Behavior Change Techniques That Prevent or Decrease Obesity in Youth With a Low Socioeconomic Status: A Systematic Review and Meta-Analysis

Background: Interventions, targeting youth, are necessary to prevent obesity later in life. Especially youth with low socioeconomic status (SES) are vulnerable to develop obesity. This meta-analysis examines the effectiveness of behavioral change techniques (BCTs) to prevent or reduce obesity among 0 to 18-year-olds with a low SES in developed countries. Method: Intervention studies were identified from systematic reviews or meta-analyses published between 2010 and 2020 and retrieved from PsycInfo, Cochrane systematic review, and PubMed. The main outcome was body mass index (BMI), and we coded the BCTs. Results: Data from 30 studies were included in the meta-analysis. The pooled postintervention effects of these studies indicated a nonsignificant decrease in BMI for the intervention group. Longer follow-up (≥12 months) showed favorable differences for intervention studies, although that BMI change was small. Subgroup analyses showed larger effects for studies with six or more BCTs. Furthermore, subgroup analyses showed a significant pooled effect in favor of the intervention for the presence of a specific BCT (problem-solving, social support, instruction on how to perform the behavior, identification of self as role model, and demonstration of the behavior), or absence of a specific BCT (information about health consequences). The intervention program duration and age group of the study population did not significantly influence the studies' effect sizes. Conclusions: Generally, the effects of interventions on BMI change among youth with low SES are small to neglectable. Studies with more than six BCTs and/or specific BCTs had a higher likelihood of decreasing BMI of youth with low SES.

360° Diagnostic Tool to Personalize Lifestyle Advice in Primary Care for People With Type 2 Diabetes: Development and Usability Study

BACKGROUND

Various multifaceted factors need to be addressed to improve the health and quality of life of people with type 2 diabetes (T2D). Therefore, we developed a web-based decision support tool that comprises a more holistic diagnosis (including 4 domains: body, thinking and feeling, behavior, and environment) and personalized advice. This 360° diagnostic tool enables people with T2D and health care professionals at the general practice to obtain an overview of the most important T2D-related issues and, subsequently, determine the most suitable intervention for the person with T2D.

OBJECTIVE

This study aimed to describe the systematic and iterative development and evaluation of the web-based 360° diagnostic tool.

METHODS

We defined the requirements for the web-based 360° diagnostic tool based on previously developed tools, a literature review, and inputs from a multidisciplinary team of experts. As part of the conceptualization, we defined 3 requirements: diagnostics; feedback; and advice, consultation, and follow-up. Next, we developed and designed the content for each of these requirements. We evaluated the diagnostic part of the tool (ie, measurement instruments and visualization) with a qualitative design, in a usability study with a think-aloud strategy and interview questions, among 8 people with T2D at a Dutch general practice.

RESULTS

For each of the 4 domains, specific parameters and underlying elements were selected, and measurement instruments (including clinical data and questionnaires) were chosen. Cutoff values were defined to identify high-, middle-, and low-ranking scores, and decision rules were developed and implemented using R scripts and algorithms. A traffic light color visual design was created (profile wheel) to provide an overview of the scores per domain. We mapped the interventions that could be added to the tool and developed a protocol designed as a card deck with motivational interview steps. Furthermore, the usability study showed that people with T2D perceived the tool as easy to use, useful, easy to understand, and insightful.

CONCLUSIONS

Preliminary evaluation of the 360° diagnostic tool by experts, health care professionals, and people with T2D showed that the tool was considered relevant, clear, and practical. The iterative process provided insights into the areas of improvement, which were implemented. The strengths, shortcomings, future use, and challenges are also discussed.

Predictors of the Acceptance of an eCoach targeting Self-management of Type 2 Diabetes Patients: A Web-Based Survey (Preprint)

Background

Type 2 diabetes (T2D) is a lifestyle-related disease whose prevalence increases with age. Diabetes self-management through mobile health (mHealth) apps enables patients with T2D to improve their health. According to the Technology Acceptance Model (TAM), technology acceptance (ie, intended use) is necessary to ensure mHealth can be implemented successfully. Therefore, the specific acceptance requirements of patients with T2D should be considered.

Objective

This cross-sectional study aims to examine the extent to which different TAM predictors are associated with the acceptance of a diabetes app including an electronic coach (eCoach; Iris app) among patients with T2D.

Methods

Using a web-based survey, data on 92 patients with T2D (mean age 62.76 years, SD 8.29 years) were collected. Acceptance of the Iris app with the TAM predictors (ie, perceived usefulness, perceived ease of use, social influence, perceived self-efficacy, perceived security, prior usage experience, perceived health, and propensity of data/information sharing) was assessed. Further, control variables (ie, gender, age, education, ethnicity, household, BMI, amount of years with diabetes, diabetes-related complaints, and medication use) were assessed.

Results

Multiple linear regression analyses showed that acceptance of the Iris app was positively associated with perceived usefulness (β=.57, P<.001), social influence (subjective norm; β=.20, P=.004), and willingness to share data (β=.25, P<.001). In addition, acceptance regarding the Iris app was higher among patients with T2D with overweight (β=.23, P=.01) or obese BMI (β=.21, P=.01). The model explained 75.8% of the variance in the acceptance of the Iris app by patients with T2D. In addition, perceived usefulness of the Iris app was positively related to perceived ease of use (β=.32, P<.001), subjective norm (β=.26, P=.004), perceived control (β=.19, P=.03), willingness to share data (β=.20, P=.01) regarding the Iris app, and perceived security regarding general use of apps/smartphone/internet (β=.15, P=.04). The model explained 58.2% of the variance in patients’ perceived usefulness about the Iris app.

