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Development, Pre-Testing and Feasibility Testing of Multi-Component Interventions, Critical for Mental Health Promotion in Primary Care among Mexican-American Adolescents Living in Rural America. CHILDREN 2023; 10:children10030465. [PMID: 36980023 PMCID: PMC10047234 DOI: 10.3390/children10030465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Abstract
Rural America is often viewed as bereft of social problems facing urban America. Rural families, however, experience stressors due to low employment rates, fewer educational opportunities, a relatively increased incidence of poverty and limited access to mental health care. These families are at increased risk for substance use, violence and associated psychological distress that occurs when failing to cope with stress. Rural children, experiencing these stressors and affected by barriers of culture, poverty and remote access to mental health care, are at higher risk for these negative health outcomes. The need for culturally appropriate intervention tailored to the target population, rural Mexican-American adolescent women, is consistently supported by evidence. A one-size-fits-all approach most likely will not effectively impact behavior and health outcomes. The fact that few studies evaluated effects of mental health interventions on multiple outcomes including substance use, violence, unintended pregnancy and STI is problematic given previously noted associations. Evidence is needed to evaluate associations between mental health interventions and these outcomes. This manuscript presents results of preliminary studies, conducted using a multi-method research approach for development, pre-testing and feasibility testing of interventions for rural primary care settings. This methodology is appropriate when dealing with the complexity of social phenomena. It provides a look at an issue from all angles and thereby the cultural context and perspective informing intervention development. These multi-component interventions are critical for mental health promotion among Mexican-American adolescent women living in rural America.
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Ajith A, Temmen C, Haynie D, Choi K. Association between adolescent smoking and subsequent college completion by parent education - A national longitudinal study. Drug Alcohol Depend 2022; 233:109360. [PMID: 35228079 PMCID: PMC8957578 DOI: 10.1016/j.drugalcdep.2022.109360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/23/2022] [Accepted: 02/15/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Educational attainment is a social determinant of health associated with better quality of life and health outcomes. Current understanding of the association between adolescent smoking and college completion is limited. This study examined the association between adolescent smoking and subsequent college completion and how it varied by parent education in a longitudinal study of U.S. adolescents followed into young adulthood. METHODS Data were collected annually from a nationally representative cohort of 10th graders who participated in the NEXT Generation Health Study (2009 -2017; N = 1407). Participants reported if they smoked during 10th-12th grades (2009-2013). Self-report college completion was assessed in 2017. Parent reported their educational attainment at baseline. Weighted logistic regression models were used to assess the association between adolescent smoking during 10th-12th grades and subsequent college completion in the entire sample and stratified by parent educational attainment, adjusting for demographics, depressive symptoms, alcohol use, and parental monitoring. RESULTS Overall, adolescents who smoked during 10th-12th grade had lower odds of subsequently completing college compared to those who did not smoke (AOR=0.33, 95%CI=0.20-0.57). This association was stronger among those whose parents had ≤high school education (AOR=0.08, 95% CI=0.02-0.31) and some college education (AOR=0.18, 95%CI=0.08-0.39). DISCUSSION Adolescents from lower educational attainment households showed disproportionately stronger association between adolescent smoking and subsequent college completion. Future research needs to determine whether and how strategies to reduce adolescent smoking may promote educational attainment especially among adolescents whose parents have less than a college education.
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Affiliation(s)
- Aniruddh Ajith
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Bldg 3 Rm 5E11, Bethesda, MD 90892, United States
| | - Chelsie Temmen
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr., Room 3139D, MSC 7004, Bethesda, MD 20892, United States
| | - Denise Haynie
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr., Room 3139D, MSC 7004, Bethesda, MD 20892, United States
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Bldg 3 Rm 5E11, Bethesda, MD 90892, United States.
