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...on Nicotine and Adolescents

www.ProjectCork.org

Spring 2003

Adolescent smoking and family structure in Europe.

Griesbach D; Amos A; Currie C. Social Science & Medicine 56(1): 41-52, 2003. (35 refs.)
This paper examines the relationship between family structure and smoking among 15-year-old adolescents in seven European countries. It also investigates the association between family structure and a number of known smoking risk factors including family socio-economic status, the adolescent's disposable income, parental smoking and the presence of other smokers in the adolescent's home. Findings are based on 1998 survey data from a cross-national study of health behaviours among children and adolescents. Family structure was found to be significantly associated with smoking among 15-year-olds in all countries, with smoking prevalence lowest among adolescents in intact families and highest among adolescents in stepfamilies. Multivariate analysis showed that several risk factors were associated with higher smoking prevalences in all countries, but that even after these other factors were taken into account, there was an increased likelihood of smoking among adolescents in stepfamilies. Further research is needed to determine the possible reasons for this association.

Assessment of nicotine dependence symptoms in adolescents: A comparison of five indicators.

O'Loughlin J; DiFranza J; Tarasuk J; Meshefedjian G; McMillan-Davey E; Paradis G et al. Tobacco Control 11(4): 354-360, 2002. (26 refs.)
Objective: To examine the psychometric properties, test-retest reliability, and convergent construct validity of five indicators of nicotine dependence (ND) symptoms in adolescents. Design: Analysis of baseline data from a prospective study on the natural history of ND in 1264 adolescents aged 12-13 years. Setting: Ten Montreal high schools. Subjects: 233 grade 7 students who had smoked cigarettes one or more times in the three months preceding the base-line data collection. Main outcome measures: Five indicators of ND symptoms including two that are multidimensional (a proxy measure of ICD-10 criteria for tobacco dependence; the Hooked on Nicotine Checklist (HONC)) and three new indicators of "symptom clusters" that emerged from principal component analysis (ND/cravings, withdrawal symptoms, self medication). Results: All five indicators demonstrated acceptable internal and test-retest reliability. The correlation between the HONC and ND/cravings was 0.910. All other correlations between indicators ranged between 0.716-0.824. There was considerable overlap in the independent correlates identified for each indicator. Conclusions: All five indicators performed well psychometrically. Until the meaning, relative importance, and usefulness of each scale is clarified in longitudinal work, decisions regarding which scale(s) are most informative will depend more on the content of the scales, the need for a multi- or unidimensional indicator, and whether or not the scale is theory based.

Availability of cigarettes as a risk factor for trial smoking in adolescents.

Woodruff SI; Candelaria JI; Laniado-Laborin R; Sallis JF; Villasenor A. American Journal of Health Behavior 27(1): 84-88, 2003. (22 refs.)
Objectives: To examine associations between cigarette availability measures with trial (ie, first) use of cigarettes. Methods: At Time 1 and one year later (Time 2), 478 adolescents completed smoking surveys. Trial smoking at Time 2 was predicted from Time 1 availability variables (prospective prediction), as well as Time 2 availability variables (cross-sectional prediction). Results: Offers from friends/classmates were a significant cross-sectional predictor. In prospective analyses, greater perceptions of ease of obtaining cigarettes from parents and greater frequency of offers from an adult were related to trial smoking. Conclusions: Adult influences, including parental factors, may predispose a young adolescent to smoke.

Curtailing tobacco use among youth: Evaluation of Project 4-Health. (review).

D'Onofrio CN; Moskowitz JM; Braverman MT. Health Education & Behavior 29(6): 656-682, 2002. (104 refs.)
This article reports the development and evaluation of Project 4-Health. a theory-driven, research-based program to prevent tobacco use among youth enrolled in 4-H Clubs throughout California. Additional goals were to involve youth in discouraging others' tobacco use and to develop youth leadership for tobacco control. To assess program effectiveness, 72 clubs were matched and assigned to the program or control condition. Of 1,853 eligible club members. 88.6% completed the pretest. Of these. 79.5% completed a posttest 4 months after conclusion of program delivery, and 77.6%, completed a second posttest 2 years later. Short-term effects were found on 7 of 24 outcome measures, indicating changes in knowledge, attitudes, and behavioral intention, but not in social influence variables or behaviors. No long-term effects were observed. Discussion considers how the challenges of designing, delivering, and evaluating the intervention influenced results and implications for preventing tobacco use through community-based youth groups.

Image advertisements' influence on adolescents' perceptions of the desirability of beer and cigarettes.

