly associated with increased likelihood of ever smoking. Perceived behavioral control and having most friends being current smokers were also significantly associated with regular smoking and smoking in the past 30days.

CONCLUSIONS

Our results suggest that the key constructs of the TPB model and friends' smoking behaviors play important roles in accounting for smoking intentions and behaviors among a sample of rural Chinese adolescents.

Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents

PURPOSE

Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey.

DESIGN

Cross-sectional, multistage, probability sample survey.

SETTING

Schools (308 middle and high schools) in Maryland.

SUBJECTS

Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n  =  57,072).

MEASURES

Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region.

ANALYSIS

Chi-square and multiple logistic regression analyses controlling for clustering.

RESULTS

Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation.

CONCLUSIONS

Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

Uncovering multiple pathways to substance use: a comparison of methods for identifying population subgroups

This paper describes and compares a selection of available modeling techniques for identifying homogeneous population subgroups in the interest of informing targeted substance use intervention. We present a nontechnical review of the common and unique features of three methods: (a) trajectory analysis, (b) functional hierarchical linear modeling (FHLM), and (c) decision tree methods. Differences among the techniques are described, including required data features, strengths and limitations in terms of the flexibility with which outcomes and predictors can be modeled, and the potential of each technique for helping to inform the selection of targets and timing of substance intervention programs.

The Family Talk About Smoking (FTAS) paradigm: new directions for assessing parent-teen communications about smoking

INTRODUCTION

Smoking experimentation represents transient risk taking for some youth, whereas for others, it is the onset of a chronic smoking trajectory. However, distinguishing these groups during the experimentation phase has proved challenging. We theorized that variations in parent and teen discourse about smoking might be informative for characterizing this heterogeneity. However, standardized methods for direct assessments of these family processes have been lacking.

METHODS

We examined the predictive utility of directly observed facets of smoking-specific communication for predicting persistence of teen smoking experimentation using a novel method, the Family Talk About Smoking (FTAS) paradigm. The FTAS was tested in a sample of 344 teens with a history of smoking experimentation during interactions with their mothers and fathers. Level of disapproval, smoking expectancies, elaboration of consequences, and quality of personal disclosure were coded during videotaped parent-teen discussions about smoking.

RESULTS

Patterns of observed smoking-specific communication varied by teen and parent smoking status. Predictive validity of the FTAS for teen persistent experimentation was demonstrated, net effects of reported smoking-specific socialization, general quality of communication, and parental smoking status. Teen smoking expectancies, disclosure, and disapproval predicted teen persistent experimentation with some differences based on whether interactions were with mothers or fathers. Prediction of persistent experimentation by observed maternal disclosure and elaboration of consequences was moderated by maternal smoking status.

CONCLUSIONS

Direct observations show promise for generating detailed characterization of individual differences in patterns of family communication about smoking. Implications for targeted prevention and future research are discussed.

Gender differences in the association between pre-adolescent smoking initiation and emotional or behavioural problems

BACKGROUND

Emotional and behavioural problems are a risk factor for the initiation of smoking. In this study, we aimed to assess this relationship beyond clinical cut-off values of problem behaviour.

METHODS

Cross-sectional national survey among 9-13 year old children with data on smoking and Childhood Behaviour Checklist (CBCL) (N = 960). Relationships between smoking and tertiles of CBCL-scores were assessed.

RESULTS

Smoking was reported by 5.9% of the children (7.1% boys and 5.0% girls, P > 0.100). Relationships between smoking and problem behaviour were present in girls, but ot in boys. Among girls, smoking was associated with attention problems, thought problems, and delinquent behaviour. For attention problems and delinquent behaviour the associations were limited to the CBCL-scores in the uppermost 16% which agrees with the subclinical cut-off value.

CONCLUSION

Pre-adolescent girls more frequently smoke if having attention problems, delinquent behaviour, or thought problems.

