Ethnic differences in predictors of adolescent smoking onset and escalation: A longitudinal study from 7th to 12th grade

The Role of Socialization Contexts on Adolescent Substance Use across Racial and Ethnic Groups

Purpose of Review

This review summarizes theories and empirical work regarding socialization contexts contributing to substance use across marginalized adolescents. Future directions and recommendations to minimize the perpetuation of racial stereotypes are provided.

Recent Findings

Neighborhoods high in social cohesion may offset substance use risk. Promoting school connectedness via increased support from teachers and peers could reduce school-based discrimination and enhance feelings of belongingness. The influence of peers on substance use engagement largely differs across racial groups and level of acculturation. Family cultural values emphasizing respect, obedience, and collectivism offer protection from substance use.

Summary

Despite lower prevalence rates of adolescent substance use within racial/ethnic groups, rates of negative consequences due to substances are far greater compared to White adolescents. Transcultural factors (e.g., strong family ties), as well as culture-specific factors, should be leveraged to delay the onset of substance use and prevent negative sequelae resulting from substance use initiation.

Model-based recursive partitioning of extended redundancy analysis with an application to nicotine dependence among US adults

Extended redundancy analysis (ERA) is used to reduce multiple sets of predictors to a smaller number of components and examine the effects of these components on a response variable. In various social and behavioural studies, auxiliary covariates (e.g., gender, ethnicity) can often lead to heterogeneous subgroups of observations, each of which involves distinctive relationships between predictor and response variables. ERA is currently unable to consider such covariate-dependent heterogeneity to examine whether the model parameters vary across subgroups differentiated by covariates. To address this issue, we combine ERA with model-based recursive partitioning in a single framework. This combined method, MOB-ERA, aims to partition observations into heterogeneous subgroups recursively based on a set of covariates while fitting a specified ERA model to data. Upon the completion of the partitioning procedure, one can easily examine the difference in the estimated ERA parameters across covariate-dependent subgroups. Moreover, it produces a tree diagram that aids in visualizing a hierarchy of partitioning covariates, as well as interpreting their interactions. In the analysis of public data concerning nicotine dependence among US adults, the method uncovered heterogeneous subgroups characterized by several sociodemographic covariates, each of which yielded different directional relationships between three predictor sets and nicotine dependence.

Electronic Cigarette and Cigarette Social Environments and Ever Use of Each Product: A Prospective Study of Young Adults in Southern California

BACKGROUND

A supportive youth cigarette social environment, for example, friends' approval of use, leads to cigarette use initiation, and cigarette users develop a more supportive social environment. Whether there is a bidirectional relationship of electronic cigarette (e-cigarette) social environment with e-cigarette use has not been studied.

METHODS

Prospective data were collected from 1441 Children's Health Study participants in 2014 (median age = 17.3 years) and at follow-up 1.5 years later. Associations were examined of (1) supportive e-cigarette social environment with subsequent e-cigarette use initiation and (2) baseline e-cigarette use with supportive e-cigarette social environment at follow-up (among those with a nonsupportive baseline social environment).

RESULTS

Participants with three to four friends using e-cigarettes at baseline (vs. no friends) had an odds ratio (OR) of 4.08 of subsequent initiation (95% confidence interval [CI] = 1.96 to 8.49); those with best friends who would have a very friendly (vs. unfriendly) reaction to e-cigarette use had an OR of 2.54 of initiation (95% CI = 1.57 to 4.10); and those with someone in the home using e-cigarettes had an OR of 1.94 of initiation (95% CI = 1.19 to 3.15). Participants who had ever used e-cigarettes at baseline developed a supportive social environment at follow-up (OR of 2.06 of having any friends who used e-cigarettes [95% CI = 1.29 to 3.30] and OR of 2.33 of having friends who were friendly toward use [95% CI = 1.32 to 4.11]). Similar bidirectional associations were observed between ever cigarette use and a supportive cigarette social environment.

CONCLUSIONS

The bidirectional relationship between a supportive e-cigarette social environment and ever use of e-cigarettes was similar to that previously observed between cigarette social environment and cigarette use.

IMPLICATIONS

Disrupting the social acceptability of youth e-cigarette use merits consideration as a strategy for preventing initiation of e-cigarette use, just as the social denormalization of cigarette use has proven to be effective in preventing cigarette initiation.