Kelly KJ; Slater MD; Karan D. Journal of Public Policy and Marketing 21(2): 295-304, 2002. (46 refs.)
The authors examine whether attitude toward the ad (A(ad)) and attitude toward the brand (A(b)) mediate the effects of visual, image-oriented content in advertisements on perceptions of the desirability of beer and cigarettes, as well as of soft drinks. Adolescents (n = 384) rated either image advertisements with visuals for cigarettes, beer, and soft drinks or comparable tombstone advertisements that had no photographs or drawings. Advertisements with image-oriented visuals were found to directly produce more positive A(ad), A(b) and attitude toward the product category (A(pc)) evaluations than did the tombstone versions. The authors then used structural equation modeling to examine the relationship among A(ad), A(b), and A(pc). The results were generally supportive of the proposed mediating model. Also, little support was found for the assumption of some advocacy groups and policy-makers that to be well received by adolescents, cigarette advertisements require human models. The authors discuss implications of findings for advertising research and public policy.

Relationship between smoking, drinking, and adolescents' self-perceived health and frequency of hospitalization: Analyses from the 1997 National Household Survey on Drug Abuse.

Johnson PB; Richter L. Journal of Adolescent Health 30(3): 175-183, 2002. (22 refs.)
Purpose: To investigate the more immediate health effects of smoking and drinking among adolescents. Methods: Secondary analyses of data from the 1997 National Household Survey on Drug Abuse were conducted to explore the relationship between subjective and objective health outcomes and the use of alcohol and tobacco among adolescents. Results: The findings suggest that adolescents who smoke or drink actually report poorer health during adolescence than those who do not. In fact, adolescents who are frequent or heavy alcohol and tobacco users report poorer subjective overall health and a greater number of overnight hospital stays during the previous year than less frequent or intense users and than nonusers. In addition, the data revealed a number of significant gender and age group differences in reports of health outcome as well. Conclusions: Demonstrating to youngsters the more immediate, negative health consequences of alcohol and tobacco use might strengthen prevention messages an ultimately decrease the use of these substances among adolescents.

Smoking among adolescents: Relation to school success, socioeconomic status, nutrition, and self-esteem.

Yorulmaz F; Akturk Z; Dagdeviren N; Dalkilic A. Swiss Medical Weekly 132(31/32): 449-454, 2002. (32 refs.)
Objective: Smoking is a worldwide health problem. This study was designed to evaluate the current status and to examine some potential factors affecting smoking among adolescents. Design: Descriptive, cross-sectional study. Setting. Community based study. Subjects: Of all middle and high school students in Edirne, Turkey, 883 (6.83%) were randomly sampled. Mean age of the subjects was 15.0 +/- 1.8 years. Method: A self-applied questionnaire was used to collect demographic data, smoking status, school success, nutritional behaviour and self-esteem. The influence of different factors on smoking was evaluated with a logistic regression model. Results: There were 89 active smokers (11.1%) with the critical age of 15 years for smoking commitment. 609 students (71.9%) were exposed to environmental tobacco smoke. Nutritional behaviour rich in vegetables (OR = 0.813), high school success (OR = 0.807), longer time reserved for homework (OR = 0.718) and eating breakfast (OR = 0.353) were significantly associated with a lower smoking rate. Having a mother, who smoked (OR = 2.155), increasing age (OR = 1.704), increasing number of siblings (OR = 1.351) and eating fast food (OR = 1.150) were associated with significantly higher smoking rates. Conclusion: An educational programme aimed at changing behaviour and attitude to tobacco smoking and including nutritional counselling with high emphasis on the transition age from early to late adolescence may be a successful primary prevention. In addition projects designed to improve school performance may lead to a reduction in smoking rates while providing an investment in the future of the teenagers.

The association of tobacco smoking and depression in adolescence: Evidence from the United States.

Martini S; Wagner FA; Anthony JC. Substance Use & Misuse 37(14): 1853-1867, 2002. (16 refs.)
Introduction. We examine a suspected causal association between tobacco smoking and depression. Using data from the National Household Survey on Drug Abuse (NHSDA), we explore variation in depression severity among current and former smokers compared to nonsmokers. We focus on the association between time since last smoke in former smokers and depression severity, to examine whether the level of tobacco-depression relationship might vary in a time-dependent fashion. Methods. Our cross-sectional data come from three public use files of the U.S. National Household Survey on Drug Abuse (NHSDA), collected with different respondents each year from 1994 to 1996, for participants 12-17 years old (N = 13,827). Ordinal logistic regression is used to assess the association between severity of depression and cigarette smoking among former. and current smokers. Results. Current smokers had the highest odds for depression, followed by former smokers, then nonsmokers. Females had higher odds of depression compared to males. The odds of depression varied in subgroups of former smokers. Odds of depression were lower with more elapsed time since last smoke. Discussion. We add new evidence on depression in association with tobacco smoking. Teens who quit smoking may reduce their odds of depressed mood, but more research is needed before a definite causal path can be established.

