The impact of self-control indices on peer smoking and adolescent smoking progression

Racial and Ethnic Disparities in Mental Health Problems and Tobacco and Cannabis Use Among US Emerging Adults

INTRODUCTION

Mental health problems in emerging adulthood are linked to tobacco and cannabis use, but whether race and ethnicity modifies these associations is unclear.

METHODS

We used data from wave 4 of the Population Assessment of Tobacco and Health Study (youth n = 6898, young adult n = 10,304) to conduct latent class analysis (LCA) of six past 30-day tobacco and cannabis use indicators (i.e., cigarettes, electronic nicotine delivery systems (ENDS), cigars, blunts, cannabis vaping, other cannabis). We estimated associations between past 30-day internalizing and externalizing (i.e., low (referent), moderate, high) problems and latent classes of tobacco/cannabis use (vs. never/former use) using adjusted multinomial logistic regression. We explored whether associations varied by race and ethnicity through stratification.

RESULTS

We identified four exclusive use latent classes and two dual/poly use latent classes for both youth and young adult samples. Race/ethnicity-stratified models identified associations between internalizing/externalizing problems and most use classes for Hispanic and non-Hispanic White youth/young adults, with mixed results for non-Hispanic Black youth/young adults. For example, Hispanic (OR: 2.50, 95% CI: 1.09-5.74) and non-Hispanic White (OR: 1.90, 95% CI: 1.18-3.06) youth with high internalizing problems had higher odds of ENDS + cannabis vaping. Externalizing problems were not associated with use among non-Hispanic Black youth while internalizing problems were not associated with use among non-Hispanic Black young adults.

CONCLUSION

We observed racial/ethnic variation in mental health problems and tobacco and cannabis use. Understanding mental health problem and tobacco product and cannabis use comorbidity may better inform culturally relevant interventions aimed to prevent and reduce use.

Mental Health Problems and Initiation of E-cigarette and Combustible Cigarette Use

BACKGROUND AND OBJECTIVES

During adolescence, mental health problems may increase the risk of initiating combustible cigarette use. However, it is unknown if this association extends to electronic cigarettes (e-cigarettes). We examined whether internalizing and externalizing problems were associated with initiation of e-cigarette, combustible cigarette, and dual-product use among adolescents.

METHODS

Participants were drawn from the Population Assessment of Tobacco and Health Study, a nationally representative longitudinal study of US adolescents followed from 2013 to 2015. The study sample included 7702 adolescents aged 12 to 17 years who at baseline reported no lifetime use of tobacco products. We examined the respective associations between baseline internalizing and externalizing problems and initiating use of e-cigarettes, combustible cigarettes, or both at 1-year follow-up.

RESULTS

Compared with adolescents with low externalizing problems, adolescents with high externalizing problems were significantly more likely to initiate use of e-cigarettes (adjusted relative risk ratio [aRRR] = 2.78; 95% confidence interval [CI]: 1.76-4.40), combustible cigarettes (aRRR = 5.59; 95% CI: 2.63-11.90), and both products (aRRR = 2.23; 95% CI: 1.15-4.31). Adolescents with high internalizing problems were at increased risk of initiating use of e-cigarettes (aRRR = 1.61; 95% CI: 1.12-2.33) but not combustible cigarettes or both products.

CONCLUSIONS

Mental health problems are associated with increased risk for initiating e-cigarette, combustible cigarette, and dual-product use in adolescence. This association is more consistent for externalizing problems than internalizing problems. Addressing mental health problems could be a promising target for preventing initiation of nicotine- and/or tobacco-product use by adolescents.

The role of financial strain and self-control in explaining health behaviours: the GLOBE study

Background

Why lower socioeconomic groups behave less healthily can only partly be explained by direct costs of behaving healthily. We hypothesize that low income increases the risk of facing financial strain. Experiencing financial strain takes up cognitive 'bandwidth' and leads to less self-control, and subsequently results in more unhealthy behaviour. We therefore aim to investigate (i) whether a low income increases the likelihood of experiencing financial strain and of unhealthy behaviours, (ii) to what extent more financial strain is associated with less self-control and, subsequently, (iii) whether less self-control is related to more unhealthy behaviour.

Methods

Cross-sectional survey data were obtained from participants (25-75 years) in the fifth wave of the Dutch GLOBE study (N = 2812) in 2014. The associations between income, financial strain, self-control and health-behaviour-related outcomes (physical inactivity in leisure-time, obesity, smoking, excessive alcohol intake, and weekly fruit and vegetable intake) were analysed with linear regression and generalized linear regression models (log link).

