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...on Nicotine

www.ProjectCork.org

Summer 2003

Adolescent smoking cessation services of school-based health centers.

Price JH; Yingling F; Dake JA; Telljohann SK. Health Education & Behavior 30(2): 196-208, 2003. (36 refs.)
A national sample of 390 junior and senior high school-based centers were mailed an 18-item survey to assess their institutional stages of change regarding smoking cessation education, referral, and prescription nicotine replacement therapy (NRT) services and their perceived barriers and benefits regarding the provision of these services. Nearly half were in the maintenance stage for cessation education programs, one-third were in mainten-ance stage for referral services, and 12% were in the maintenance stage for NRT. The most frequently cited perceived benefits included an increased awareness of short- and long-term effects of smoking (education pro-grams and referral services) and increasing student access to cessation methods (NRT). The greatest barriers cited were a lack of financial resources (education programs), problems with student transportation (referral services), and staff not having the authority to provide prescription services (NRT). School-based centers can do more to help stop adolescents from using tobacco.

Concurrent use of tobacco products by California adolescents.

Gilpin EA; Pierce JP. Preventive Medicine 36(5): 575-584, 2003. (48 refs.)
Background. To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age. Methods. Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use. Results. Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use. Conclusions. Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Embedded health behaviors from adolescence to adulthood: The impact of tobacco.

Booth-Butterfield M. Health Communication 15(2): 171-184, 2003. (62 refs.)
Prevention of cancer risk behaviors before they become embedded in an individual's life is crucial. Health-related behaviors should be viewed for their embeddedness, critical aspects of which are (a) the complexity of the behavior itself; (b) factors, both biological and. psychological, within the individual communicator; (c) and external situational or sociocultural factors. The more extensively a behavior is embedded, the more difficult it will be to alter. Relative levels of embeddedness of the risk behavior and as entanglement with other nonrisky behaviors will evolve and change throughout one's life course. Smoking across the life span provides an excellent example of a thoroughly integrated, embedded behavior. How smoking is embedded with other behaviors changes from adolescence, where biological factors may be less salient and habit strength less pronounced, through adulthood, where habit strength is greater but health concerns, are a more predictive factor. Researchers can produce more focused communication interventions by examining how health-endangering behaviors are embedded among benign behaviors or among other potentially dangerous behaviors - ideally, the pattern of health behavior embeddedness, should be analyzed prior to developing intervention communication strategies.

Employed adolescents and beliefs about self-efficacy to avoid smoking.

Fagan P; Eisenberg M; Frazier L; Stoddard AM; Avrunin JS; Sorensen G. Addictive Behaviors 28(4): 613-626, 2003. (27 refs.)
This paper examines self-efficacy to avoid cigarette smoking and its association with smoking and quitting behavior, peer and worksite influences, nicotine depend-ence, and sociodemographic variables among employed adolescents. A cross-sectional survey was used to collect data from employed adolescents ages 15-18 who worked in 10 participating grocery stores in Massachusetts. Eighty-three percent of workers (n=379) completed the survey. Results from the multivariate model indicate that daily smokers were less confident in their ability to avoid smoking than those who smoked less frequently. As nicotine dependence increased, self-efficacy beliefs decreased. In addition, as friends' encouragement to quit increased, self-efficacy beliefs also increased. Work-related variables were not associated with self-efficacy beliefs among smokers. This study suggests that smoking frequency, nicotine dependence, and friends' encourage-ment to quit are associated with self-efficacy to avoid smoking. Researchers may tailor interventions for daily and less-than-daily smokers, build on peer networks that encourage quitting and help smokers resist pressures to smoke, and enhance strategies for coping with nicotine dependence in high-risk situations.

Relationships between cigarette smoking and weight control in young women.

Delnevo CD; Hrywna M; Abatemarco DJ; Lewis MJ. Family & Community Health 26(2): 140-146, 2003. (23 refs.)
While multiple risk factors are associated with smoking, body weight concern is a significant risk factor for smoking among young women, including adolescents. This article explores the relationship between frequency of smoking and weight loss strategies among a nationally representative sample of high school females (n = 7,828). Adjusted odds ratios were generated for smoking, weight goals, and weight loss strategies, controlling for demographics. Daily smokers were two to four times more likely to fast, use pills, and purge to control their weight than nonsmokers. Tobacco control efforts for young women must address the influence of weight concern on smoking in this population.

Smoking differences among African American, Hispanic, and White middle school students in an urban setting.