Conclusions

Among patients with T2D, the belief that the use of the Iris app is helpful/beneficial, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the acceptance of this app. In addition, the belief that the use of (health) apps is reliable and secure, the belief that the use of the Iris app is easy to use, a higher perceived capability and personal control with using this app, the willingness to share their Iris app data, and others’ approval of using this app can stimulate the perceived usefulness of such an app. These TAM predictors explained a high variance in acceptance and perceived usefulness of the Iris app. Implications for practice are addressed.

Who Sets the Aggressive Popularity Norm in Classrooms? It's the Number and Strength of Aggressive, Prosocial, and Bi-Strategic Adolescents

Previous work has shown that during adolescence, classrooms vary greatly in the extent to which aggression is rewarded with popularity (the ‘popularity norm’). Aggressive popularity norms may promote the proliferation of aggression and negatively affect the classroom climate. It is, however, unknown how these norms emerge in the first place. This longitudinal study therefore investigated whether aggressive popularity norms can be predicted by the classroom composition of students. We examined whether the prevalence of six student types - socially and non-socially dominant prosocial, aggressive, and bi-strategic adolescents (adolescents who are both highly prosocial and aggressive) - contributed to the norm by establishing a popularity hierarchy: strong classroom asymmetries in popularity. We collected peer-nominated data at three secondary schools in the Netherlands (SNARE-study; N_students = 2843; N_classrooms = 120; 51.4% girls; M_age = 13.2). Classroom-level regression analyses suggest that the classroom percentage of socially dominant aggressive and bi-strategic students predicted higher aggressive popularity norms, both directly and by enhancing the classrooms’ popularity hierarchy. Instead, the presence of non-socially dominant aggressive students and socially dominant prosocial students contributed to lower aggressive popularity norms. Socially dominant prosocial students also buffered against the role of socially dominant aggressive adolescents in the aggressive popularity norm (moderation), but not against bi-strategic adolescents’ role. Our findings indicate that interventions aimed at reducing aggressive popularity norms should first and foremost take the composition of classrooms at the start of the school year into account; and should not only encourage prosocial behavior, but also actively discourage aggression.

Parental alcohol-specific rules effectively reduce adolescents' tobacco and cannabis use: A longitudinal study

AIMS

The current study aimed to longitudinally examine the direct and indirect effects (via alcohol use) of parental alcohol-specific rule-setting on adolescent tobacco and cannabis use. Based on the gateway hypothesis, we expected parental alcohol-specific rules to affect adolescent tobacco and cannabis use through adolescent alcohol use.

DESIGN AND PARTICIPANTS

A longitudinal design including three waves and 906 Dutch adolescents (Mage = 13.51 years, SD = 0.60) was used to apply zero-inflated Poisson models (ZIP).

MEASUREMENTS

Self-report questionnaires measured adolescents' perceived rules about alcohol at T1, cigarette use at T1 and T3 (frequency of life-time and current smoking), cannabis use at T1/T3 (frequency of yearly and monthly use) and frequency of monthly alcohol use at T1/T2.

FINDINGS

Stricter alcohol-specific rules at T1 predicted lower incidence and prevalence rates of cigarette (life-time: β = -0.20, p < .00; current: β = -0.21, p = .04) and cannabis use (monthly: β = -0.43, p = .02; yearly: β = -0.28, p = .19) two years later (T3). This direct effect was no longer significant when alcohol use at T1 was controlled for. Moreover, a significant indirect effect of alcohol-specific rules at T1 on tobacco and cannabis use T3 via monthly alcohol use T2 was found.

CONCLUSIONS

The current study demonstrated that strict rules regarding alcohol may not only reduce alcohol but subsequently also other substance use such as tobacco and cannabis. Thus, interventions targeting the prevention of alcohol use, which appears to serve as a gateway, also affects the involvement in other substances.

Associations between Ethnic Minority Status and Popularity in Adolescence: the role of Ethnic Classroom Composition and Aggression

Although there are theoretical reasons to expect an association between ethnic minority status and popularity, research on this topic is scarce. Therefore, this association was investigated including the moderating role of the ethnic classroom composition and the mediating role of aggression. Data from the longitudinal Dutch SNARE (Social Network Analysis of Risk behavior in Early adolescence) project were used among first-year students (comparable to 5th grade) (N = 1134, N_classrooms = 51, M = 12.5 years, 137 non-Western ethnic minority students). Popularity and aggression were assessed with peer nominations. Multi-level Structural Equation Models showed that ethnic minority status was indirectly associated with higher popularity, through higher aggression. Moreover, with increasing numbers of ethnic minority students in the classroom, popularity levels of both ethnic majority and ethnic minority students decreased. Only when differences in aggression between ethnic minority and majority students were included in the analyses, while the ethnic classroom composition was not included, lower popularity levels were found for ethnic minority than ethnic majority students. Scientific and practical implications of this study were addressed in the discussion.

Classroom Popularity Hierarchy Predicts Prosocial and Aggressive Popularity Norms Across the School Year

This study examined the coevolution of prosocial and aggressive popularity norms with popularity hierarchy (asymmetries in students' popularity). Cross-lagged-panel analyses were conducted on 2,843 secondary school students (Nclassrooms  = 120; Mage  = 13.18; 51.3% girls). Popularity hierarchy predicted relative change in popularity norms over time, but not vice versa. Specifically, classrooms with few highly popular and many unpopular students increased in aggressive popularity norms at the beginning of the school year and decreased in prosocial popularity norms at the end of the year. Also, strong within-classroom asymmetries in popularity predicted relatively higher aggressive popularity norms. These findings may indicate that hierarchical contexts elicit competition for popularity, with high aggression and low prosocial behavior being seen as valuable tools to achieve popularity.