Results

Experiencing great compared with no financial strain increased the risk of all health-behaviour-related outcomes, independent of income. Low self-control, as compared with high self-control, also increased the risk of an unhealthy lifestyle. Taking self-control into account slightly attenuated the associations between financial strain and the outcomes.

Conclusion

Great financial strain and low self-control are consistently associated with unhealthy behaviours. Self-control may partly mediate between financial strain and unhealthy behaviour. Interventions that relieve financial strain may free up cognitive bandwidth and improve health behaviour.

Impulsivity related personality traits and cigarette smoking in adults: A meta-analysis using the UPPS-P model of impulsivity and reward sensitivity

BACKGROUND

Although there is considerable evidence of an association between impulsivity and cigarette smoking, the magnitude of this association varies across studies. Impulsivity comprises several discrete traits that may influence cigarette use in different ways. The present meta-analysis aims to examine the direction and magnitude of relationships between specific impulsivity-related traits, namely lack of premeditation, lack of perseverance, sensation seeking, negative urgency, positive urgency and reward sensitivity and both smoking status and severity of nicotine dependence in adults across studies and to delineate differences in effects across these relationships.

METHODS

Ninety-seven studies were meta-analysed using random-effects models to examine the relationship between impulsivity-related traits and smoking status and severity of nicotine dependence. A number of demographic and methodological variables were also assessed as potential moderators.

RESULTS

Smoking status and severity of nicotine dependence were significantly associated with all impulsivity-related traits except reward sensitivity. Lack of premeditation and positive urgency showed the largest associations with smoking status (r = 0.20, r = 0.24 respectively), while positive urgency showed the largest association with severity of nicotine dependence (r = 0.23). Study design moderated associations between lack of premeditation and lack of perseverance and smoking status, with larger effects found in cross-sectional compared to prospective studies.

CONCLUSIONS

Finding suggest that impulsivity is associated with an increased likelihood of being a smoker and greater nicotine dependence. Specific impulsivity-related traits differentially relate to smoking status and severity of nicotine dependence. Understanding the complexity of impulsivity-related traits in relation to smoking can help to identify potential smokers and could inform cessation treatment.

Childhood self-control predicts smoking throughout life: Evidence from 21,000 cohort study participants

Objective: Low self-control has been linked with smoking, yet it remains unclear whether childhood self-control underlies the emergence of lifetime smoking patterns. We examined the contribution of childhood self-control to early smoking initiation and smoking across adulthood. Methods: 21,132 participants were drawn from 2 nationally representative cohort studies; the 1970 British Cohort Study (BCS) and the 1958 National Child Development Study (NCDS). Child self-control was teacher-rated at age 10 in the BCS and at ages 7 and 11 in the NCDS. Participants reported their smoking status and number of cigarettes smoked per day at 5 time-points in the BCS (ages 26–42) and 6 time-points in the NCDS (ages 23–55). Both studies controlled for socioeconomic background, cognitive ability, psychological distress, gender, and parental smoking; the NCDS also controlled for an extended set of background characteristics. Results: Early self-control made a substantial graded contribution to (not) smoking throughout life. In adjusted regression models, a 1-SD increase in self-control predicted a 6.9 percentage point lower probability of smoking in the BCS, and this was replicated in the NCDS (5.2 point reduced risk). Adolescent smoking explained over half of the association between self-control and adult smoking. Childhood self-control was positively related to smoking cessation and negatively related to smoking initiation, relapse to smoking, and the number of cigarettes smoked in adulthood. Conclusions: This study provides strong evidence that low childhood self-control predicts an increased risk of smoking throughout adulthood and points to adolescent smoking as a key pathway through which this may occur.

Emotional self-control and dysregulation: A dual-process analysis of pathways to externalizing/internalizing symptomatology and positive well-being in younger adolescents

OBJECTIVES

There is little knowledge about how emotional regulation contributes to vulnerability versus resilience to substance use disorder. With younger adolescents, we studied the pathways through which emotion regulation attributes are related to predisposing factors for disorder.

METHODS

A sample of 3561 adolescents (M age 12.5 years) was surveyed. Measures for emotional self-control (regulation of sadness and anger), emotional dysregulation (angerability, affective lability, and rumination about sadness or anger), and behavioral self-control (planfulness and problem solving) were obtained. A structural model was analyzed with regulation attributes related to six intermediate variables that are established risk or protective factors for adolescent substance use (e.g., academic involvement, stressful life events). Criterion variables were externalizing and internalizing symptomatology and positive well-being.