Reports of perceived racial discrimination among African American children predict negative affect and smoking behavior in adulthood: A sensitive period hypothesis

We examined the prospective relations between a cultural risk factor, perceived racial discrimination (PRD), and subsequent negative affect and health behavior (smoking) in a panel of 889 African American children (part of the Family and Community Health Study). Cultural moderators (protective factors) of these relations were also examined. PRD was assessed six times from ages 10.5 (Wave 1) to 24.5 (Wave 6), and negative affect (anger and depressive symptoms) was assessed at Wave 2 (age 12.5) and Wave 6 (age 24.5). Results indicated that Wave 1 PRD predicted Wave 6 smoking, controlling for multiple factors related to smoking and/or PRD, including smoking at age 15.5. Structural equation models indicated that these relations between Wave 1 PRD and smoking were mediated by both early and later negative affect. The models also indicated that Wave 1 PRD had a direct impact on Wave 6 anger (assessed 14 years later), controlling for the effects of PRD on early affect. Cultural socialization was associated with lower rates of adolescent smoking, and it buffered the relation between PRD and Wave 6 anger. The impact of early PRD experiences along with suggestions for culturally informed interventions and preventive interventions that might buffer against early PRD effects are discussed.

Mechanisms of toxicity and biomarkers of flavoring and flavor enhancing chemicals in emerging tobacco and non-tobacco products

Tobacco products containing flavorings, such as electronic nicotine delivery devices (ENDS) or e-cigarettes, cigars/cigarillos, waterpipes, and heat-not-burn devices (iQOS) are continuously evolving. In addition to increasing the exposure of teenagers and adults to nicotine containing flavoring products and flavoring enhancers, chances of nicotine addiction through chronic use and abuse also increase. These flavorings are believed to be safe for ingestion, but little information is available about their effects on the lungs. In this review, we have discussed the in vitro and in vivo data on toxicity of flavoring chemicals in lung cells. We have further discussed the common flavoring agents, such as diacetyl and menthol, currently available detection methods, and the toxicological mechanisms associated with oxidative stress, inflammation, mucociliary clearance, and DNA damage in cells, mice, and humans. Finally, we present potential biomarkers that could be utilized for future risk assessment. This review provides crucial parameters important for evaluation of risk associated with flavoring agents and flavoring enhancers used in tobacco products and ENDS. Future studies can be designed to address the potential toxicity of inhaled flavorings and their biomarkers in users as well as in chronic exposure studies.

Pre-adolescent Receptivity to Tobacco Marketing and Its Relationship to Acquiring Friends Who Smoke and Cigarette Smoking Initiation

BACKGROUND

This study extends research on receptivity to tobacco marketing over a key developmental period for cigarette smoking experimentation.

PURPOSE

The purpose of this study was to understand the effect of receptivity to tobacco marketing and exposure to friends who smoke on smoking experimentation.

METHODS

Participants were 10 to 13 years old who had never tried cigarettes (n = 878), interviewed six times at 8-month intervals.

RESULTS

At baseline, 25% percent of the 10 and 11 years old in the sample of never smokers were receptive to tobacco marketing, while less than 5% had friends who smoked. Having a friend who smoked at study baseline and acquiring such friends for the first time during the study were the strongest predictors of smoking experimentation. Initial receptivity to tobacco marketing increased the risk of smoking experimentation independently of having friends who smoke at baseline or acquiring friends who smoke throughout the study period.

CONCLUSIONS

The high level of receptivity observed even among 10 and 11 years old and its robust relationship with cigarette smoking experimentation independent of the significant risk associated with having friends who smoke suggests that successful prevention of receptivity may require intervention at an early age.

Racial/Ethnic Differences in Cigarette Use Trends in the United States among Multiracial and Other Youth, 1994-2008

Tobacco use among the multiracial population is grossly underresearched. This study explored the cigarette-smoking trends of multiracial individuals over time in comparison with monoracial individuals and assessed the relationship between cigarette smoking and factors at the individual, family, peer, school, and state levels. This study used data collected by the National Longitudinal Study of Adolescents and Adult Health from 1994 to 2008. This study examined a subsample of 9,421 respondents who self-identified as Black, Asian, American Indian, Hispanic, White, or multiracial. Generalized estimating equations were used to analyze the population-level data. Findings suggest that multiracial individuals reported high rates of cigarette use over time. The most consistent correlates of cigarette use were family factors, peer cigarette use, and school policies that prohibit staff from smoking on school premises. Additional research is needed to identify the correlates and causes of cigarette use among multiracial adolescents and young adults.