The role of academic status norms in friendship selection and influence processes related to academic achievement

This study examined the role of academic status norms in friendship selection and influence processes related to academic achievement across the 2nd year of secondary school (SNARE project; N = 1,549 students from 70 classes; M_age = 13.69 years). Academic status norms were operationalized as the class-level correlation between academic achievement and 4 types of peer status: popularity, acceptance, unpopularity, and rejection. Longitudinal social network analyses indicated that the unpopularity and popularity norm play a role in friendship selection processes (but not influence processes) related to academic achievement. In line with our hypotheses, the unpopularity norm in the classroom strengthened similarity-based friendship selection among low-achieving adolescents and predicted greater avoidance of academically similar friends among high-achieving adolescents. Also, the popularity norm strengthened friendship selection among similar peers, both among low and high achievers. Acceptance and rejection norms did not play a role in friendship processes. In sum, the average achievement of popular and unpopular peers shapes friendship preferences in the classroom, which may have important implications for adolescent academic development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Effect of Rap/Hip-Hop Music on Young Adult Smoking: An Experimental Study

BACKGROUND

Music may influence young people's behavior through its lyrics. Substance use references occur more frequently in rap/hip-hop than in other music genres.

OBJECTIVES

The aim was to examine whether the exposure to rap/hip-hop lyrics referring to substance use affected cigarette smoking.

METHODS

An experiment with a 3-group between subject design was conducted among 74 daily-smoking young adults ranging in age from 17 to 25 years old. Three conditions were tested in a mobile lab (camper vehicle) from May to December 2011, i.e., regular chart pop music (N = 28), rap/hip-hop with non-frequent references to substance use (N = 24), and rap/hip-hop with frequent references to substance use (N = 22).

RESULTS

One-way ANOVA showed that participants listening to substance use infused rap/hip-hop songs felt significantly less pleasant, liked the songs less, and comprehended the songs less compared to participants listening to pop songs. Poisson loglinear analyses revealed that compared to the pop music condition, none of the two rap/hip-hop music conditions had a significant effect on acute smoking. Thus, contrary to expectations, the two different rap/hip-hop conditions did not have a significantly different effect on acute smoking.

CONCLUSIONS

Listening to rap/hip-hop, even rap hip/hop with frequent referrals to substance use (primarily alcohol and drug use, and general smoking referrals), does not seem to encourage cigarette smoking among Dutch daily-smoking young adults, at least short term.

Imitating the Risky Decision-Making of Peers: An Experimental Study Among Emerging Adults

This experiment examined whether emerging adults imitate the risky decision-making of peers and whether peer susceptibility functions as a moderator. Overall, 63 emerging adults participated with a confederate of the same gender. The participants were randomly assigned to the experimental (confederate engaged in risky decision-making) or control (confederate did not engage in risky decision-making) condition. Risky decision-making was measured with the Stop-Light Game task, and peer susceptibility was measured with a questionnaire. Linear regression analyses showed that the participants engaged in more risky decision-making when the peer displayed risky decision-making. Peer susceptibility was not found to be a significant moderator of this relationship. The findings showed that health education programs need to consider imitation to reduce the risky decision-making of emerging adults more effectively.

The Effect of Active and Passive Peer Discouragement on Adolescent Risk taking: An Experimental Study

This experiment investigated the effect of peer discouragement on adolescent risk taking. Overall, 269 Dutch adolescents aged 11-15 years completed a risk taking computer task in the presence of an e-confederate who demonstrated very little risk taking (passive peer discouragement) and/or sent risk-discouraging messages to participants (active peer discouragement). The results showed that, compared to a situation with no peer discouragement, adolescents took significantly less risk only when they encountered a combination of active and passive peer discouragement; hence, when peers practiced what they preached. No gender differences were found in the effect of passive and active peer discouragement on risk taking. The results showed that digital peer messages play a promising role in diminishing adolescent risk taking.

Early Adolescent Friendship Selection Based on Externalizing Behavior: the Moderating Role of Pubertal Development. The SNARE Study

This study examined friendship (de-)selection processes in early adolescence. Pubertal development was examined as a potential moderator. It was expected that pubertal development would be associated with an increased tendency for adolescents to select their friends based on their similarities in externalizing behavior engagement (i.e., delinquency, alcohol use, and tobacco use). Data were used from the first three waves of the SNARE (Social Network Analysis of Risk behavior in Early adolescence) study (N = 1144; 50 % boys; M_age = 12.7; SD = 0.47), including students who entered the first year of secondary school. The hypothesis was tested using Stochastic Actor-Based Modeling in SIENA. While taking the network structure into account, and controlling for peer influence effects, the results supported this hypothesis. Early adolescents with higher pubertal development were as likely as their peers to select friends based on similarity in externalizing behavior and especially likely to remain friends with peers who had a similar level of externalizing behavior, and thus break friendship ties with dissimilar friends in this respect. As early adolescents are actively engaged in reorganizing their social context, adolescents with a higher pubertal development are especially likely to lose friendships with peers who do not engage in externalizing behavior, thus losing an important source of adaptive social control (i.e., friends who do not engage in externalizing behavior).