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Bernat DH, Choi K. Differences in Cigarette Use and the Tobacco Environment Among Youth Living in Metropolitan and Nonmetropolitan Areas. J Rural Health 2018; 34:80-87. [PMID: 27443961 PMCID: PMC5585066 DOI: 10.1111/jrh.12194] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE To examine cigarette use and the tobacco-related environment among adolescents living in metropolitan and nonmetropolitan areas. METHODS Data from adolescents ages 14-17 that completed the 2012 Florida Youth Tobacco Survey were analyzed (n = 40,746). This includes a representative sample of middle and high school students throughout the state. RESULTS Nonmetropolitan adolescents were more likely than metropolitan adolescents to report lifetime smoking, past 30-day smoking, daily smoking, initiating smoking at younger ages, having smoked a greater number of cigarettes in their lifetime and in the past 30 days, friend acceptance of adult smoking, a parent offering them a cigarette, living with a smoker, and that smoking was allowed in their home. Nonmetropolitan adolescents were also more likely to have seen tobacco ads the last time they visited convenience marts, gas stations, grocery stores, and big box stores, and flavored tobacco products or ads for them. These differences persisted after controlling for demographics. CONCLUSIONS The present results suggest vast differences in smoking behavior among nonmetropolitan and metropolitan adolescents and that targeting social and environmental factors may be beneficial for reducing tobacco disparities among nonmetropolitan adolescents.
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Affiliation(s)
- Debra H Bernat
- Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland
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Houston KA, Mitchell KA, King J, White A, Ryan BM. Histologic Lung Cancer Incidence Rates and Trends Vary by Race/Ethnicity and Residential County. J Thorac Oncol 2018; 13:497-509. [PMID: 29360512 PMCID: PMC5884169 DOI: 10.1016/j.jtho.2017.12.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/30/2017] [Accepted: 12/21/2017] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lung cancer incidence is higher among non-Hispanic (NH) blacks than among the NH white and Hispanic populations in the United States. However, national cancer estimates may not always reflect the cancer burden in terms of disparities and incidence in small geographic areas, especially urban-rural disparities. Moreover, there is a gap in the literature regarding rural-urban disparities in terms of cancer histologic type. METHODS Using population-based cancer registry data-Surveillance, Epidemiology and End Results and National Program of Cancer Registries data-we present age-adjusted histologic rates and trends by race/ethnicity and residential county location at the time of first cancer diagnosis. Rate ratios were calculated to examine racial/ethnic differences in rates. Annual percent change was calculated to measure changes in rates over time. RESULTS We found that declines in squamous cell carcinoma are occurring fastest in metropolitan counties, whereas rates of adenocarcinoma increased fastest in counties nonadjacent to metropolitan areas. Further, although NH black men have increased lung cancer incidence compared with NH white and Hispanic men in all geographic locations, we found that the degree of the disparity increases with increasing rurality of residence. Finally, we discovered that among women whose lung cancer was diagnosed when they were younger than 55 years, the incidence of squamous cell carcinoma and adenocarcinoma was higher for NH blacks than for NH whites. CONCLUSIONS Our results highlight disparities among NH blacks in nonadjacent rural areas. These findings may have significant impact for the implementation of smoking cessation and lung cancer screening programs.
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Affiliation(s)
- Keisha A. Houston
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Khadijah A. Mitchell
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
| | - Jessica King
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Arica White
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD, 20892
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Fergus S, Zimmerman MA, Caldwell CH. Psychosocial Correlates of Smoking Trajectories Among Urban African American Adolescents. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558405274688] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known of smoking trajectories or of the correlates of smoking trajectories among African American youth. Ninth-grade African American adolescents (n = 566) were interviewed in Year 1 and then were subsequently interviewed annually for 3 additional years. Five trajectories of cigarette smokers were identified: abstainers, experimenters/consistent light smokers, consistent regular smokers, accelerators, and quitters. Psychological well-being at Year 1 was lower among consistent regular smokers and accelerators as compared to abstainers. Variance in other problem behaviors mirrored the smoker trajectories. At Year 4,the abstainers and experimenters/consistent light smokers reported greater participation in sports activities as compared to the quitters, whereas the abstainers reported greater participation in other school activities as compared to the consistent regular smokers.