Impact of Total Vending Machine Restrictions on US Young Adult Smoking

INTRODUCTION

In an analysis of smoking using a longitudinal sample of US young adults, we extend research on tobacco vending machine restrictions beyond its prior focus on minors by examining the influence of total vending machine restrictions, which apply to adult-only facilities and represents the only remaining vending machine exemption since the enactment of the Family Smoking Prevention and Tobacco Control Act. We identify whether the passage of a restriction influences an individual's smoking on repeated observations, and if the propensity is lower among those who live in locations with a restriction.

METHODS

Combining a repository of US tobacco policies at all geographic levels with the nationally-representative geocoded National Longitudinal Survey of Youth 1997 and Census data, we use multilevel logistic regression to examine the impact of total vending machine restrictions on any past 30-day smoking and past 30-day smoking of one pack per day among young adults (ages 19-31), while accounting for other tobacco control policy, community, and individual covariates.

RESULTS

We find that total vending machine restrictions decrease any recent smoking (OR = 0.451; p < .01), net of other covariates. Though the passage of a restriction does not alter an individual's smoking over time, living longer in an area that has a restriction lowers the propensity that an individual will smoke at all (OR = 0.442; p < .05). We find no effect of total vending machine restrictions on smoking a pack daily.

CONCLUSIONS

Total vending machine restrictions appear to be an effective, yet highly underutilized, means of tobacco control.

IMPLICATIONS

Past scientific inquiries examining vending machine restrictions have focused upon minor access, adolescent perceptions of availability, and subsequent smoking. The potential for total vending machine restrictions, which extend to adult-only facilities, to influence patterns of smoking among those of legal age, remains significant. Those who are subject to total vending machine restrictions for longer periods are less likely to have recently smoked, but individuals do not change their smoking behavior in response to the passage of a restriction. These restrictions do not affect heavy smokers. Such policies are an effective but underutilized policy mechanism to prevent smoking among young adults.

Ethnic and Gender differences in Strategies Used by Adolescents when Attempting to Quit or Reduce Smoking

Few adolescent smoking cessation programs have been able to match the success rate found in adult programs. The current study identified smoking cessation strategies used by adolescents and whether strategies differed as a function of ethnic, gender, or individual smoking-level. Participants were 136 high school students who made an attempt to quit or reduce their smoking. Logistic regressions revealed that individuals making an actual quit attempt and African American adolescents used cessation strategies presumed to be more effective. Adolescents are more likely to use informal cessation methods and may need to be provided with more information on effective quit strategies.

Adolescent alcohol use: Social comparison orientation moderates the impact of friend and sibling behaviour

OBJECTIVES

Research has indicated that both peers and siblings influence adolescents' alcohol use (e.g., Windle, 2000, Appl. Dev. Sci., 4, 98). The present two studies examined whether social comparison orientation (SCO) moderates the effects of perceived friend and sibling alcohol use on adolescents' alcohol use cognitions and behaviours.

DESIGN AND METHODS

Two studies examined the role of SCO as a moderator of social influence (perceived friend alcohol use in Study 1 and both perceived friend use and sibling-reported alcohol use in Study 2) on prototype perceptions and willingness to drink alcohol (Studies 1 and 2) as well as actual alcohol consumption (Study 2) among early adolescents.

RESULTS

In Study 1, cross-sectional results indicated that SCO moderated the effect of perceived friend alcohol use on favourable images of drinkers and willingness to drink. Study 2 found that SCO moderated the effects of perceived friend use and sibling use on favourable images of alcohol users, willingness to use alcohol, and change in alcohol use over 3 years such that adolescents who reported engaging in social comparison more often reported greater willingness, more favourable images, and increases in alcohol use when perceived friend use or sibling use was high.

CONCLUSIONS

These studies highlight the importance of SCO as a moderator of susceptibility to the social influences of friends and siblings and may hold important implications for adolescent alcohol use prevention programmes and models of health risk behaviour.

The relationship of alcohol use and physical activity from an ecologic perspective

PURPOSE

To determine the predictors of alcohol use (AU) and their relationship to physical activity (PA) among adolescents and to examine differences among groups using an ecologic model.