RESULTS

Indirect pathways were found from emotional regulation to symptomatology through academic competence, stressful events, and deviance-prone attitudes and cognitions. Direct effects were also found: from emotional dysregulation to externalizing and internalizing symptomatology; emotional self-control to well-being; and behavioral self-control (inverse) to externalizing symptomatology. Emotional self-control and emotional dysregulation had independent effects and different types of pathways.

CONCLUSIONS

Adolescents scoring high on emotional dysregulation are at risk for substance dependence because of more externalizing and internalizing symptomatology. Independently, youth with better behavioral and emotional self-control are at lower risk. This occurs partly through relations of regulation constructs to environmental variables that affect levels of symptomatology (e.g., stressful events, poor academic performance). Effects of emotion regulation were found at an early age, before the typical onset of substance disorder.

Identifying Shared Latent Dimensions of Psychological Symptoms: Implications for the Psychological Correlates of Smoking

Shared latent dimensions may account for the co-occurrence of multiple forms of psychological dysfunction. However, this conceptualization has rarely been integrated into the smoking literature, despite high levels of psychological symptoms in smokers. In this study, we used confirmatory factor analysis to compare three models (1-factor, 2-factor [internalizing-externalizing], and 3-factor [low positive affect-negative affect-disinhibition]) of relations among nine measures of affective and behavioral symptoms implicated in smoking spanning depression, anxiety, happiness, anhedonia, ADHD, aggression, and alcohol use disorder symptoms. We then examined associations of scores from each of the manifest scales and the latent factors from the best-fitting model to several smoking characteristics (i.e., experimentation, lifetime established smoking [≥100 cigarettes lifetime], age of smoking onset, cigarettes/day, nicotine dependence, and past nicotine withdrawal). We used two samples: (1) College Students (N =288; mean age =20; 75 % female) and (2) Adult Daily Smokers (N=338; mean age=44; 32 % female). In both samples, the 3-factor model separating latent dimensions of deficient positive affect, negative affect, and disinhibition fit best. In the college students, the disinhibition factor and its respective indicators significantly associated with lifetime smoking. In the daily smokers, low positive and high negative affect factors and their respective indicators positively associated with cigarettes/day and nicotine withdrawal symptom severity. These findings suggest that shared features of psychological symptoms may be parsimonious explanations of how multiple manifestations of psychological dysfunction play a role in smoking. Implications for research and treatment of co-occurring psychological symptoms and smoking are discussed.

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy

BACKGROUND

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward.

METHODS

We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence.

RESULTS

CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation.

CONCLUSION

CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers.

Psychological symptoms, smoking lapse behavior, and the mediating effects of nicotine withdrawal symptoms: A laboratory study

The influence of psychological symptoms on smoking-lapse behavior is critical to understand. However, this relationship is obscured by comorbidity across multiple forms of psychological symptoms and their overlap with nicotine withdrawal. To address these challenges, we constructed a structural model of latent factors underlying 9 manifest scales of affective and behavioral symptoms and tested relations between latent factors and manifest scale residuals with nicotine withdrawal and smoking lapse in a laboratory analog task. Adult daily smokers (N = 286) completed a baseline session at which several forms of affective and behavioral symptoms were assessed and 2 experimental sessions (i.e., following 16 hr of smoking abstinence and following regular smoking), during which withdrawal symptoms and delay of smoking in exchange for monetary reinforcement, as an analogue for lapse propensity, were measured. A single second-order factor of general psychological maladjustment associated with more severe withdrawal-like symptoms, which in turn associated with shorter delay of smoking. The first-order factors, which tapped qualitatively unique domains of psychological symptoms (low positive affect, negative affect, disinhibition), and the manifest scale residuals provided little predictive power beyond the second-order factor with regard to lapse behavior. Relations among general psychological maladjustment, withdrawal-like symptoms, and lapse were significant in both abstinent and nonabstinent conditions, suggesting that psychological maladjustment, and not nicotine withdrawal per se, accounted for the relation with lapse. These results highlight the potential for smoking-cessation strategies that target general psychological maladjustment processes and have implications for addressing withdrawal-like symptoms among individuals with psychological symptoms.