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Liu L, Edland S, Myers MG, Hofstetter CR, Al-Delaimy WK. Smoking prevalence in urban and rural populations: findings from California between 2001 and 2012. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:152-61. [PMID: 26821213 DOI: 10.3109/00952990.2015.1125494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco smoking and related health problems are still major public health concerns in the United States despite the declining smoking prevalence. OBJECTIVES This study explored differences in smoking prevalence between urban and rural areas potentially relevant to tobacco control efforts in California. METHODS Public use adult smoking data from the California Health Interview Survey (CHIS) between 2001 and 2011-2012 were analyzed. A total of 282 931 adults were surveyed across the six CHIS cycles. A ZIP code-based geographic classification (Urban, Second-City, Suburban, and Town/Rural) was used to examine the association between smoking prevalence and area of residency. RESULTS The overall smoking prevalence in California decreased from 17.0% in 2001 to 13.8% in 2011-2012. Within each CHIS cycle, the Town/Rural areas had the highest smoking prevalence, followed by Urban and Second-City areas, and Suburban areas had the lowest. Pooled data from all CHIS cycles showed a similar pattern, with rates in Urban, Second-City, Suburban and Town/Rural areas being 15.2%, 15.2%, 13.1% and 17.3%, respectively. Weighted multivariate logistic regression analysis indicated significantly higher odds of smoking in Urban, Second-City and Town/Rural areas compared to Suburban areas (all adjusted odds ratios > 1.10), although this trend varied by race/ethnicity, being present in non-Hispanic Whites and not present in Hispanics. CONCLUSIONS Town/Rural and Urban populations of California are consistently at higher risk of smoking than Suburban populations. These results indicate a need for population-specific tobacco control approaches that address the lifestyle, behavior, and education of disparate populations within the same state or region.
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Affiliation(s)
- Lianqi Liu
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
| | - Steven Edland
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
| | - Mark G Myers
- b Psychology Service, Veterans Affairs San Diego Healthcare System, and the Department of Psychiatry , University of California, San Diego , La Jolla , CA , USA
| | - C Richard Hofstetter
- c Graduate School of Public Health and the Department of Political Science, San Diego State University , San Diego , CA , USA
| | - Wael K Al-Delaimy
- a Department of Family Medicine and Public Health , University of California, San Diego , La Jolla , CA , USA
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Johns M, Sacks R, Rane M, Kansagra SM. Exposure to tobacco retail outlets and smoking initiation among New York City adolescents. J Urban Health 2013; 90:1091-101. [PMID: 23700202 PMCID: PMC3853172 DOI: 10.1007/s11524-013-9810-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study was designed to estimate the relationship between exposure to tobacco retail outlets and smoking initiation in a racially diverse urban setting. Using data from the 2011 NYC Youth Risk Behavior Survey, multivariable logistic regression analyses were conducted to estimate the exposure-initiation relationship and test for effect modification, while controlling for covariates. The predicted probability of smoking initiation from the multivariable model increased from 7.7 % for zero times a week exposed to tobacco retailers to 16.0 % for exposure seven times or more per week. The odds of initiation were significantly higher among adolescents exposed to tobacco retail outlets two times or more a week compared with those exposed less often (AOR = 1.41; 95 % CI: 1.08, 1.84). Risk-taking behavior modified the relationship between exposure and initiation, with the odds of initiation highest among those low in risk-taking (AOR = 1.78; 95 % CI: 1.14, 1.56). These results are consistent with past research, showing that frequent exposure to tobacco marketing in retail settings is associated with increased odds of initiation. Reducing exposure to tobacco retail marketing could play an important role in curtailing smoking among adolescents, especially those less prone to risk-taking.
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Affiliation(s)
- Michael Johns
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th St., 9th Floor, CN-18, Long Island City, NY, 11101, USA,
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Hong NS, Kim KY, Park SW, Kim JY, Bae J, Lee WK, Kim KS. Trends in cigarette use behaviors among adolescents by region in Korea. J Prev Med Public Health 2012; 44:176-84. [PMID: 21894066 PMCID: PMC3249254 DOI: 10.3961/jpmph.2011.44.4.176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Understanding recent trends in cigarette smoking among adolescents is important in order to develop strategies to prevent cigarette smoking. The aim of this study was to compare recent trends in cigarette smoking for adolescents living in rural areas, small towns and metropolitan cities in Korea. Methods The raw data from the Korea Youth Risk Behavior Web-based Survey (KYRBWS) from 2005 to 2009 were used. Data were analyzed by using the method of complex survey data analysis considering complex sampling design. Logistic regression models were used to evaluate significant linear time trends in cigarette smoking. The indicators of cigarette use behaviors were 'current smoking rate', 'frequent smoking rate', 'heavy smoking rate' and 'smoking experience rate before 13 years of age'. All analyses were conducted according to gender. Results Statistically significant increasing trends in current smoking rate and frequent smoking rate were observed and borderline significant increasing trends in heavy smoking rate were shown among rural boys. Among metropolitan city boys, statistically significant increasing trends were also seen for frequent smoking. Statistically significant decreasing trends in current smoking rate were observed among small town and metropolitan city girls. Smoking experience rate before 13 years of age for rural girls decreased significantly. Conclusions Cigarette smoking prevalence among adolescents in the rural areas has increased in the last five years especially among boys. Our findings suggest that anti-tobacco program for adolescents should be conducted primarily for those in rural areas.