DESIGN AND METHODS

Cross sectional secondary analysis of 11,432 adolescents (51% 8th and 49% 10th graders).

RESULTS

Attitude, perception of risk, and academic performance were the strongest predictors of AU. PA did not moderate, but it had a positive influence on AU in 10th graders. Differences were observed among groups.

PRACTICE IMPLICATIONS

Nurses can address individual and school factors in an effort to decrease AU and guide nurses in creating an individualized plan.

Longitudinal study of adolescents' attempts to promote and deter friends' smoking behavior

PURPOSE

Little research has examined the extent to which adolescents directly attempt to influence friends' smoking. This study examines adolescents' reported actions to promote or deter friends' smoking, and whether actions vary by adolescents' smoking experience.

METHODS

Data were collected between 2001 and 2004 at four time points across the 9th and 10th grades from an ethnically diverse school-based sample (N = 395; 53% female).

RESULTS

Deterrence of smoking was reported by a greater percentage of adolescents than was promotion of smoking, both among those who had ever smoked and never smoked. By the end of the study, over 45% of ever smokers and less than 5% of never smokers had promoted smoking among friends. In contrast, over 70% of ever smokers and roughly 40% of never smokers had deterred smoking. Among adolescents who had ever smoked, positive consequences of smoking by fall of 10th grade predicted attempts to promote smoking by the end of 10th grade (OR = 4.37, p < .05). To a lesser extent, negative consequences of smoking predicted attempts to deter smoking (OR = 2.60, p < .08). These effects were independent of the opposite type of smoking consequences, level of personal smoking experience, having close friends who smoked, prior attempts to influence friends' behavior, and smoker's gender.

CONCLUSIONS

Models of peer influence should account for both positive and negative influence of adolescents on friends' health behavior. Adolescents who have engaged in risk-taking and experienced negative consequences may be a resource in designing and delivering interventions; future research should evaluate their ability to change friends' behavior.

Differences in time to onset of smoking and nicotine dependence by race/ethnicity in a Midwestern sample of adolescents and young adults from a high risk family study

OBJECTIVE

The objective of this study was to determine whether race/ethnicity was associated with time to smoking initiation and time from first cigarette to onset of DSM-IV nicotine dependence (ND) after adjusting for familial and individual psychosocial risk factors.

METHODS

Cox proportional hazards models with time-dependent covariates were used to analyze data from 1376 offspring aged 12-33 years from 532 families at high risk for substance use problems due to paternal alcohol problems and 235 low risk families. Fifty-six percent of the sample self-identified as African-American (AA) and 44% were mainly of European descent.

RESULTS

Controlling for covariates, AAs began smoking at older ages (HR=0.58; 95% CI: 0.48-0.70) and had longer times between smoking initiation and onset of ND compared to non-AAs (HR=0.25, 95% CI: 0.16-0.39 for ND onset occurring <18 years and HR=0.49, 95% CI: 0.30-0.80 for ND onsets ≥ age 18). After additionally controlling for number of cigarettes smoked daily, the racial/ethnic effects for onset of ND were attenuated, but remained statistically significant for ND onset <18 (HR=0.34, 95% CI: 0.19-0.61); however, the estimate was no longer significant for later ND onset (HR=0.84, 95% CI: 0.50-1.41).

CONCLUSIONS

AA adolescents and young adults initiate smoking at older ages and have longer transition periods between initiation and onset of ND compared to non-AAs, even after controlling for many relevant psychiatric and psychosocial covariates; however, racial/ethnic differences in time to onset of nicotine dependence in late adolescence and young adulthood may be explained by differences in daily quantity smoked.

A comparison of individual versus community influences on youth smoking behaviours: a cross-sectional observational study

OBJECTIVES

To compare individual with community risk factors for adolescent smoking.

DESIGN

A cross-sectional observational study with multivariate analysis.

SETTING

National telephone survey.

PARTICIPANTS

3646 US adolescents aged 13-18 years in 2007 recruited through a random digit-dial survey.

OUTCOME MEASURES

Ever tried smoking and, among experimental smokers, smoking intensity (based on smoking in past 30 days).

