Smokeless tobacco use by middle school males: a preliminary test of the reasoned action theory

Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort

BACKGROUND

Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball.

OBJECTIVES

This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort.

METHODS

Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use).

RESULTS

Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.

Assessing the Get Real about Violence curriculum: process and outcome evaluation results and implications

Guided largely by the theory of reasoned action, the Get Real about Violence curriculum attempts to reduce verbal and physical aggression, as well as behaviors that encourage verbal or physical aggression, such as watching a fight and spreading rumors about a fight that is going to happen. This 12-lesson curriculum was evaluated using a pretest-posttest control group design. Participants were 293 seventh-grade boys and girls enrolled in two public junior high schools in a moderate size Midwestern city. The curriculum had its greatest effect on verbal aggression, where the experimental school outperformed the control school on three of four variables, including behavior, behavioral intent, and attitudes. The experimental school also outperformed the control school in several other instances, including intent to watch a fight, intent to spread rumors about a fight, and beliefs and opinions about fighting and violence in general. Implications for the Get Real about Violence curriculum, and for youth violence prevention and intervention programs are discussed.

The role of social influences and tobacco availability on adolescent smokeless tobacco use

OBJECTIVE

To examine the potential explanatory effect of various demographic, social influence, sanction, and tobacco availability variables on the use of smokeless tobacco (ST) by adolescent males.

DESIGN

The data used in our analyses are from a community-based tobacco policy intervention trial that included a 60-item baseline school survey. During Spring 1993, all 8th, 9th, and 10th-grade students enrolled in 14 school districts in small Minnesota cities were surveyed. We used mixed-model logistic regression to determine which variables were significantly correlated with smokeless tobacco use by males in the past week.

RESULTS

Of this sample of 2924 adolescent males, 10% (n = 291) reported using smokeless tobacco in the past week. Compared to the overall sample, smokeless tobacco users reported higher family and friend use of smokeless tobacco. In addition, 64% of users reported smoking in the past 30 days, and almost half (49.1%) said they had attempted to purchase tobacco in the past 30 days. Variables found to be significantly associated with smokeless tobacco use in the past week included younger age, having a best friend using tobacco, inflated perceptions of their peers' use of tobacco products, beliefs that school and parental sanctions are not high for tobacco use, recent tobacco purchase, and perceived belief that tobacco is not difficult to obtain from social sources.

CONCLUSIONS

This study confirms previous research correlating demographic and social influence factors with ST use and demonstrates the role that sanction and availability variables play in ST use.

Why do adolescents eat low nutrient snacks between meals? An analysis of behavioral determinants with the Fishbein and Ajzen model

This article presents determinants of eating sweet and fat snacks between meals by adolescents (12-15 years). A preliminary qualitative study focused on eliciting students' interpretation of the self-rated terminology 'low nutrient sweet and fat snacks' and the development of a written questionnaire following the principles of the theory of reasoned action (Fishbein & Ajzen, 1980). In a quantitative study a questionnaire was administered to 560 students in the first and second grade of Dutch secondary education. In the data-analysis frequent and moderate users were compared. Frequent users had a more positive attitude towards the intake of sweet and fat snacks than moderate users. The intention to consume sweet snacks was more positive for frequent users. As opposed to frequent users, moderate users had a negative intention towards consuming fat snacks between meals. Moreover, moderate users experienced more social influence against the intake of both snacks than the frequent users. This study demonstrates the usefulness of the theory of reasoned action in relation to the self-rated consumption of sweet and fat snacks eaten between meals. In predicting intention to consume such snacks, attitude turned out to be more important than subjective norm. Finally, the correlation between actual eating behavior as reported by the students, and the behavioral intentions was relatively moderate which was probably caused by inconsistency between intention and behavior.

Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents

Past studies which examined correlates of smokeless tobacco or cigarette use have investigated use of one tobacco product regardless of use of the other product. Thus, the etiology of exclusive use of the two tobacco products is not clear. The present study investigated the relationship of problem-prone-related variables to exclusive versus overlapping use of smokeless tobacco and cigarettes. Two samples of southern California male students (eighth-grade and high school) were divided into groups according to their tobacco use status: neither product, cigarettes only, smokeless tobacco only, or both tobacco products. Generally, triers and monthly users of both tobacco products reported a higher risk-taking preference, greater susceptibility to peer social influence to use tobacco products, and greater likelihood to have tried marijuana and alcohol than did subjects who were not users of either tobacco product. Adolescents who used either product, but not both, reported similar scores on most of the variables examined, which fell in between combined or nonuse categories. These results suggest that the number of tobacco products used, not the specific product, is associated with problem-prone attributes.

Which lesson components mediate refusal assertion skill improvement in school-based adolescent tobacco use prevention?

Any of three components of current school-based refusal assertion training might mediate improvement of seventh grade students' ability to refuse tobacco use offers: 1) teaching students knowledge of ways to say "no," 2) engaging students in the practice of refusal assertion, or 3) motivating students to perform refusal assertion in a socially skilled way. A 3-condition true field experimental "component study" of the differential effects of these three components yielded improvement in role-played behavioral skill to refuse tobacco offers that was evident in both the Knowledge and Practice conditions but not in the Motivation condition. In these same two conditions, skills training led to a significant decrease in students' intention to use smokeless tobacco in the future but not cigarettes. A focus on engaging students in Knowledge and Practice components of refusal assertion training appears warranted.

Attitudes, norms, and self-efficacy: a model of adolescents' HIV-related sexual risk behavior

Using data from a cross-sectional, statewide survey of 1,720 Texas ninth graders in 13 school districts, a model of psychosocial predictors of human immunodeficiency virus (HIV)-related sexual risk behavior was tested. Predictor variables in the model, based on variables from the Theory of Reasoned Action and Social Learning Theory, were attitudes, norms, self-efficacy, and behavioral intentions. Attitudes, norms, and self-efficacy predicted 36.4% of the variance in the intention to limit the number of sexual partners and the same variables plus intention predicted 24.6% of the variance in number of sexual partners in the past year. Attitudes, norms, and self-efficacy regarding condom use predicted 17.0% of the variance in condom use intentions; these variables plus intentions predicted 19.0% of the variance in condom use frequency. Attitudes, norms, and intentions were directly related to the number of sexual partners, while self-efficacy ad condom use intentions were directly related to frequency of condom use.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

Typology and correlates of smokeless tobacco use

The incidence, use patterns, and correlates of smokeless tobacco have become increasingly important as usage rates rise and harmful health effects become established. The present study assessed the incidence of smokeless tobacco use in a Southeastern U.S. sample and selected correlates of use. From the responses of 3725 high school students, 19.9% reported trying smokeless tobacco products (35.5% for males, 5.8% for females). Most agreed that tobacco use has harmful health consequences. Those disagreeing with these health beliefs were more likely to use smokeless tobacco. Cigarette smoking was strongly associated with initial use. Of those reporting any use of smokeless tobacco, most used it for less than an hour per day, but 18% reported 3 or more hours of use per day. Forty-four percent reported a first use of smokeless tobacco before 13 years of age. Early initial use was associated with greater frequency and duration of use. Early initial users also reported greater influence from family and advertisements. Encouragement from friends, however, appeared to be the major factor regardless of age at initial use. Of particular concern is that 8.4% of those having any experience with smokeless tobacco felt they were addicted to the substance. Finally, 27.9% reported swallowing the substance or spittle, suggesting the need for further research on the potential health implications of this behavior.