Young People Smokers' Reactions on Peer Influence Not to Smoke

BACKGROUND

Peers exert influence not to smoke but little is yet known on how this affects young people's behavior and cognitions.

OBJECTIVES

This experimental study investigates the impact of two types of peer influence not to smoke on the verbalized attitudes and responses of daily-smoking young people.

METHODS

Two conditions were conducted: 1) a peer confederate stating three times that s/he had quit smoking and was glad to have done so (covert peer influence); 2) a peer confederate making similar statements, but urging to quit smoking (overt peer influence). The participant performed a music task with the peer in order to disguise the true nature of the experiment. Thirty-one daily-smoking young people (16-24 years) participated; 44 responses in the overt and 34 responses in the covert condition were analyzed in a discourse analysis.

RESULTS

The participants in the covert condition were more elaborative about smoking, i.e., taking an active role in a dialogue about the experiences of the peer or the participant in quitting smoking while in the overt condition participants showed more passive resistance, i.e., not showing an intention to follow the advice but avoid causing the peer embarrassment or discomfort. Open resistance, i.e., demonstration of being well-informed and indicating the redundancy of the advice, does not significantly differ in these two conditions but occurs, for both, primarily at the third discouragement.

CONCLUSIONS

Overt and frequent discouragement seems to be less effective in stimulating young people to take an active role in the dialogue with their peers about smoking.

Executive functioning before and after onset of alcohol use disorder in adolescence. A TRAILS study

INTRODUCTION

The aim of the present study was to investigate whether executive functioning (EF) in early adolescence predicted alcohol use disorder (AUD) in late adolescence and whether adolescents with AUD differed in maturation of EF from controls without a diagnosis.

METHODS

We used the data from the Tracking Adolescents' Individual Lives Survey (TRAILS), a cohort of 2230 Dutch adolescents. Working memory, inhibition, and attention were measured at ages 11 and 19. At age 19, lifetime DSM-IV diagnoses were determined, resulting in a control group (n = 1111) and two AUD groups, i.e., alcohol abusers (n = 381) and alcohol dependents (n = 51). Regression analyses assessed whether EF at age 11 predicted the transition to AUD in late adolescence and whether AUD affected maturation of EF from age 11 to 19.

RESULTS

EF in early adolescence did not predict AUD in late adolescence. A significant interaction effect emerged between gender and alcohol dependence for shift attention (β = 0.12, SE=0.36), with girls showing smaller maturational rates. This effect remained significant after controlling for alcohol intake (ages 16 and 19) and comorbid psychiatric disorders.

DISCUSSION

Our results do not replicate the finding that EF in early adolescence is a significant predictor of AUD in late adolescence. Furthermore, for the majority of tasks, adolescents with AUD do not differ in EF maturation over the course of adolescence. Alcohol dependent girls however, show less maturation of shift attention. This is independent of the quantity of alcohol intake, which could suggest that non-normative maturation of EF is associated with the behavioural components of AUD.

Adolescent Heavy Drinking Does Not Affect Maturation of Basic Executive Functioning: Longitudinal Findings from the TRAILS Study

Background and Aims

Excessive alcohol use is assumed to affect maturation of cognitive functioning in adolescence. However, most existing studies that have tested this hypothesis are seriously flawed due to the use of selective groups and/or cross-sectional designs, which limits the ability to draw firm conclusions. This longitudinal study investigated whether patterns of alcohol use predicted differences in maturation of executive functioning in adolescence. Additionally, gender was tested as a possible moderator.

Methods

We used data from the Tracking Adolescents’ Individual Lives Survey (TRAILS), which comprises a cohort of 2,230 Dutch adolescents. Maturation of executive functioning was measured by assessing the standardized improvement on each of four basic executive functions (i.e., inhibition, working memory, and shift- and sustained attention) between ages 11 and 19. Participants were assigned to one of six (heavy) drinking groups (i.e., non-drinkers, light drinkers, infrequent heavy drinkers, increased heavy drinkers, decreased heavy drinkers, and chronic heavy drinkers). We conducted linear regression analyses, and adjusted for relevant confounders.

Results

The six drinking groups did not reveal significant differences in maturation between drinking groups. E.g., maturation executive functioning of chronic heavy drinkers in comparison to non-drinkers; inhibition: B = -0.14, 95% CI [-0.41 to 0.14], working memory: B = -0.03, 95% CI [-0.26 to 0.21], shift attention: B = 0.13, 95% CI [-0.17 to 0.41], sustained attention: B = 0.12, 95% CI [-0.60 to 0.36]. Furthermore, gender was not found to be a significant moderator.

Conclusions

Four years of weekly heavy drinking (i.e., chronic heavy drinkers) did not result in measurable impairments in four basic executive functions. Thus, regular heavy drinking in adolescence does not seem to affect these basic behavioural measures of executive functioning.

Perceptions of medical students towards antibiotic prescribing for upper respiratory tract infections in Saudi Arabia

Introduction

This survey evaluates knowledge, attitudes and practices of medical students towards use of antibiotics for upper respiratory infections (URTIs).

Methodology

Cross-sectional questionnaire study among 1042 randomly selected medical students in Saudi Arabia.

Results

Respondents were mostly Saudis (97.5%), had previous knowledge of antibiotics (99.7%) and their usage (98.3%) against bacterial infections (93.7%). 18.1% thought that they could be used for viral infections. Nearly all students (97.2%) used antibiotics themselves during the previous year and self-medication without a prescription was high at 49% of cases. Most antibiotics were taken for URTI symptoms (61.8%). Female medical students had better knowledge on antibiotic effectiveness against bacteria and viruses, and overall knowledge increased with study year. Health seeking behaviour rates for symptoms of RTI and associated estimated necessity for antibiotics varied but were highest for cough with yellow/green phlegm.