RESULTS

One-third of participants (35.6%, N=1297) had tried smoking. After controlling for individual risk factors, neither tobacco outlet density nor proximity were associated with tried smoking or smoking intensity. Associations with trying smoking included age (adjusted OR (AOR)=1.23, 95% CI 1.16 to 1.31), lower socioeconomic status (AOR=0.82, 95% CI 0.74 to 0.91), sibling smoking (AOR=2.13, 95% CI 1.75 to 2.59), friend smoking (AOR=2.60, 95% CI 2.19 to 3.10 for some and AOR=7.01, 95% CI 5.05 to 9.74 for most), movie smoking exposure (AOR=2.66, 95% CI 1.95 to 3.63), team sports participation (AOR=0.69, 95% CI 0.54 to 0.89) and sensation seeking (AOR=7.72, 95% CI 5.26 to 11.34). Among experimental smokers, age (AOR=1.32, 95% CI 1.21 to 1.44), minority status (AOR=0.48, 95% CI 0.30 to 0.79 for Black; AOR=0.46, 95% CI 0.31 to 0.69 for Hispanic; AOR=0.53, 95% CI 0.43 to 0.85 for mixed race/other), friend smoking (AOR=3.37, 95% CI 2.37 to 4.81 for some; AOR=20.27, 95% CI 13.22 to 31.08 for most), team sports participation (AOR=0.38, 95% CI 0.26 to 0.55) and sensation seeking (AOR=6.57, 95% CI 3.71 to 11.64) were associated with smoking intensity.

CONCLUSIONS

The study suggests that interventions and policies to prevent and reduce youth smoking should focus on individual risk factors for smoking, including supporting participation in team sports, minimising exposure to movie smoking, addressing the social influence of friend smoking and addressing experience seeking among high sensation-seekers.

Media as social influence: racial differences in the effects of peers and media on adolescent alcohol cognitions and consumption

Racial differences in the effects of peer and media influence on adolescents' alcohol cognitions and consumption were examined in a large-scale panel study. With regard to peer influence, results from cross-lagged panel analyses indicated that the relation between perceived peer drinking and own drinking was significant for both Black and White adolescents, but it was stronger for the White adolescents. With regard to media influence, structural modeling analyses indicated that exposure to drinking in movies was associated with more alcohol consumption 8 months and 16 months later. These effects were mediated by increases in the favorability of the adolescents' drinker prototypes, their willingness to drink, and their tendency to affiliate with friends who were drinking. Multiple group analyses indicated that, once again, the effects (both direct and indirect) were much stronger for White adolescents than for Black adolescents. The results suggest media influence works in a similar manner to social influence and that Whites may be more susceptible to both types of influence.

Recent findings on peer group influences on adolescent smoking

This review addresses peer group influences on adolescent smoking with a particular focus on recently published longitudinal studies that have investigated the topic. Specifically, we examine the theoretical explanations for how social influence works with respect to adolescent smoking; discuss the association between peer and adolescent smoking; consider socialization and selection processes with respect to smoking; investigate the relative influence of best friends, close friends, and crowd affiliations; and examine parenting behaviors that could buffer the effects of peer influence. Our review indicates the following with respect to adolescent smoking: (a) substantial peer group homogeneity of smoking behavior; (b) support for both socialization and selection effects, although evidence is somewhat stronger for selection; (c) an interactive influence of best friends, peer groups, and crowd affiliation; and (d) an indirect protective effect of positive parenting practices against the uptake of adolescent smoking. We conclude with implications for research and prevention programs.

Prevalence and psychosocial correlates of current smoking among adolescent students in Thailand, 2005

This article examines the prevalence of current smoking and associated psychosocial correlates and whether these correlates differ by sex among adolescent students in Thailand. Data were analyzed from the Thailand Global Youth Tobacco Survey (GYTS), a school-based, cross-sectional survey conducted in 2005 and completed by Mathayom 1, 2, and 3 (U.S. seventh through ninth grades) students. Weighted prevalence estimates of the percentage of students who were current smokers (smoked on ≥ 1 day during the past 30 days) and noncurrent smokers were calculated for the sample and for each psychosocial variable. Separate logistic regression models were calculated for males and females to examine the independent association of the psychosocial correlates of current smoking. Significant correlates for both males and females included close peer smoking, secondhand smoke exposure, being offered a free cigarette by a tobacco industry representative, and belief that smoking is not harmful. These correlates are examined in the context of comprehensive tobacco control laws in Thailand.