Protective families in high- and low-risk environments: implications for adolescent substance use

This study used data from a sample of 6th to 12th grade students (N = 48,641, 51% female), nested in 192 schools, to determine if the influence of family-based protective factors varied across different school contexts. Hierarchical logistic regression models were used to examine the effects of individual-level family protective factors, relative to school-level aggregates of the same factors, on recent (past 30 days) use of cigarettes, alcohol, and marijuana. Cross-level interactions indicated that the effect of the student's level of family protection, relative to other students in their school, differed depending on the aggregated school level of family protection. The results suggested that the benefit of belonging to a well-functioning family was more influential for students attending schools characterized by higher-than-average aggregated levels of protection compared to students attending schools of lower-than-average protection. Thus, family-level factors offered less protection for students in relatively high-risk school contexts. These results were consistent with a protective-reactive interaction and suggest that a thorough understanding of adolescent substance use must consider the complex interplay among adolescents, their families, and their social environments.

Determinants of first puff and daily cigarette smoking in adolescents

Few prospective studies of smoking initiation have investigated a wide range of time-varying and invariant predictor variables at the individual and contextual levels concurrently. In this study (1999-2005), 877 Canadian students (mean age = 12.7 years) who had never smoked at baseline completed self-report questionnaires on cigarette smoking and 32 predictor variables in 20 survey cycles during secondary school. Height and weight were measured in survey cycles 1, 12, and 19. School administrators completed questionnaires on school tobacco control policies/activities, and trained observers collected data on access to tobacco products in commercial establishments near schools. Younger age, single-parent family status, smoking by parents, siblings, friends, and school staff, stress, impulsivity, lower self-esteem, feeling a need to smoke, not doing well at school, susceptibility to tobacco advertising, alcohol use, use of other tobacco products, and attending a smoking-tolerant school were independent determinants of smoking initiation. Independent determinants of daily smoking onset among initiators of nondaily smoking included smoking by siblings and friends, feeling a need to smoke, susceptibility to tobacco advertising, use of other tobacco products, and self-perceived mental and physical addiction. Adolescent tobacco control programs should address multiple individual and contextual-level risk factors. Strategies that address nicotine dependence symptoms are also needed for adolescents who have already initiated smoking.

Encouraging Young Western Australians to Be Smarter than Smoking

Purpose.

Smarter than Smoking is a multistrategy statewide youth smoking intervention. This article describes key strategies and results from its inception in 1995 to 2005.

Design.

Comprehensive evaluation included formative research and baseline and follow-up surveys. Triennial national surveys provided independent monitoring of adolescent smoking prevalence.

Setting.

Western Australia.

Subjects.

10- to 15-year-olds.

Intervention.

A multipronged strategy mix, including mass media, the Internet, sponsorship, school initiatives, publications, and advocacy.

Measures.

Smoking prevalence, media awareness, and attitudes toward smoking and campaign messages.

Analysis.

Trend comparisons across the first decade of the project, along with descriptive statistics.

Results.

Significant attitudinal and behavioral shifts were observed following media waves and over time. There was a steady increase in the proportion who had never smoked (from 40% in 1996 to 61 % in 2005). Results also showed a significant decrease in smoking prevalence from 1996 to 2005, down from 28% to 7% among 14-year-olds and from 43% to 14% among 15-year-olds.

Conclusions.

Smarter than Smoking was effective in achieving positive shifts in awareness, attitudes, intentions, and behavior. Effectiveness appeared to have been enhanced by sustained long-term funding youth involvement in strategy development, and a strong research and evaluation base.

Predictors of the transition from experimental to daily smoking among adolescents in the United States

PURPOSE

This study examined factors affecting the transition from experimental smoking at baseline to two types of daily smoking, temporary daily smoking, and continued daily smoking, at 1-year follow-up.

DESIGN AND METHODS

This study analyzed data from the National Longitudinal Study of Adolescent Health (n = 4,903 U.S. adolescents). Baseline predictors were selected based on Problem Behavior Theory.