Conclusions

The depth of knowledge that healthcare professionals have in relation to the proper use of antibiotics is essential in spreading the right message within communities. This is the first large study among medical students in Saudi Arabia, shedding important light on areas for improvement in the medical curriculum as well as antibiotic practices of medical students themselves.

Effects of nicotine dependence and depressive symptoms on smoking cessation: a longitudinal study among adolescents

INTRODUCTION

Nicotine dependence has been shown to hamper successful smoking cessation in adolescents. Nicotine dependence and depression are highly comorbid, but the relation between depression and smoking cessation is not yet fully understood. Therefore, the present study examines both the longitudinal reciprocal relation between nicotine dependence and depressive symptoms, and the longitudinal effect of these factors on successful smoking cessation and number of quit attempts.

METHODS

A 2-wave longitudinal study was conducted among 535 adolescents aged 13-18. Written self-report questionnaires were administered in a classroom setting. Two models were tested, examining the mutual relation between nicotine dependence and depressive symptoms, as well as the predictive value of these factors on smoking cessation (n = 535), and number of quit attempts (n = 473) 1 year later.

RESULTS

Adolescents with more depressive symptoms have significantly higher levels of nicotine dependence 1 year later. Higher levels of nicotine dependence negatively predicted subsequent successful smoking cessation, whereas depressive symptoms did not. In contrast, depressive symptoms predicted a higher number of unsuccessful quit attempts in the following year, whereas nicotine dependence did not.

CONCLUSIONS

The findings suggest that adolescents tend to smoke cigarettes in order to diminish their depressive feelings, which might provide some support for the self-medication theory. Smoking cessation programs aiming at adolescents should not only focus on symptoms of nicotine dependence but should also pay attention to depressive feelings, since these feelings are related to a higher number of unsuccessful quit attempts.

Young adult smoking in peer groups: an experimental observational study

INTRODUCTION

The aim of this experimental observational study is to examine whether, in a group setting (same-sex triads), passive peer influence (imitation) in the context of homogeneous and heterogeneous (contradictory) behavior of peer models affects young adults' smoking behavior.

METHODS

An experiment was conducted among 48 daily-smoking college and university students aged 17-25. Participants had to complete a 30-min music task with two same-sex confederates. We tested the following three conditions: (a) neither of the confederates is smoking, (b) one confederate is smoking and the other is not, and (c) both confederates are smoking. The primary outcome tested was the total number of cigarettes smoked during the task.

RESULTS

Students in the condition with two smoking peer models and in the condition with one smoking peer model and one nonsmoking peer model smoked significantly more cigarettes than those in the condition with two nonsmoking peer models. However, results for the condition with two smoking peer models did not differ significantly from the condition with one smoking peer model and one nonsmoking peer model.

CONCLUSIONS

Our findings show that in a group setting, the impact of the homogeneity of smoking peers on young adults' smoking behavior is not greater than the impact of the heterogeneity of smoking and nonsmoking peers. This would suggest that the smoking peer in the group has a greater impact on the daily-smoking young adult, thus reducing or even eliminating the protective effect of the nonsmoking peer model.

Explaining educational differences in adolescent substance use and early sexual debut: the role of parents and peers

Previous studies from a wide variety of European countries have demonstrated that low educated adolescents engage more frequently in health risk behaviors compared to high educated adolescents. The present study investigates the mediating roles of parental knowledge and time spent with peers in this relationship. Data were retrieved from a nationally representative sample of 12- to 16-year old Dutch adolescents (N=5422). Risk behaviors were measured by adolescents' report of daily smoking, binge drinking and cannabis use in the previous month, and sexual debut before age 17. Low educated adolescents indicated that their parents had less knowledge on their whereabouts and reported spending more time with peers than high educated adolescents. Both factors mediated the relationship with health risk behaviors. These results hint to parenting practices and adolescent peer relations as points of reference for prevention and intervention work aiming to reduce educational inequalities in adolescent health risk behaviors.

The impact of active and passive peer influence on young adult smoking: an experimental study

BACKGROUND

Peers influence adolescent and young adult smoking, but little is known about the underlying mechanisms. It is necessary to understand whether the current assumption of peer pressure is valid, or whether an alternative explanation as imitation is more appropriate. We examined whether passive (imitation) and/or active (pressure) peer influence affects young adult smoking.

METHODS

An experiment was conducted among 68 daily-smoking students aged 16-24. The actual study aim was masked. Participants had to do a 30-min music task with a confederate. The experiment consisted of a 2 (smoking condition: confederate smokes or not) by 2 (pressure condition: confederate offers the participant a cigarette or not) factorial design, resulting in four conditions: (1) no smoking and no pressure (N=15); (2) smoking but no pressure (N=16); (3) pressure but no smoking (N=20); and (4) smoking and pressure (N=17). The primary outcome tested was the total number of cigarettes smoked during this music assignment.

RESULTS

Peer smoking significantly predicted the total number of cigarettes smoked by young adults while peer pressure did not. The interaction effect of peer pressure and peer smoking was not significant.

CONCLUSIONS

Peer pressure did not have a significant additional contribution, over and above smoking of the peer. Passive (imitation) peer influence affected young adult smoking rather than active (pressure) peer influence. Thus, smoking cessation efforts should aim at preventing interaction with smoking peers and raising awareness about its impact.