Adolescent pathways to adult smoking: ethnic identity, peer substance use, and antisocial behavior

African-Americans and Puerto Ricans were interviewed during adolescence, in their early twenties, and then again in their mid-twenties. Results indicated that earlier adolescent smoking, family conflict, and weak ethnic identity were significantly related to antisocial behavior, which in turn was related to associating with friends who smoked and/or used illegal drugs, and ultimately, to their own smoking. Results further indicate that early interventions in the development of tobacco use should focus on decreasing parental and adolescent smoking and parent-child conflict. If intervention occurs at a later time point, the emphasis should be on increasing ethnic identity and decreasing antisocial behavior. (Am J Addict 2010;00:1-9).

Differences between intermittent and light daily smokers in a population of U.S. military recruits

INTRODUCTION

Few studies have assessed differences between intermittent and light smokers, particularly among young adults. Exploring these differences promotes a systematic approach to research and treatment in low-level smokers. This study explored demographic, tobacco-related, and psychosocial predictors of intermittent nondaily smoking relative to light smoking among basic military training (BMT) recruits. The impact of smoking status on abstinence rates at follow-up was also assessed.

METHODS

Participants were 5,603 U.S. Air Force BMT intermittent nondaily (n = 3,134) or light daily (n = 2,469) smoking recruits participating in a population-based group randomized trial targeting tobacco use prevention and cessation (Klesges et al., 2006, Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. Journal of Consulting and Clinical Psychology, 74, 295-306.). Participants completed baseline measures assessing demographics; tobacco use and history; and common social, attitudinal, and behavioral risk factors for tobacco use. Flights of recruits were randomly assigned to a tobacco use intervention or health education control intervention. At the 1-year follow-up, participants reported 7-day point prevalence and continuous abstinence.

RESULTS

Intermittent nondaily smoking relative to light daily smoking was associated with lesser perceived addiction, intermittent and daily use of smokeless tobacco, nonsmoking male and female heads of household, lesser likelihood of smoking while stressed or while bored, and higher likelihood of intentions to quit smoking. Intermittent smokers were significantly more likely than light daily smokers to report abstinence at follow-up.

DISCUSSION

Intermittent and daily light smokers differ on several tobacco-related and psychosocial variables. Attending to these factors in prevention and cessation programs may enhance abstinence in both groups.

Density of tobacco retailers near schools: effects on tobacco use among students

OBJECTIVES

We examined the relationship between students' tobacco use and the density and proximity of tobacco retailers near their schools.

METHODS

We used data from the 2003-2004 California Student Tobacco Survey and California retail licensing data. Measures included students' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors.

RESULTS

Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources.

CONCLUSIONS

Our results support the plausibility of reducing rates of students' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.

Watching and drinking: expectancies, prototypes, and friends' alcohol use mediate the effect of exposure to alcohol use in movies on adolescent drinking

OBJECTIVE

To investigate the psychological processes that underlie the relation between exposure to alcohol use in media and adolescent alcohol use.

DESIGN

The design consisted of a structural equation modeling analysis of data from four waves of a longitudinal, nationally representative, random-digit dial telephone survey of adolescents in the United States.

MAIN OUTCOME MEASURES

The main outcome measures were adolescent alcohol consumption and willingness to use alcohol. Tested mediators were alcohol-related norms, prototypes, expectancies, and friends' use.

RESULTS

Alcohol prototypes, expectancies, willingness, and friends' use of alcohol (but not perceived prevalence of alcohol use among peers) were significant mediators of the relation between movie alcohol exposure and alcohol consumption, even after controlling for demographic, child, and family factors associated with both movie exposure and alcohol consumption.

CONCLUSION

Established psychological and interpersonal predictors of alcohol use mediate the effects of exposure to alcohol use in movies on adolescent alcohol consumption. The findings suggest that exposure to movie portrayals may operate through similar processes as other social influences, highlighting the importance of considering these exposures in research on adolescent risk behavior.

Comparing the effects of entertainment media and tobacco marketing on youth smoking in Germany

AIMS

To examine differential effects of smoking in films and tobacco advertising on adolescent smoking. We hypothesize that movie smoking will have greater effects on smoking initiation, whereas tobacco advertising receptivity will primarily affect experimentation.

DESIGN

Longitudinal observational study of adolescents.

SETTING

School-based surveys conducted in Schleswig-Holstein, Germany.

PARTICIPANTS

A total of 4384 adolescents age 11-15 years at baseline and re-surveyed 1 year later; ever smoking prevalence was 38% at time 1.