RESULTS

Important problem behavior theory-related predictors of smoking were the number of friends who smoke, academic performance, and alcohol, marijuana, and other illicit drug use. Other significant predictors were age, gender, race, depression, perceived general health, and cigarette availability at home.

PRACTICE IMPLICATIONS

To prevent teens from progressing to daily smoking, nursing professionals should consider multifaceted factors based on multiple theories.

Understanding differences in substance use among bisexual and heterosexual young women

BACKGROUND

Numerous studies have documented higher substance use rates among bisexual than heterosexual young women, although little is known about the developmental factors contributing to these differences. Based on self-reported sexual orientation collected at age 23, this study identified similarities and differences between bisexual and heterosexual women in their substance use at ages 14 and 18, compared these groups at ages 14 and 18 on key psychosocial factors known to predict young adult substance use, and determined whether these psychosocial factors at age 18 could account for sexual orientation differences in substance use at age 23.

METHODS

Longitudinal survey data from a West Coast cohort were used to compare heterosexual (n = 1,479) and bisexual (n = 141) women on their substance use and psychosocial characteristics.

RESULTS

During adolescence, bisexual women were more likely to have been current and solitary substance users; reported stronger pro-drug beliefs and lower resistance self-efficacy; perceived greater parental approval of their substance use; had more exposure to substance-using peers; and reported poorer mental health. By age 23, bisexual women had higher rates of current substance use, greater quantity and frequency of use, and more problematic alcohol and drug use. Differences in problematic use at age 23 could be partially explained by risk factors assessed five years earlier at age 18, particularly pro-drug social influences and beliefs.

CONCLUSIONS

Notwithstanding the lack of longitudinal data on sexual orientation, these results provide important insights regarding the drug prevention needs of bisexual women.

Reducing early smokers' risk for future smoking and other problem behavior: insights from a five-year longitudinal study

PURPOSE

To identify risk and protective factors during early and later adolescence that predict future regular smoking and multiple problem behavior among at-risk youth, defined as those who tried smoking by grade 7.

METHODS

At grades 7, 10, and 12, data were collected from 2,000 early smokers drawn from California and Oregon. Multivariate regression analyses tested predictors of the two grade 12 outcomes in separate models using data from grades 7 and 10. Gender interactions and buffering of risk factors by protective factors were assessed.

RESULTS

For at-risk youth, consistent protective factors against future smoking and problem behavior included living in an intact nuclear family (all four models) plus getting good grades and parental disapproval of smoking/drug use (three of four models). Consistent risk factors included exposure to substance-using peers (four models) and problems in school (three of four models). Adult substance use was a predictor during early, but not later, adolescence; pro-smoking/drug use beliefs were significant predictors during later adolescence. There were few differences across gender and no significant buffers against risk.

CONCLUSIONS

At-risk youth would likely benefit from peer resistance training, parental involvement in prevention efforts, and efforts to improve educational performance during both middle school and high school. Changing pro-drug beliefs may be more effective among older adolescents.

The role of risk and protective factors in substance use across adolescence

PURPOSE

To compare the relative influence of risk and protective factors across several domains on adolescent substance use in a large sample of youth.

METHODS

Cross-sectional survey data were collected from students in grades 6, 8, 10, and 12 in Pennsylvania (N = 91,778). Generalized linear mixed models were estimated for each grade level to examine associations among indices of three risk factors (individual, peer, and family) and three protective factors (family, school, and community) and both recent and lifetime substance use.

RESULTS

The risk factors were stronger predictors of substance use outcomes compared with the protective factors, regardless of grade level or substance use type. In particular, the individual and peer risk factors were strongly related to lifetime and recent use of cigarettes, alcohol, and marijuana. Among the protective factors, the strongest associations with substance use were found in the community domain. Several age-related differences in the associations were also found, suggesting that family and community factors were more salient among younger adolescents whereas peer and school factors were stronger among older adolescents.