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Affiliation(s)
- Nam Soo Hong
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
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Oredein T, Foulds J. Causes of the decline in cigarette smoking among African American youths from the 1970s to the 1990s. Am J Public Health 2011; 101:e4-e14. [PMID: 21852655 PMCID: PMC3222352 DOI: 10.2105/ajph.2011.300289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2011] [Indexed: 11/04/2022]
Abstract
Adult cigarette smoking prevalence trends among African Americans (AAs) and Whites are similar. However, during the decline in youth smoking that occurred between the mid-1970s and the early 1990s, the drop in smoking rates among AA adolescents was more than double that among Whites. We examined the evidence for potential explanations for this phenomenon. On the basis of our findings, we propose that racial differences in parental attitudes, religious ties, negative perceptions and experiences of the health effects of smoking, worsening poverty, increased use of food stamps, and price sensitivity were major factors contributing to the more rapid decrease in and continued lower rates of smoking among AA youths.
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Affiliation(s)
- Tyree Oredein
- School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, USA.
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Sahmoun AE, Schwartz GG. Smoking and Supplement Use Among Men in a Rural Population. J Diet Suppl 2009; 6:280-9. [DOI: 10.1080/19390210903149493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Asumda F, Jordan L. Minority youth access to tobacco: a neighborhood analysis of underage tobacco sales. Health Place 2009; 15:140-7. [PMID: 18482856 DOI: 10.1016/j.healthplace.2008.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 03/12/2008] [Accepted: 03/18/2008] [Indexed: 11/18/2022]
Abstract
The geographic and racial-ethnic inequities in health in the US are concerning, and their reduction is a priority for the national health initiative: Health People 2010. Though voluntary, life-style factors, such as smoking, are partially a cause of unevenness in health outcomes, targeting tobacco to minority youth raises questions about the extent to which behaviors are exacerbated by the local retail environment. In this case study, a GIS analysis of neighborhoods where businesses sold tobacco to minors was conducted with 2005 Florida Department of Health, and US census data, finding that in Miami, underage tobacco sales were significantly more concentrated in Hispanic majority neighborhoods.
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Affiliation(s)
- Faizal Asumda
- University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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Cupertino PA, Richter KP, Cox LS, Nazir N, Greiner AK, Ahluwalia JS, Ellerbeck EF. Smoking cessation pharmacotherapy preferences in rural primary care. Nicotine Tob Res 2008; 10:301-7. [PMID: 18236294 DOI: 10.1080/14622200701825817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pharmacotherapy is a critical adjunct to smoking cessation therapy. Little is known about relative preferences for these agents among smokers in primary care settings. In the context of a population-based clinical trial, we identified 750 smokers in primary care practices and independent of their readiness to quit offered them a free treatment course of either bupropion or transdermal nicotine replacement (TNR). Smokers opting for pharmacotherapy completed standardized contraindication screens that were reviewed by the patient's primary care physician. Most participants (67%) requested pharmacotherapy. Use of pharmacotherapy was positively associated with higher nicotine dependence and readiness to quit. Of the smokers requesting pharmacotherapy, 51% requested bupropion and 49% requested TNR. Choice of bupropion was related to no history of heart disease and no previous use of bupropion. Although potential contraindications to treatments were identified for 21.7% of bupropion and 6.6% of TNR recipients, physicians rarely felt that these potential contraindications precluded the use of these agents. When cost is removed as a barrier, a large proportion of rural smokers are eager to use smoking cessation pharmacotherapy, especially agents that they have not tried before. Although some comorbid conditions and concurrent drug therapies were considered contraindications, particularly to bupropion, physicians rarely considered these clinically significant risks enough to deny pharmacotherapy.
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Affiliation(s)
- Paula A Cupertino
- University of Kansas Medical Center, Department of Preventive Medicine and Public Health, Kansas City, KS, USA.