Shared versus specific features of psychological symptoms and cigarettes per day: structural relations and mediation by negative- and positive-reinforcement smoking

This study examined the extent to which shared versus specific features across multiple manifestations of psychological symptoms (depression, anxiety, ADHD, aggression, alcohol misuse) associated with cigarettes per day. Subsequently, we investigated whether negative- (i.e., withdrawal relief) and positive- (i.e., pleasure enhancement) reinforcement smoking motivations mediated relations. Adult daily smokers (N = 338) completed self-report measures and structural equation modeling was used to construct a 3-factor (low positive affect-negative affect-disinhibition) model of affective and behavioral symptoms and to test relations of each latent factor (shared features) and indicator residual (specific features) to smoking level. Shared dimensions of low positive affect, negative affect, and disinhibition associated with smoking rate. Negative-reinforcement smoking mediated the link between latent negative affect and heavier daily smoking. Specific features of psychological symptoms unique from latent factors were generally not associated with cigarettes per day. Features shared across several forms of psychological symptoms appear to underpin relations between psychological symptoms and smoking rate.

Predictors of middle school students' interest in participating in an incentive-based tobacco prevention and cessation program in connecticut

Behavioral incentives have been used to encourage smoking cessation in older adolescents, but the acceptability of incentives to promote a smoke-free lifestyle in younger adolescents is unknown. To inform the development of novel, effective, school-based interventions for youth, we assessed middle school students' interest in participating in an incentive-based tobacco abstinence program. We surveyed 988 students (grades 6–8) attending three Connecticut middle schools to determine whether interest in program participation varied as a function of (1) intrapersonal factors (i.e., demographic characteristics (sex, age, race), smoking history, and trait impulsivity) and/or (2) aspects of program design (i.e., prize type, value, and reward frequency). Primary analyses were conducted using multiple regression. A majority of students (61.8%) reported interest in program participation. Interest did not vary by gender, smoking risk status, or offering cash prizes. However, younger students, non-Caucasian students, behaviorally impulsive students, and students with higher levels of self-regulation were more likely to report interest. Inexpensive awards (e.g., video games) offered monthly motivated program interest. In sum, middle school students reported high levels of interest in an incentive-based program to encourage a tobacco-free lifestyle. These formative data can inform the design of effective, incentive-based smoking cessation and prevention programs in middle schools.

An examination of pathways from childhood maltreatment to adolescent binge drinking

Considerable clinical and empirical evidence has accumulated over the past decades indicating that there is a strong association between childhood maltreatment and heavy episodic drinking in adolescence, but there is a paucity of empirically based knowledge about the processes linking the association. The aim of this paper is to examine mechanisms that might account for the association between childhood maltreatment and heavy episodic drinking in adolescence. Using a nationally representative sample of adolescents (ages ranging 12-21; N = 6,337), this study examined the role of individual self-regulatory processes in the associations, controlling for age, gender, race/ethnicity, peer substance use, parental alcoholism, and parent-child conflict. Factor analyses were used to test the measurement structure of self-regulatory processes. Findings confirmed the association between childhood maltreatment and heavy episodic drinking in adolescence. Structural modeling analyses indicated indirect effects for childhood maltreatment primarily through poor self-regulatory processes and peer substance use. Implications for future research are discussed.

Where is the pleasure in that? Low hedonic capacity predicts smoking onset and escalation

INTRODUCTION

Hedonic capacity is a dispositional ability to experience pleasure in response to stimuli that are typically rewarding. The ability to derive pleasure from natural reinforcers has been relatively overlooked as a risk factor for adolescent smoking. The present study sought to provide initial evidence for a relationship between hedonic capacity and adolescent smoking onset and escalation.

METHODS

The sample was composed of 1,106 adolescents participating in a prospective longitudinal survey study of adolescent health behaviors. Variables were measured via self-report every 6 months for 4 waves of data spanning 18 months. We hypothesized that adolescents with lower hedonic capacity may be less responsive to natural reinforcers and therefore be prone to take up and rely on smoking as a reinforcer.

RESULTS

A two-part latent growth curve model indicated that adolescents low in hedonic capacity were over two and a half times more likely to have smoked a cigarette in the past month at age 15.5 years (odds ratio = 2.64, 95% CI = 1.08-6.45) and to show a 90% increase (β = 0.9, z = 2.28, p = .02) in the rate of smoking escalation every 6 months across the following 18 months compared with adolescents with high hedonic capacity.

CONCLUSIONS

This study provides the first evidence implicating hedonic capacity as a risk factor for adolescent smoking initiation and progression. Adolescents low in hedonic capacity may be an important population to target for smoking prevention and smoking cessation efforts possibly through behavioral skills to enhance pleasure derived through natural reinforcers.