CONCLUSIONS

These findings provide support for the social development model (SDM), which proposes that adolescent substance use is associated with factors across multiple spheres of influence. Age-related differences in these associations suggest that effective interventions to reduce adolescent substance use may need to emphasize different domains of risk and protective factors at different stages of adolescent development.

Ecodevelopmental x intrapersonal risk: substance use and sexual behavior in Hispanic adolescents

Hispanic adolescents are a rapidly growing population and are highly vulnerable to substance abuse and HIV infection. Many interventions implemented thus far have been "one size fits all" models that deliver the same dosage and sequence of modules to all participants. To more effectively prevent substance use and HIV in Hispanic adolescents, different risk profiles must be considered. This study's purpose is to use intrapersonal and ecodevelopmental risk processes to identify Hispanic adolescent subgroups and to compare substance use rates and sexual behavior by risk subgroup. The results indicate that a larger proportion with high ecodevelopmental risk (irrespective of the intrapersonal risk for substance use) report lifetime and past 90-day cigarette and illicit drug use. In contrast, a larger proportion with high intrapersonal risk for unsafe sex (irrespective of ecodevelopmental risk) report early sex initiation and sexually transmitted disease incidence. Implications for intervention development are discussed in terms of these Hispanic adolescent subgroups.

Psychiatric and familial predictors of transition times between smoking stages: results from an offspring-of-twins study

The modifying effects of psychiatric and familial risk factors on age at smoking initiation, rate of progression from first cigarette to regular smoking, and transition time from regular smoking to nicotine dependence (ND) were examined in 1269 offspring of male twins from the Vietnam Era Twin Registry. Mean age of the sample was 20.1 years. Cox proportional hazard regression analyses adjusting for paternal alcohol dependence and ND status and maternal ND were conducted. Both early age at first cigarette and rapid transition from initiation to regular smoking were associated with externalizing disorders, alcohol consumption, and cannabis use. Rapid escalation from regular smoking to ND was also predicted by externalizing disorders, but in contrast to earlier transitions, revealed a strong association with internalizing disorders and no significant relationship with use of other substances. Findings characterize a rarely examined aspect of the course of ND development and highlight critical distinctions in risk profiles across stages of tobacco involvement.

The End of Behavioral Genetics?

Although genetic models were in the ascendance within psychology during the early 20(th) century, the association of early behavioral genetic research with the eugenics movement served to discredit the field in the eyes of many. Twin and adoption studies throughout the latter half of the 20(th) century helped to reestablish the importance of behavioral genetic models and set the stage for the current focus of the field on developing and testing models of gene-environment interplay. Research findings on developmental behavioral genetic research, gene-environment interaction, and the use of behavioral genetic models to test causal hypotheses are used to highlight the contributions of contemporary behavioral genetic research to psychological research. It is argued that future efforts to investigate models of gene-environment interplay will depend heavily of the field's ability to identify the specific genetic variants that contribute to individual differences in behavior. The anticipated yield from genome-wide association studies gives much reason to be optimistic about the future vitality of behavior genetics.

Vision survival after open globe injury predicted by classification and regression tree analysis

OBJECTIVE

To assist ophthalmologists in treating ocular trauma patients, this study developed and validated a prognostic model to predict vision survival after open globe injury.

DESIGN

Retrospective cohort review.

PARTICIPANTS

Two hundred fourteen patients who sought treatment at the Wilmer Ophthalmological Institute with open globe injuries from January 1, 2001, through December 31, 2004, were part of the data set used to build the classification tree model. Then, to validate the classification tree, 51 patients were followed up with the goal to compare their actual visual outcome with the outcome predicted by the tree grown from the classification and regression tree analysis.

METHODS

Binary recursive partitioning was used to construct a classification tree to predict visual outcome after open globe injury. The retrospective cohort treated for open globe injury from January 1, 2001, through December 31, 2004, was used to develop the prognostic tree and constitutes the training sample. A second independent sample of patient eyes seen from January 1, 2005, through October 15, 2005, was used to validate the prognostic tree.