MEASUREMENTS

The main outcome variable combined two items assessing life-time and current smoking (alpha = 0.87). Baseline never smokers were analyzed separately from those who had tried smoking (ever smokers). Exposure to smoking in 398 internationally distributed US movies was modeled as a continuous variable, with 0 corresponding to the 5th percentile and 1 to the 95th percentile of exposure. Tobacco marketing receptivity consisted of naming a brand for a favorite tobacco advertisement. Ordinal logistic regressions controlled for socio-demographics, other social influences, personality characteristics of the adolescent and parenting style.

FINDINGS

Whereas 34% of ever smokers were receptive to tobacco marketing at time 1, only 6% of never smokers were. Among time 1 never smokers, exposure to movie smoking was a significantly stronger predictor of higher time 2 smoking level [adjusted proportional odds ratio = 2.76, 95% confidence interval (1.84, 4.15)] than was tobacco marketing receptivity (1.53 [1.07, 2.20]). Among time 1 ever smokers, both tobacco marketing receptivity and exposure to movie smoking predicted higher levels of time 2 smoking [2.17 (1.78, 2.63) and 1.62 (1.18, 2.23), respectively], and the two estimates were not significantly different.

CONCLUSIONS

In this longitudinal study, exposure to movie smoking was a stronger predictor of smoking initiation than tobacco marketing receptivity, which was more common among ever smokers. The results suggest that entertainment media smoking should be emphasized in programs aimed at preventing onset, and both exposures should be emphasized in programs aimed at experimental smokers.

Tobacco industry control of menthol in cigarettes and targeting of adolescents and young adults

OBJECTIVES

We examined whether tobacco manufacturers manipulate the menthol content of cigarettes in an effort to target adolescents and young adults.

METHODS

We analyzed data from tobacco industry documents describing menthol product development, results of laboratory testing of US menthol brands, market research reports, and the 2006 National Survey on Drug Use and Health.

RESULTS

The tobacco industry attracted new smokers by promoting cigarettes with lower menthol content, which were popular with adolescents and young adults, and provided cigarettes with higher menthol content to long-term smokers. Menthol cigarette sales remained stable from 2000 to 2005 in the United States, despite a 22% decline in overall packs sold.

CONCLUSIONS

Tobacco companies manipulate the sensory characteristics of cigarettes, including menthol content, thereby facilitating smoking initiation and nicotine dependence. Menthol brands that have used this strategy have been the most successful in attracting youth and young adult smokers and have grown in popularity.

Cardiovascular disease risk in adolescent smokers: evidence of a 'smoker lifestyle'

This study assessed the prevalence of traditional cardiovascular disease risk factors in 119 adolescent smokers, compared to an age-matched sample of non-smokers. Participants were assessed for body mass index (BMI), relative body fat, systolic/diastolic/mean arterial blood pressure, total serum cholesterol, aerobic fitness, family (parents or siblings) smoking habits and history of cardiovascular disease. The results showed that BMI and relative body fat were significantly increased, while aerobic fitness was significantly decreased in smokers. Male smokers further demonstrated increased diastolic blood pressure and mean arterial pressure. Smokers also showed increased prevalence for family smoking habits and cardiovascular disease history. Prevalence rates for all other cardiovascular disease risk factors were increased in smokers, but the differences between groups did not reach statistical significance. It is concluded that the studied adolescent smokers demonstrated a higher risk for developing cardiovascular disease later in life, compared to their non-smoking counterparts.

Movie smoking exposure and smoking onset: a longitudinal study of mediation processes in a representative sample of U.S. adolescents

The authors tested 2 mechanisms for the relation of movie smoking exposure with onset of cigarette smoking in adolescence. Longitudinal data with 8-month follow-up were obtained from a representative sample of 6,522 U.S. adolescents, ages 10-14 years. Structural modeling analysis based on initial nonsmokers, which controlled for 10 covariates associated with movie exposure, showed that viewing more smoking in movies was related to increases in positive expectancies about smoking and increases in affiliation with smoking peers, and these variables were both related to smoking onset. A direct effect of movie exposure on smoking onset was also noted. Mediation findings were replicated across cross-sectional and longitudinal analyses. Tests for gender differences indicated that girls showed larger effects of movie exposure for some variables. Implications for policy and prevention research are discussed.