Behavioral and emotional regulation and adolescent substance use problems: a test of moderation effects in a dual-process model

In a structural model, we tested how relations of predictors to level of adolescent substance use (tobacco, alcohol, marijuana), and to substance-related impaired-control and behavior problems, are moderated by good self-control and poor regulation in behavioral and emotional domains. The participants were a sample of 1,116 public high-school students. In a multiple-group analysis for good self-control, the paths from negative life events to substance use level and from level to behavior problems were lower among persons scoring higher on good behavioral self-control. In a multiple-group analysis for poor regulation, the paths from negative life events and peer use to level of substance use were greater among persons scoring higher on poor behavioral (but not emotional) regulation; an inverse path from academic competence to level was greater among persons scoring higher on both aspects of poor regulation. Paths from level to impaired-control and behavior problems were greater among persons scoring higher on both poor behavioral and poor emotional regulation. Theoretical implications concerning the role of behavioral and emotional regulation in moderation effects are discussed.

Good self-control moderates the effect of mass media on adolescent tobacco and alcohol use: tests with studies of children and adolescents

OBJECTIVE

To investigate whether self-control moderates the effect of media influences on tobacco and alcohol use among youth and if so how this effect occurs.

DESIGN

In Study 1, a regional sample of 10-year olds (N = 290) was interviewed in households; attention to tobacco/alcohol advertising was assessed. In Study 2, a national sample of youth ages 10-14 years (N = 6,522) was surveyed by telephone; exposure to tobacco/alcohol use in movies was assessed. Good self-control was measured in both studies.

MAIN OUTCOME MEASURES

Willingness to use substances and affiliation with peer substance users (Study 1); involvement in smoking or drinking (Study 2).

RESULTS

In Study 1, the effect of tobacco/alcohol advertising on predisposition for substance use was lower among persons scoring higher on good self-control. In Study 2, the effect of movie smoking/alcohol exposure on adolescent tobacco/alcohol use was lower, concurrently and prospectively, among persons scoring higher on good self-control. Moderation occurred primarily through reducing the effect of movie exposure on positive smoking/alcohol expectancies and the effect of expectancies on adolescent use; some evidence for moderation of social processes was also noted. Covariates in the analyses included demographics, sensation seeking, and IQ.

CONCLUSION

Good self-control reduces the effect of adverse media influences on adolescent tobacco and alcohol use. Findings on the processes underlying this effect may be useful for media literacy and primary prevention programs.

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.

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.

[Smoking behavior and predictors of smoking initiation in childhood and early adolescence]

PURPOSE

The purposes of this study were (a) to identify smoking behavior by following a cohort representative of the population of 4th grade elementary schoolers in South Korea over a four-year period (2004-2007), and (b) to explore predictors of smoking initiation among non-smokers in Wave 1.

METHODS

Secondary data, the Korea Youth Panel Study, was analyzed in this study. First, frequencies or percentages were calculated to identify smoking behavior (i.e., smoking initiation, smoking intensity, and smoking duration). Second, binary logistic regression analysis was performed to examine significant factors related to smoking initiation.

RESULTS

Smoking initiation and daily smoking were more pronounced when the participants entered middle school. In bivariate analysis, statistically significant predictors of smoking initiation were loneliness at school, self-control, delinquent behavior, depressive symptoms, and stress. However, after controlling for other factors, only a high level of risk-taking tendency and a greater number of delinquent behaviors remained statistically significant.

CONCLUSION

Based on greater involvement in smoking among first-year middle schoolers, smoking prevention strategies should be provided to elementary schoolers rather than middle schoolers. A risk-taking tendency and delinquent behaviors should be considered as proxy measures to detect the high-risk group for smoking initiation.

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.

Does delay discounting play an etiological role in smoking or is it a consequence of smoking?