MAIN OUTCOME MEASURES

Two main visual outcomes were assessed: vision survival (range, 20/20-light perception) and no vision (included no light perception, enucleation, and evisceration outcomes).

RESULTS

A prognostic model for open globe injury outcome was constructed using 214 open globe injuries. Of 14 predictors determined to be associated with a no vision outcome in univariate analysis, presence of a relative afferent pupillary defect and poor initial visual acuity were the most predictive of complete loss of vision; presence of lid laceration and posterior wound location also predicted poor visual outcomes. In an independent cohort of 51 eyes, the prognostic model had 85.7% sensitivity to predict no vision correctly and 91.9% specificity to predict vision survival correctly.

CONCLUSIONS

The open globe injury prognostic model constructed in this study demonstrated excellent predictive accuracy and should be useful in counseling patients and making clinical decisions regarding open globe injury management.

Kiss and tell: what do we know about pre- and early adolescent females who report dating? A pilot study

STUDY OBJECTIVE

To evaluate the implications of dating in pre- and early adolescent females.

DESIGN

Cross-sectional survey.

SETTING

Child psychiatry clinic; pediatric clinic; family clinic.

PARTICIPANTS

Pre- and early adolescent females (n = 80) aged 11-14 and their parents.

INTERVENTION

Pre- and early adolescent females aged 11-14 and a parent were recruited during a regular clinic visit. Pre- and early adolescent females completed a survey that included measures of dating; sensation seeking; lifetime individual and peer drug use; Attention Deficit Hyperactive Disorder, Oppositional Defiant Disorder and Conduct Disorder symptoms; and onset of menses. Parents were asked similar questions about their child's dating behaviors and peer relationships.

MAIN OUTCOME MEASURE

Association of early dating with individual and peer drug use, sensation seeking, aggressive behavior, and onset of menses.

RESULTS

In pre- and early adolescent females, dating regularly is associated with nicotine and alcohol use, sensation seeking, and aggressive behavior. Dating regularly is also associated with onset of menses and a younger age of onset of menses in those who had started menstruating. Parents under-report their child's dating practices and associated high-risk behaviors.

CONCLUSION

Early dating is associated with nicotine and alcohol use, sensation seeking, aggressive behavior, and early onset of menses in adolescent females. Questions about early dating are a simple and efficient way to open inquiry of both parents and children about high-risk behaviors in the clinic setting.

The HYP program-targeted motivational interviewing for adolescent violations of school tobacco policy

OBJECTIVE

To evaluate the efficacy of a short-term tobacco-focused intervention for high school students referred by school administrators because of tobacco use.

METHOD

A sample of 56 adolescents (66% male, mean age 15 years) was recruited through referrals from three state high schools. Participants were randomly assigned to a one-hour motivational interview (MI) session or to standard care (advice/education). The two groups were followed up at one, three, and six-month intervals.

RESULTS

The MI intervention resulted in significant short-term reductions in quantity and frequency of smoking relative to standard care, however, effects were not maintained at 3- and 6-month follow-up. Improvements in refusal self-efficacy were significant relative to standard care.

CONCLUSION

For adolescents who are established smokers and at high risk of other problems, motivational interviewing was associated with modest short-term gains relative to standard care.

The dose-response relationship of adolescent religious activity and substance use: variation across demographic groups

This article addresses two inconsistent findings in the literature on adolescent religious activity (RA) and substance use: whether a dose-response relationship characterizes the association of these variables, and whether the association varies by grade, gender, ethnicity, family structure, school type, and type of substance. Multinomial logistic regression analyses of a large, diverse data set of high school students in metropolitan Columbus, Ohio ( n = 33,007), found marked differences in alcohol, marijuana, and cigarette use among youths who never, occasionally, or regularly participated in RA. Weekly RA was consistently associated with less substance use, yet occasional RA sometimes was associated with greater use. Four groups accounted for variations in the RA-substance use relationship: African American youths, younger White youths, 12th-grade White males, and 12th-grade White females. Researchers should avoid assuming the RA-substance use relationship is dose-response and consider the implications of this complexity for theory and practice.