Internet chameleons: an experimental study on imitating smoking peers through digital interaction

INTRODUCTION

Existing experimental studies indicate that young adults are more likely to smoke in the company of real-life smoking peers. However, it is still unclear whether imitation can explain these findings or whether alternatively the mere smell and not the smoking behavior may have been the trigger to smoke. One way to study this issue is by analyzing the exposure to real-life smoking peers without the possibility of smelling the smoker's cigarette, for example, during digital interaction on the Internet. Although many youngsters meet and interact with each other online, research on exposure to smoking peers through the Internet has not yet been investigated.

METHODS

This experiment was conducted among 36 daily smoking young people aged 16-24 years. Smoking behavior was observed during a 30-min joint music assignment. During this assignment, the confederate and participant sat in 2 separate rooms and interacted with each other online and via webcam.

RESULTS

The findings show that young adults interacting with heavy-smoking peers on the Internet and via webcam smoked significantly more cigarettes than those who interacted with nonsmoking peers.

CONCLUSIONS

Young adult smokers strongly imitate smoking in interaction with peers in online communication via webcam, without smelling the smoker's cigarette. Antismoking policies and smoking cessation programs should focus on (raising awareness of) avoiding smoking peers, even during digital interaction.

DRD2 and DRD4 in relation to regular alcohol and cannabis use among adolescents: does parenting modify the impact of genetic vulnerability? The TRAILS study

AIMS

The aims of the present study were to determine the direct effect of DRD2 and DRD4, as well as their interaction with parenting (i.e. rejection, overprotection and emotional warmth), on the development of regular alcohol and cannabis use in 1192 Dutch adolescents from the general population.

METHODS

Information was obtained by self-report questionnaires. Perceived rejection, overprotection and emotional warmth were assessed at age 10-12. Regular alcohol and cannabis use were determined at age 15-18 and defined as the consumption of alcohol on 10 or more occasions in the past four weeks, and the use of cannabis on 4 or more occasions in the past four weeks. Models were adjusted for age, sex, parental alcohol or cannabis use, and externalizing behavior.

RESULTS

Carrying the A1 allele of the DRD2 TaqIA polymorphism, or the 7 repeat DRD4, was not directly related to regular alcohol or cannabis use. In addition, adolescent carriers of these genetic risk markers were not more susceptible to the influence of less optimal parenting. Main effects for parenting indicated that overprotection increased the risk of regular alcohol use, whereas the risk of cannabis use was enhanced by parental rejection and buffered by emotional warmth.

CONCLUSIONS

Our findings do not support an association between DRD2/DRD4 and regular alcohol and cannabis use in adolescents. Given the substance-specific influences of rejection, overprotection and emotional warmth, these parenting factors might be promising candidates for prevention work.

Actions speak louder than words: an experiment on the impact of peers discouraging young adult smoking

This study investigates whether antismoking peer pressure and/or nonsmoking peers are protective factors and decrease young adults' likelihood to smoke. An experiment was conducted among 59 daily-smoking young adults aged 16-24 years. The experiment consisted of four conditions. During the session, the confederate and participant sat in a camper van and had to do a 30-min joint music task. The participants' smoking behavior was observed during this task. The results of Poisson log-linear analysis, controlling for participants' carbon monoxide level and gender, showed that young adults smoked fewer cigarettes in the presence of a nonsmoking model pressuring the young adult not to smoke compared to a heavy-smoking model not using any pressure. At the same time, the results of Fisher's exact test indicated that the total number of cigarettes smoked did not differ significantly for nonsmoking peers verbally pressuring the young adult not to smoke compared to nonsmoking peers not verbally pressuring the young adult. Our findings indicate that the protective effect of peer influence merely lies in that the peer does not smoke. Therefore, antismoking programs and policy should focus specifically on reducing exposure to smoking peers.

Prenatal smoking exposure and the risk of behavioral problems and substance use in adolescence: the TRAILS study

AIMS

To study the prospective relationship between maternal smoking during pregnancy (MSP) and behavioral problems, heavy alcohol use, daily smoking, and ever use of cannabis in the offspring, and to assess the role of confounding and mediating factors in a systematic way.

METHODS

Population-based cohort study of 2,230 respondents, starting in 2001 when respondents were around the age of 11 years, and two follow-up measurements at intervals of about 2.5 years (response rates of 96.0 and 81.4%).

RESULTS

Almost one third of the respondents' mothers had smoked tobacco during pregnancy. These respondents were at an increased risk for all outcomes except internalizing problems (significant odds ratios ranged from 1.40 to 2.97). The successive models showed that the potential confounding factors reduced the strength of all relationships. In the full model, the strongest relationship was found for mothers who smoked more than 10 cigarettes a day during pregnancy and daily smoking in early adolescence (odds ratio: 1.56), but none of the relationships were statistically significant.

CONCLUSIONS

MSP is a marker for future behavioral outcomes in the offspring, but reducing the prevalence of MSP is unlikely to make a meaningful contribution to the prevention of these problems in adolescents.

Adolescent's weight concerns and the onset of smoking

The hypothesis that adolescents start smoking because they perceive it as a strategy to control their weight was examined. At the same time, we controlled for sociodemographic, individual, and parental factors. Longitudinal data were collected among 428 Dutch families (mother, father, and two siblings between 13 and 16 years of age) in two measurements: the first in 2002-2003 and the second a year later. Logistic regression analyses supported the hypothesis: weight control motives to smoke were positively related with smoking initiation. The study's limitations and implications are discussed.