Although higher delay discounting rates have been linked to cigarette smoking, little is known about the stability of delay discounting, whether delay discounting promotes smoking acquisition, whether smoking contributes to impulsive choices, or if different relationships exist in distinct subgroups. This study sought to fill these gaps within a prospective longitudinal cohort study (N=947) spanning mid-adolescence to young adulthood (age 15-21 years old). Smoking and delay discounting were measured across time. Covariates included peer and household smoking, academic performance, depression, novelty seeking, inattention and hyperactivity/impulsivity symptoms, and alcohol and marijuana use. The associated processes latent growth curve modeling (LGCM) with paths from the delay discounting level factor (baseline measure) and the trend factor (slope) to the smoking trend factor (slope) fit the data well, chi(2)((19,n=947)) =15.37, p=.70, CFI=1.00, RMSEA=0, WRMR=.36. The results revealed that delay discounting did not change significantly across time. Baseline delay discounting had a significant positive effect on smoking trend (beta=.08, z=2.16, p=.03). A standard deviation (SD=1.41) increase in baseline delay discounting resulted in an 11% increase (OR=1.11, 95% CI=1.03, 1.23) in the odds of smoking uptake. The alternative path LCGM revealed that smoking did not significantly impact delay discounting (p's>.05). Growth mixture modeling identified three smoking trajectories: nonsmokers, early/fast smoking adopters, and slow smoking progressors. Delay discounting was higher in the smoking versus nonsmoking trajectories, but did not discriminate between the smoking trajectories, despite different acquisition patterns. Delay discounting may provide a variable by which to screen for smoking vulnerability and help identify subgroups to target for more intensive smoking prevention efforts that include novel behavioral components directed toward aspects of impulsivity.

Prospective associations of social self-control with drug use among youth from regular and alternative high schools

Background

This study examined the one year prospective associations between adolescent social self-control and drug outcomes (cigarette use, alcohol use, marijuana use, hard drug use, and problem drug use) among adolescents from regular and continuation high schools. In our previous cross-sectional study, poor social self-control was found to be associated with higher drug use, controlling for 12 personality disorder categories. In this study, we attempted to find out (a) whether lack of social self-control predicted drug use one year later, and (b) whether drug use at baseline predicted social self-control one year later.

Methods

We surveyed 2081 older adolescents from 9 regular (N = 1529) and 9 continuation (alternative) (N = 552) high schools in the Los Angeles area. Data were collected at two time points in an interval of approximately 1 year.

Results

Past 30-day cigarette smoking, marijuana use, hard drug use, and problem drug use at baseline were found to predict lower social self-control at follow-up, controlling for baseline social self-control and demographic variables. The effect of problem drug use as a one-year predictor of social self-control was found to be moderated by school type (regular or continuation high school), such that the relationship was significant for continuation high school students only. Conversely, social self-control was found to predict past 30-day alcohol use, marijuana use, and problem drug use, controlling for baseline drug use and demographic variables. For alcohol use, marijuana use, and problem drug use outcomes, school type was not found to moderate the effects of social self-control, though an interaction effect was found regarding cigarette smoking. Social self-control was a significant predictor of cigarette use only at regular high school.

Conclusion

The results indicate that social self-control and drug use share a reciprocal relationship. Lack of social self-control in adolescents seems to result in increased drug use, which in turn is likely to further decrease social self-control. Thus, it seems that social self-control is an alterable cognitive-behavioral attribute which can be improved through skill-based interventions in order to prevent drug use among adolescents. Policies aimed at preventing drug abuse among adolescents may benefit from institutionalizing social self-control skills training.

Beliefs about the risks of smoking mediate the relationship between exposure to smoking and smoking

OBJECTIVE

Peer and family smoking are key predictors of adolescent smoking. Yet, it is unclear whether the effect of these variables is direct or indirect through the effects of mediating mechanisms. One possible mechanism is smoking risk beliefs. We hypothesized an indirect effect such that exposure to peer and family smoking may affect adolescents' smoking through two sets of risk beliefs; beliefs about the personal harm of smoking, and beliefs about the general immediate harm of smoking, and these beliefs may in turn affect smoking.

METHODS

Our sample was 963 participants taking part in a longitudinal study of the biobehavioral determinants of smoking. We measured exposure to peer and household smoking in grade 10, smoking risk beliefs in grade 11, and modeled the effects of these variables prospectively on smoking one year post high school graduation in a Structural Equation Model (SEM).

RESULTS

Beliefs about the personal harm and general immediate harm of smoking had significant and negative direct effects on smoking one year post high school. However, controlling for 10th grade smoking, only personal harm beliefs mediated the relationship between household smoking exposure and smoking behavior. Specifically, personal harm beliefs mediated the effect of having a household member who smokes on smoking one year post high school graduation.

CONCLUSIONS

The findings are consistent with the hypothesized mediation model and suggest that exposure to household smoking may affect adolescent smoking through its effects on beliefs about the personal harm of smoking, beyond the effects of previous smoking.