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Scales MB, Monahan JL, Rhodes N, Roskos-Ewoldsen D, Johnson-Turbes A. Adolescents' perceptions of smoking and stress reduction. HEALTH EDUCATION & BEHAVIOR 2008; 36:746-58. [PMID: 18477670 DOI: 10.1177/1090198108317628] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study examined how adolescents perceive the relationship between smoking and stress and where they learn that smoking cigarettes may be an effective stress-reduction mechanism. Eight focus groups were conducted with low-income African American and European American 14- to 16-year-olds in urban and rural locations, in which they suggested that the primary reasons why they smoked-namely, as a coping mechanism (to calm nerves), for social acceptance, and because of environmental influences. Family issues, boyfriend/girlfriend problems, and school were common stressors. Although participants overwhelmingly believed that people smoke to reduce their stress, a few believed that cigarettes do not actually reduce stress. When asked for examples of smoking in popular media, teens predominantly generated examples of individuals smoking to reduce stress. Ethnic and gender differences were found among the types of media in which they had seen smoking, their opinions of anti-smoking messages, and the media's perceived influence.
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Hutcheson TD, Greiner KA, Ellerbeck EF, Jeffries SK, Mussulman LM, Casey GN. Understanding Smoking Cessation in Rural Communities. J Rural Health 2008; 24:116-24. [DOI: 10.1111/j.1748-0361.2008.00147.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brady JE, Weitzman BC. Inconsistencies in place definition: How different operational place definitions affect estimates of adolescent smoking and drinking risk. Health Place 2006; 13:562-8. [PMID: 16839799 DOI: 10.1016/j.healthplace.2006.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2005] [Revised: 11/17/2005] [Accepted: 05/01/2006] [Indexed: 10/24/2022]
Abstract
We find that estimates of the prevalence of teenage smoking and drinking in "urban," "suburban," and "rural" areas vary with different definitions of these types of geographic units. Given the salience of youth risk behavior to the public debate, we urge researchers to purposefully choose their definitions of geographic areas and to be explicit about those choices.
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Affiliation(s)
- Joanne E Brady
- Principal Research Associate, National Development Research Institute, 71 West 23rd Street, 8th Floor, New York, NY 10010, USA.
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Völzke H, Neuhauser H, Moebus S, Baumert J, Berger K, Stang A, Ellert U, Werner A, Döring A. Urban-rural disparities in smoking behaviour in Germany. BMC Public Health 2006; 6:146. [PMID: 16756650 PMCID: PMC1513566 DOI: 10.1186/1471-2458-6-146] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/06/2006] [Indexed: 11/21/2022] Open
Abstract
Background It is currently not clear whether individuals living in metropolitan areas differ from individuals living in rural and urban areas with respect to smoking behaviours. Therefore, we sought to explore the relation between residential area and smoking behaviours in Germany. Methods We used a nationwide German census representative for the general population of Germany. A number of 181,324 subjects aged 10 years or older were included. Information on the average daily usage of cigarettes that have or had been smoked formerly or currently was available in subjects who have ever smoked. A daily consumption of more than 20 cigarettes was considered heavy smoking. Logistic regression analyses were performed sex-stratified and adjusted for relevant confounders. Results Analyses revealed inhabitants of metropolitan areas to be more likely current smokers than inhabitants of rural areas (odds ratio 1.56, 95%-confidence interval 1.51; 1.62). Among current and former smokers those who lived in urban communities had also increased odds for being heavy smokers than those who lived in rural communities. Conclusion We conclude that living in an urban and particularly living in a metropolitan area is a determinant of both smoking and severity of current smoking. Tobacco control programs should recognize the difference in living conditions between rural and urban areas.