Parental communication appears not to be an effective strategy to reduce smoking in a sample of Dutch adolescents

This longitudinal study examined the reciprocal effects of the frequency of parent-adolescent communication on tobacco-related issues (smoking-specific communication), and adolescents' smoking. Participants were 428 Dutch older and younger siblings between 13 and 16 years old. Smoking-specific communication did not affect youth smoking in general; however, among younger, but not older, siblings, smoking-specific communication was associated with a higher likelihood of smoking over time. In addition, when adolescents already smoked parents started to talk more frequently about smoking-related issues with their older and younger adolescents later on. Neither the quality of smoking-specific communication, the quality of parent-adolescent relationship, nor parental smoking moderated these reciprocal effects. In conclusion, prevention campaigns encouraging parents to undertake smoking-specific communication might not be desirable.

Exposure to movie smoking, antismoking ads and smoking intensity: an experimental study with a factorial design

BACKGROUND

This study examines whether smoking portrayal in movies or antismoking advertisements affect smoking intensity among young adults.

METHODS

We conducted an experimental study in which 84 smokers were randomly assigned using a two (no-smoking versus smoking portrayal in the movie) by three (two prosocial ads, two antismoking ads or one of each) factorial design. Participants viewed a 60-minute movie with two commercial breaks and afterwards completed a questionnaire. Smoking during the session was allowed and observed.

RESULTS

Exposure to the movie with smoking had no effect on smoking intensity. Those who viewed two antismoking ads had significantly lower smoking intensity compared with those who viewed two prosocial ads. There was no interaction between movie smoking and antismoking ads. Baseline CO (carbon monoxide) level had the largest effect on smoking intensity.

CONCLUSION

These findings provide further evidence to support antismoking ads placed with movies because of their possible effect on young adult smoking behaviour. However, caution is warranted, because nicotine dependence appears to be the primary predictor of smoking intensity among young adult smokers in this study.

If Parents Establish a No-Smoking Agreement With Their Offspring, Does This Prevent Adolescents From Smoking? Findings From Three Dutch Studies

Data from three studies were used to investigate whether the establishment of a no-smoking agreement is related to lower odds of adolescent smoking. The prevalence of a no-smoking agreement was first explored by using a national sample involving 4,501 Dutch adolescents. Second, data from a longitudinal study among 595 early adolescents and their parents were used to test whether establishing a no-smoking agreement prevents adolescents from smoking. Third, the authors tested among 856 early- and mid-adolescents and their parents, whether in addition to the establishment of a no-smoking agreement, the frequency and quality of communication on smoking issues had an effect on adolescent smoking. The findings do not support that establishing a no-smoking agreement is an effective deterrent with regard to adolescent smoking. Parents who want to prevent smoking might consider focusing their efforts on establishing a good quality of communication on smoking issues whereas parents who just talk a lot about smoking issues without considering the quality of their communication might do more harm than good.

Genetic factors contribute to the association between peers and young adults smoking: univariate and multivariate behavioral genetic analyses

This present study investigated the genetic and environmental influences on the associations between adolescents' peer characteristics (i.e., peer college orientation, and peer delinquency) and smoking in young adulthood. We used longitudinal data from the Nonshared Environment and Adolescent Development (NEAD) project. Parents' reports on adolescents' peer characteristics and adolescents' self-reports on smoking in young adulthood were examined. Genetic and environmental influences on each construct as well as on the association between the two were analyzed. Findings showed that genetic and nonshared environmental influences contributed to peer college orientation and smoking status. Genetic, shared and nonshared environmental influences contributed to peer delinquency. Further, genetic and nonshared environmental influences contributed to the association between adolescents' peer college orientation and smoking in young adulthood. Genetic and shared environmental influences contributed to the association between adolescents' peer delinquency and smoking in young adulthood. In conclusion, the present study showed that genetic influences contributed to adolescents' peer characteristics and, in addition, genetic factors mediated the association between peer characteristics and smoking.

Frequency and quality of parental communication as antecedents of adolescent smoking cognitions and smoking onset

The present study examines whether aspects of parental communication about smoking function as antecedents of adolescent smoking cognitions. In this longitudinal full-family study (428 families), parent and adolescent reports were used to assess parental communication. Concepts of the Theory of Planned Behavior were measured among adolescents. Differences between older and younger siblings within the family were examined. Cross-sectionally, frequency and quality of communication were associated with smoking cognitions. Longitudinally, only quality of communication preceded smoking cognitions. This effect was mainly found for younger siblings. The results of this study emphasize the importance of quality of parental communication rather than frequency. Communication patterns based on mutual respect and equality help to prevent adolescent smoking onset.

Imitation of cigarette smoking: an experimental study on smoking in a naturalistic setting

AIMS

Examine whether smokers imitate smoking behaviour of strangers and to what extent this is moderated by the nature of social interactions.

DESIGN AND PARTICIPANTS

An experiment with a three (heavy smoking, light smoking, or no smoking condition) by two (warm versus cold social interaction condition) factorial design. Daily smoking young adults were exposed to same-gender confederates and were observed in a bar laboratory.

MEASUREMENTS

Smoking and social behaviour were observed and coded during a 30-min break between two tasks, consisting of rating television advertisements.