Kelder SH; Prokhorov A; Barroso CS; Murray N; Orpinas P; McCormick L. Addictive Behaviors 28(3): 513-522, 2003. (16 refs.)
Introduction: Cross-sectional studies have repeatedly observed that African American adolescents are less likely to smoke when compared to White and Hispanic adoles-cents. Although much is known among high school samples, few scientifically based studies have reported these race and ethnic differences in cigarette smoking among younger samples. Methods: This study employed a secondary analysis of data from a 3-year middle school violence prevention project. The study design was a 3-year serial cross-sectional survey, out of which a cohort of students from sixth to eighth grade was formed. Smoking measurers were taken yearly. Results: 8865 students responded in 1994, 9115 in 1995, and 9364 in 1996; 1589 students are in the 3-year cohort. Smoking prevalence rates from both measurement periods confirm the disparity between African Americans, Whites, and Hispanic youth. Although weak in sixth grade, by eighth grade, White and Hispanic students are smoking at two to four times the rate of their African American classmates. Conclusions: Clearly, more etiological research needs to be conducted to understand the social, cultural, and intrapersonal forces that operate to inhibit the onset of smoking in African American youth and promote the onset of smoking in White and Hispanic youth.

Symptoms of nicotine dependence and other predictors of student smoking at school: Implications for school smoking policy.

Soteriades ES; DiFranza JR; Savageau JA; Nicolaou M. Journal of School Health 73(4): 154-158, 2003. (26 refs.)
Students who violate school smoking policies present a difficult health and disciplinary issue for school officials. Professionals know little about the characteristics of students who smoke at school. In a prospective study of 679 students in two cities in central Massachusetts, researchers examined how nicotine dependence contributes to the problem of smoking at school. After three years of follow up, smoking at school was reported by 10.3% of students. Among subjects who admitted to smoking at school, 63% reported that symptoms of nicotine dependence preceded their smoking at school. After adjusting for other variables, student smokers with symptoms of nicotine dependence were nine times more likely to report smoking in school (OR 9.1, 95% CI 2.9 - 28.5) than were student smokers without symptoms. Smoking at school was more common among daily smokers and those who paid for their own cigarettes. Age, gender, race, and parental smoking status were not significantly associated with students' reports of smoking at school. These data suggest nicotine dependence as an important contributor to the problem of smoking at school, but not the only reason why students violate school smoking policies. Disciplinary action against students caught violating school smoking policies should be supplemented with an offer of treatment for nicotine dependence.

Tobacco dependence: Adolescents' perspectives on the need to smoke.

Johnson JL; Bottorff JL; Moffat B; Ratner PA; Shoveller JA; Lovato CY. Social Science & Medicine 56(7): 1481-1492, 2003. (20 refs.)
To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.

Treatment of adolescent tobacco smokers: issues and opportunities for exposure reduction approaches. (review).

Moolchan ET; Aung AT; Henningfield JE. Drug and Alcohol Dependence 70(3): 223-232, 2003. (88 refs.)
The cycle of tobacco dependence typically begins with the initiation of tobacco use during adolescence. Many teenagers try to quit smoking, fail and subsequently desire treatment for their tobacco dependence. Adolescents do not currently benefit from the same level of societal support for quit attempts as adults, and they may be less motivated for total cessation despite the short and long-term health consequences of smoking. Overall, the combination of low participation, high attrition and low complete cessation rates for adolescent smokers in treatment prompts the consideration of alternative treatment endpoints. It is likely that interactions among the processes of child and adolescent development, smoke exposure and trajectory influence patterns of tobacco use and treatment for tobacco dependence in adolescents. A rational framework is needed to integrate the study of these dynamic interactions to address tobacco dependence among youth from an exposure reduction, in addition to a cessation, perspective. This paper considers the issues and potential implications of tobacco exposure reduction therapy as an intermediate treatment goal for adolescent smokers who are dependent or dependence-prone, but for whom initial treatment interventions do not yield complete tobacco cessation.

What to convey in antismoking advertisements for adolescents: The use of protection motivation theory to identify effective message themes.

Pechmann C; Zhao GZ; Goldberg ME; Reibling ET. Journal of Marketing 67(2): 1-18, 2003. (93 refs.)
Antismoking advertising is increasingly used, but its message content is controversial. In an initial study in which adolescents coded 194 advertisements, the authors identified seven common message themes. Using protection motivation theory, the authors develop hypotheses regarding the message theme effects on cognitions and intentions and test them in an experiment involving 1667 adolescents. Three of the seven message themes increased adolescents' nonsmoking intentions compared with a control; all did so by enhancing adolescents' perceptions that smoking poses severe social disapproval risks. Other message themes increased health risk severity perceptions but were undermined by low perceived vulnerability.