Are car drivers holding a motorcycle licence less responsible for motorcycle--car crash occurrence? A non-parametric approach

The purpose of this work is to evaluate the effect of a specific motorcycle licence, held by car drivers, in responsibility for motorcycle-car crashes. The data were provided by a multicentric case-control study (MAIDS) regarding the risk of crash and serious injuries of motorcyclists. A non-parametric method, classification and regression tree (CART), was used to accomplish the objective, and then compared to standard unconditional logistic regression. Drivers owning a motorcycle licence turned out to be less responsible for motorcycle-car crashes than drivers who do not have one; both types of analysis are consistent with this result. It is reasonable to assume that car drivers who hold a motorcycle licence have acquired more ability in riding and controlling two wheeled vehicles than drivers without a licence, and this may help them in predicting motorcycles manoeuvres.

Smoking and young people's mental health

PURPOSE OF REVIEW

This review addresses the evidence on smoking and young people's mental health, reported during 2004.

RECENT FINDINGS

Research studies have confirmed the previously reported epidemiological associations of smoking with gender, race and social class, as well as suspected risk factors and antecedents. Among youths, the prevalence of smoking varies across subgroups of the population, classified by race/ethnicity and social class. Gender differences in smoking vary cross-nationally. Smoking among youths is higher when parents, siblings, or peers smoke. Smoking is also higher in youths with histories of early conduct problems, drinking and illegal drug use, depression, and suicidal behaviors. The protective role of youth involvement in sports and the lesser opportunity to smoke among youths involved in religious practice were also confirmed. Among young people, early conduct problems and associated early onset of daily smoking predict a greater likelihood of becoming nicotine dependent. The interpretation of the high smoking rate among schizophrenic patients as self-medication has been challenged by a recent study that reported that smoking predicted subsequent first hospitalization for schizophrenia. New findings suggest that young persons who experienced their first exposure to nicotine as relaxing are at elevated risk for becoming nicotine dependent.

SUMMARY

Longitudinal cohort studies and cross-sectional studies have been published on smoking and young people's mental health. These studies describe smoking correlates and identify predictors of negative outcomes of smoking, as well as predictors of nicotine dependence, smoking initiation, and smoking cessation.

Brief report: social risk factors predict cigarette smoking progression among adolescents with asthma

OBJECTIVE

To compare smoking progression in adolescents with and without asthma and to compare their psychosocial risk factors.

METHODS

Participants were 1,507 adolescents with asthma and 1,507 healthy matched controls from Waves I and II of the Add Health Project assessed at baseline and again 1 to 2 years later at follow-up. Three levels of smoking progression (defined as smoking more frequently and/or intensely over time) were identified: (a) Late Experimenters (never smokers at baseline, ever smokers at follow-up), (b) Early Experimenters (ever smokers at baseline, current/current frequent smokers at follow-up), and (c) Early Smokers (current smokers at baseline, current frequent smokers at follow-up).

RESULTS

Twenty percent of adolescents experienced progression in their smoking behavior; those with and without asthma were equally likely to progress. Among adolescents who progressed, 37% were Late Experimenters, 42% were Early Experimenters, and 21% were Early Smokers. Exposure to friends who smoked was a consistent and powerful social risk factor for smoking progression among adolescents with asthma-more so than among adolescents without asthma. This effect was intensified among Late Experimenters by the presence of a positive history of parent smoking.

CONCLUSIONS

Findings underscore the importance of addressing cigarette smoking behavior and its social risk factors among adolescents with asthma in both clinical and public health contexts, during early adolescence, and through research on this topic.