FINDINGS

Participants imitated the smoking behaviour of confederates. After controlling for young people's craving, confederate's smoking explains 35% of the variance in the number of cigarettes smoked. Participants are more likely to smoke and to continue smoking in the warm social interaction condition. Lighting up the first cigarette was affected by confederate's smoking and participant's urges to smoke. Lighting up a second was affected by the heavy smoking condition and warm social interaction condition. Lighting up a third cigarette was affected only by the heavy smoking condition.

CONCLUSION

Imitation largely explains why individuals light up a cigarette and continue to smoke.

Correspondence between proxy and self-reports on smoking in a full family study

OBJECTIVES

The present study investigated the reliability of proxy reports obtained from family members with self-reports on adolescent and parental lifetime and current smoking status.

METHODS

Data were assessed from 416 families, consisting of both biological parents and two adolescent siblings aged 13-17 years. These families were assessed at baseline and 1 year later. Sensitivity, specificity, positive predictive value and negative predictive value were calculated to test whether proxy reports corresponded with self-reports.

RESULTS

Mothers scored higher than fathers on most measures on lifetime and current smoking status of both children. The sensitivity was low for parental reports, but moderate to high for children's reports. Specificity and positive predictive value were high in all proxy reports. The negative predictive value was moderate (parents as proxy reporters) to low (children as proxy reporters) on lifetime smoking, but high on current smoking.

CONCLUSIONS

Adolescents, aged 13-17 years, can be used as a reliable source to assess the smoking status of their mothers and fathers. Parents, however, appeared to accurately identify the smoking status of their adolescent children less reliably.

Association between personality and adolescent smoking

The present study examined the association between adolescents' personality traits and smoking, and tested whether this association was moderated by birth order or gender. Participants were 832 Dutch siblings aged 13 to 17 years participating at baseline assessment (T1) and at follow-up 12 months later (T2). Personality was assessed by applying a variable-centered approach including five personality dimensions (Extraversion, Agreeableness, Conscientiousness, Emotional Stability and Openness to Experience), and a person-oriented approach using three personality types (i.e., Resilients, Overcontrollers and Undercontrollers). Cross-sectional findings indicated that Extraversion (at T1 and T2), Agreeableness (at T2), Conscientiousness (at T2), and Emotional Stability (at T2) were related to adolescent smoking. Longitudinal findings indicated that only Extraversion and Emotional Stability were related to onset of adolescent smoking. Using a person-oriented approach, Overcontrollers and Undercontrollers did not differ from Resilients on smoking onset. No indication was found for a moderating effect of birth order on the association between personality and smoking. Additional findings showed that gender moderated the effect of Agreeableness on adolescents' smoking onset. Implications for prevention are also addressed.

Parental rules and communication: their association with adolescent smoking

AIMS

To examine the association between parental rules and communication (also referred to as antismoking socialization) and adolescents' smoking.

DESIGN AND PARTICIPANTS

A cross-sectional study including 428 Dutch two-parent families with at least two adolescent children (aged 13-17 years).

MEASUREMENTS

Parents' and adolescents' reports on an agreement regarding smoking by adolescents, smoking house rules, parental confidence in preventing their child from smoking, frequency and quality of communication about smoking, and parent's reactions to smoking experimentation.

FINDINGS

Compared with fathers and adolescents, mothers reported being more involved in antismoking socialization. There were robust differences in antismoking socialization efforts between smoking and non-smoking parents. Perceived parental influence and frequency and quality of communication about smoking were associated with adolescents' smoking. The association between antismoking socialization practices and adolescents' smoking was not moderated by birth order, parents' smoking or gender of the adolescent.

CONCLUSIONS

Encouraging parents, whether or not they themselves smoke, to discuss smoking-related issues with their children in a constructive and respectful manner is worth exploring as an intervention strategy to prevent young people taking up smoking.

Parental factors and adolescents' smoking behavior: an extension of The theory of planned behavior

BACKGROUND

The aim of the present study is to investigate whether general parenting factors (i.e., quality parent-child relationship, psychological control, strict control, parental knowledge) and parental smoking add to The theory of planned behaviour [Organ Behav. Hum. Dec. 50 (1991) 179] in predicting the onset of smoking. A mediation model is applied in which parental factors affect smoking behavior indirectly by affecting smoking cognitions (i.e., attitude, self-efficacy, and social norm).

METHODS

The model was tested in a longitudinal study on 1,070 adolescents, aged 10-14 years old. Structural equation models (SEM) on current and on future smoking behavior were tested.

RESULTS

The findings showed that the quality of the parent-child relationship and parental knowledge affected adolescents' smoking behavior indirectly, while parental smoking behavior had a direct effect. Strict control and psychological control were found to be unrelated to adolescents' smoking onset.

CONCLUSIONS

In prevention campaigns, parents should be informed of the extent to which they exert influence on their child's smoking behavior and should be given advice and information on how they can prevent their children from starting to smoke.

Parental smoking and respiratory tract infections in children

The adverse health consequences of exposing children to tobacco smoke have been well documented. Re-calculation of the data available from cohort and cross-sectional studies worldwide shows that between 500-2500 excess hospitalisations and between 1000 to 5000 excess diagnoses per 100 000 young children as result from respiratory infections can be directly attributed to parental smoking. Results of published meta-analyses support these figures, which are probably under-estimated because of the effects of non-differential misclassification bias. These excess infections are a source of preventable morbidity and have a high cost to the community. They also have important long-term consequences because children who have respiratory infections in early life are at an increased risk of developing asthma in later childhood. More effective strategies that prevent smoking in young people before they become parents have the potential to lead to reductions in these high rates of unnecessary morbidity in the next generation of children.