The relationship between employment and substance use among students aged 12 to 17.

Wu LT; Schlenger WE; Galvin DM. Journal of Adolescent Health 32(1): 5-15, 2003. (46 refs.)
Purpose: To examine the association between employment status and substance use among students aged 12 to 17 years. Methods: Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. Results: About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. Conclusions: The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.

Tobacco, alcohol, and illicit drug use: Racial and ethnic differences among US high school seniors, 1976-2000.

Wallace JM Jr; Bachman JG; O'Malley PM; Johnston LD; Schulenberg JE; Cooper SM. Public Health Reports 117(3 Supplement): S67-S75, 2002. (19 refs.)
Objective: This study examines differences in adolescents' use of tobacco, alcohol, and illicit drugs by racial and ethnic groups. Method: The authors analyzed questionnaire data from large, nationally representative samples of U.S. high school seniors to examine differences in drug use prevalence and trends among racial and ethnic groups between 1976 and 2000. Results: On average, American Indian seniors showed the highest levels of tobacco, alcohol, and illicit drug use. Cuban American and white seniors also tended to have relatively high levels of substance use, followed by Mexican American and Puerto Rican seniors. Other Latin American, African American, and Asian American seniors reported the lowest levels of drug use. Most of these differences are longstanding, but some have widened and others narrowed during the past 25 years. Conclusions: Significant differences exist in adolescent use of tobacco, alcohol, and illicit drugs by racial and ethnic groups, and these differences have changed overtime. Future research should examine these differences and seek to identify the sources and consequences of the disparities.

Public Domain.

Alcohol, tobacco and marijuana use among pregnant teenagers: 6-year follow-up of offspring growth effects.

Cornelius MD; Goldschmidt L; Day NL; Larkby C. Neurotoxicology and Teratology 24(6): 703-710, 2002. (50 refs.)
This prospective study evaluated the relations between maternal alcohol, tobacco and marijuana use during pregnancy and children's growth at 6 years. In this cohort of pregnant teenagers and their offspring, mothers were recruited from an urban prenatal clinic between 1990 and 1995, and observed from their fourth prenatal month. At the delivery assessment, there were 413 live-born singletons. At the 6-year visit, 345 children and mothers were evaluated. Prenatal alcohol and marijuana exposure were significantly associated with growth deficits, after controlling statistically for other prenatal substance use, current maternal substance use, current environmental tobacco exposure (ETS) and sociodemographic and growth-related covariates. There was a significant negative association between the second and third trimester alcohol exposure and offspring height. Third trimester alcohol exposure predicted reduced skinfold thickness. Exposure to any prenatal marijuana in the second trimester was significantly associated with shorter stature. First trimester tobacco exposure was associated with increased skinfold thickness among the 6-year-olds. The effects of prenatal alcohol exposure on growth at birth persisted in older children despite a low level of exposure during gestation. Effects of prenatal marijuana exposure on reduced height were not anticipated and occurred only when use was categorized as any/none. These data are consistent with an emerging body of evidence indicating that, by contrast to the growth deficits associated with smoking during pregnancy, which are evident at birth, the shorter stature associated with prenatal alcohol exposure continues to be evident during childhood.

Tobacco and alcohol use: Prevention program for Hispanic migrant adolescents.

Elder JP; Litrownik AJ; Slymen DJ; Campbell NR; Parra-Medina D; Choe S et al. American Journal of Preventive Medicine 23(4): 269-275, 2002. (29 refs.)
Objectives: Evaluate a community-based tobacco/alcohol use-prevention program group compared with an attention-control condition (first aid/home safety) group. Methods: A total of 660 adolescents and 1 adult caregiver for each were recruited through the Migrant Education Program to participate in an 8-week intervention. Random assignment to the two groups occurred in 22 schools. Seventy 8-week intervention groups (37 tobacco/alcohol and 33 attention-control) were conducted. Assessments occurred at baseline, immediate post-intervention, and 1- and 2-year follow-ups. Susceptibility to smoking and alcohol as well as smoking and drinking over the past 30 days were the primary outcomes of interest. Results: Following intervention, no between-group differences in smoking or drinking were significant. Thirty-day smoking started and remained at very low levels, with the highest group prevalence at any measurement period being 4.7% and the lowest 2.5%. Those considered susceptible to smoking dropped by nearly 40% in the attention-control group and by 50% in the intervention group from baseline to the final follow-up. (The overall reduction from post-test to final follow-up was statistically significant.) Less-acculturated children were less likely to report drinking in the past 30 days. Conclusions: The current intervention was not demonstrated to be effective in preventing cigarette or alcohol consumption. This perhaps is due to very low baseline levels of smoking and drinking in the migrant youth participants.