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Affiliation(s)
- Henry Völzke
- Institute of Epidemiology and Social Medicine, University of Greifswald, Germany
| | | | - Susanne Moebus
- Institute for Medical Informatics, University of Essen, Germany
| | - Jens Baumert
- Institute of Epidemiology, GSF National Research Centre for Environment and Health Neuherberg, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Muenster, Germany
| | - Andreas Stang
- Institute of Medical Epidemiology, Biometry and Informatics, Martin Luther University of Halle-Wittenberg, Germany
| | | | - André Werner
- Institute of Epidemiology and Social Medicine, University of Greifswald, Germany
| | - Angela Döring
- Institute of Epidemiology, GSF National Research Centre for Environment and Health Neuherberg, Germany
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Zollinger TW, Saywell RM, Overgaard AD, Przybylski MJ, Dutta-Bergman M. Antitobacco media awareness of rural youth compared to suburban and urban youth in Indiana. J Rural Health 2006; 22:119-23. [PMID: 16606422 DOI: 10.1111/j.1748-0361.2006.00019.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE This study examined the awareness and impact of antitobacco media messages among rural, suburban, and urban youth. METHOD Self-administered questionnaires were received from 1,622, 1,059, and 1,177 middle school (sixth, seventh, and eighth grade) students in rural, suburban, and urban locations, respectively. Logistic regression compared media awareness and impact among the groups, controlling for grade, gender, race, and smoking behavior. RESULTS Compared to rural youth, suburban youth were more likely to recall media messages about the dangerous health effects of tobacco use (odds ratio [OR] = 1.94) and have their personal choice to use tobacco affected by the messages (OR = 1.85). Suburban and urban youth more often recalled antitobacco messages (OR = 2.00 and 2.15), reported that the messages made them think about the dangers of tobacco use (OR = 2.02 and 1.47), believed that these ads prevent youth from initiating tobacco use (OR = 3.21 and 1.46) and stop youth from using tobacco (OR = 2.25 and 1.47), and recalled seeing specific campaign television ads (OR = 3.72 and 3.57). Urban youth were more likely to recall specific campaign messages on the radio (OR = 1.58). Neither suburban nor urban youth differed from the rural youth on whether the campaign-specific radio and television ads made them think about not using tobacco. CONCLUSIONS The results support the need for targeting antitobacco media announcements to youth, based on their residence.
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Affiliation(s)
- Terrell W Zollinger
- Department of Family Medicine and Bowen Research Center, Indiana University School of Medicine, Long Hospital 200, Indianapolis, Indiana 46202-5102, USA.
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Affiliation(s)
- Sharon M Coyer
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Sasco AJ, Laforest L, Benhaïm-Luzon V, Poncet M, Little RE. Smoking and its correlates among preadolescent children in France. Prev Med 2002; 34:226-34. [PMID: 11817919 DOI: 10.1006/pmed.2001.0980] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Smoking often begins in early adolescence, and addiction can occur rapidly. For effective smoking prevention efforts with younger children, knowledge of their early smoking experience is needed. The purpose of this paper was to report the smoking experience of French elementary school children and to describe their lifestyle habits and health knowledge. METHODS A cross-sectional study of 913 children age 9-11 years in 31 randomly selected schools of the Loire administrative department in France was conducted, using anonymous previously validated questionnaires. Correlates of smoking initiation and intention to smoke in the future were assessed by unconditional logistic regression analysis. RESULTS A total of 12.3% of the children had smoked at least one cigarette, 5.1% within the previous 30 days. Correlates of ever smoking were male sex, older age, engaging in physical activity, reporting not following safety-related recommendations, or drinking alcohol. Of the 112 children who reported ever smoking, 45.5% stated that they did not want to remain smokers in the future and an additional 26.8% were not sure. CONCLUSIONS Information on the smoking experience of preadolescents should help in designing effective prevention programs, which are essential for reinforcing abstinence in nonsmokers and preventing others from progressing to addiction.
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Affiliation(s)
- Annie J Sasco
- Unit of Epidemiology for Cancer Prevention, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 8, France.
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Sarvela PD, Monge EA, Shannon DV, Nawrot R. Age of first use of cigarettes among rural and small town elementary school children in Illinois. THE JOURNAL OF SCHOOL HEALTH 1999; 69:398-402. [PMID: 10685376 DOI: 10.1111/j.1746-1561.1999.tb06356.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study determined age of first use of cigarettes among rural and small town elementary school students. Data were collected from 1,950 elementary school students, grades kindergarten through sixth, attending seven different schools in southern Illinois. Bivariate odds ratios and multivariate logistic regression procedures identified risk factors of cigarette use among this elementary school population. A Duncan multiple-range test revealed no significant difference in cigarette use between grades kindergarten through fifth (average percentage of use for those grades was 4.7%), but use increased significantly to 17.4% in the sixth grade. Predictor variables with the greatest odds ratios were having tried alcohol (OR = 8), having tried chewing tobacco or snuff (OR = 4.4), and being in the sixth grade (OR = 2.2). Healthy People 2010 draft objectives emphasize prevention and reduction of tobacco use among youth. To be effective, tobacco prevention programs must begin in the elementary school years.
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Affiliation(s)
- P D Sarvela
- Center for Rural Health and Social Service Development, Southern Illinois University, Carbondale 62901-6892.
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