Correlates of overweight status in Chinese youth: an East-West paradox

OBJECTIVE

To examine the odds of overweight and related correlates in Chinese adolescents.

METHOD

Cross-sectional study in 9023 adolescents.

RESULTS

Chinese youth were more likely to be overweight if they spent more time being sedentary; slept <7 hours/night; were male; were younger; participated more in vigorous physical activity; and had higher levels of parental education, a higher frequency of vegetable intake, and a lower frequency of sweet/fast food intake.

CONCLUSIONS

Overweight-related correlates seem to play different roles in the Chinese culture than in Western cultures. This may be due to culture-specific perceptions and changes in lifestyle accompanying socioeconomic transitions.

The influence of worries on emotional eating, weight concerns, and body mass index in Latina female youth

PURPOSE

To investigate the effect of worries on weight concerns, emotional eating, and body mass index (BMI) percentile in an ethnically diverse sample of female youth.

METHODS

This study used baseline and follow-up data from a brief school-based physical activity intervention trial involving minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationships between emotional eating, weight concerns, and BMI percentile at follow-up. Multilevel modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS version 9.1.

RESULTS

The sample consisted of 404 minority females (67.1% Latina; mean age = 12.5 ± .6; 60.6% were of normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p < .001 for both). At follow-up, baseline worries significantly predicted emotional eating (p = .027) and weight concerns (p < .001) but not BMI percentile (p = .183). Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however, it did moderate the relationship between baseline worries and follow-up BMI percentile (p = .003).

CONCLUSIONS

In this sample, worries were associated with psychosocial variables but not with BMI percentile. Reducing worries in those with high emotional eating scores may influence future weight gain among Latina females.

Association of the calcyon neuron-specific vesicular protein gene (CALY) with adolescent smoking initiation in China and California

Although previous investigations have indicated a role for genetic factors in smoking initiation, the underlying genetic mechanisms are still unknown. In 2,339 adolescents from a Chinese Han population in the Wuhan Smoking Prevention Trial (Wuhan, China, 1998-1999), the authors explored the association of 57 genes in the dopamine pathway with smoking initiation. Using a conservative approach for declaring significance, positive findings were further examined in an independent sample of 603 Caucasian adolescents followed for up to 10 years as part of the Children's Health Study (Southern California, 1993-2009). The authors identified 1 single nucleotide polymorphism (rs2298122) in the calcyon neuron-specific vesicular protein gene (CALY) that was positively associated with smoking initiation in females (odds ratio = 2.21, 95% confidence interval: 1.49, 3.27; P = 8.4 × 10(-5)) in the Wuhan Smoking Prevention Trial cohort, and they replicated the association in females from the Children's Health Study cohort (hazard rate ratio = 2.05, 95% confidence interval: 1.27, 3.31; P = 0.003). These results suggest that the CALY gene may influence smoking initiation in adolescents, although the potential roles of underlying psychological characteristics that may be components of the smoking-initiation phenotype, such as impulsivity or novelty-seeking, remain to be explored.

Development and validation of a scale to assess attitudes and beliefs about menthol cigarettes among african american smokers

To develop more effective smoking cessation interventions for the 70% of African American smokers who smoke menthol cigarettes, it is important to understand smokers' reasons for choosing menthols verses nonmenthols. This study conducted a focus group of African American smokers about their attitudes and beliefs about menthol cigarettes. These attitudes and beliefs, along with others from the literature, were included in a survey of 720 African American smokers in Los Angeles County, California. Five common factors emerged-Medicinal Effects, Image, Less Harmful, Tradition, and Taste/Sensation. Menthol smokers had significantly higher scores on the Taste/Sensation, Medicinal Effects, and Less Harmful scales than nonmenthol smokers did. Men were significantly more likely than women to endorse Medicinal Effects, Image, and Tradition, whereas women were significantly more likely to endorse Taste/Sensation. Education was inversely associated with endorsement of Medicinal Effects, Image, Less Harmful, and Tradition. Respondents aged 40 years or older had significantly higher scores on Medicinal Effects, Image, and Less Harmful, compared with younger respondents. Smoking cessation interventions for African American menthol smokers should address commonly held myths that menthols have medicinal effects and are less harmful than nonmenthols, especially among smokers who are older, male, and/or have low levels of education. The new measures presented in this article could be useful for tailoring cessation interventions to individual smokers' attitudes and beliefs about menthol cigarettes.

The perceived consequences of safer injection: an exploration of qualitative findings and gender differences

Injection drug users (IDUs) are at a risk for HIV and other bloodborne pathogens via syringe and paraphernalia sharing, with females being at elevated risk. Consequences of injection risk behavior such as the risk of becoming infected with HIV have been relatively well studied, though less is known about the consequences of refusing to share injection equipment. We conducted indepth qualitative interviews with 26 IDUs recruited from a syringe exchange program in Los Angeles, California, USA, to understand the consequences of refusing to share injection equipment and to determine whether these perceived consequences differ by gender. Perceived consequences were organized into four domains using a social ecological framework: microsystem (perceived risk for HIV, drug withdrawal or forgoing drug use), exosystem (trust and social norms), mesosystem (precarious housing and shelter policies), and macrosystem (syringe access/inconvenience, economic and legal consequences). Gender differences were identified in some, but not in all areas. Effective public health interventions among IDUs will benefit from a holistic perspective that considers the environmental and social rationality (Kowalewski, M., Henson, K.D., & Longshore, D. (1997). Rethinking perceived risk and health behavior: A critical review of HIV prevention research. Health Education and Behavior, 24(3), 313-325) of decisions regarding injection risk behavior and assists individuals in addressing the consequences that they perceive to be the most salient.

Cultural values associated with substance use among Hispanic adolescents in southern California

Cultural values can shape people's attitudes toward substance use and influence their risk of experimentation with drugs. This article examines the relationships between cultural values (familism, respeto, and machismo), fatalism (a culturally encouraged personality disposition), and substance use among Hispanic adolescents. In 2005, cross-sectional data were collected from 1,616 Hispanic ninth grade students in Los Angeles. Each cultural value was associated with lifetime substance use; however, these relationships depended on the type of substance and gender. Our findings suggest that it might be useful to incorporate the cultural values and address the personality trait of fatalism in prevention programs for Hispanic adolescents. The study's limitations are noted.

Cognitive behavioral theories used to explain injection risk behavior among injection drug users: a review and suggestions for the integration of cognitive and environmental models

Injection drug users (IDUs) are at risk for HIV and viral hepatitis, and risky injection behavior persists despite decades of intervention. Cognitive behavioral theories (CBTs) are commonly used to help understand risky injection behavior. The authors review findings from CBT-based studies of injection risk behavior among IDUs. An extensive literature search was conducted in spring 2007. In total, 33 studies were reviewed- 26 epidemiological and 7 intervention studies. Findings suggest that some theoretical constructs have received fairly consistent support (e.g., self-efficacy, social norms), whereas others have yielded inconsistent or null results (e.g., perceived susceptibility, knowledge, behavioral intentions, perceived barriers, perceived benefits, response efficacy, perceived severity). The authors offer some possible explanations for these inconsistent findings, including differences in theoretical constructs and measures across studies and a need to examine the environmental structures that influence risky behaviors. Greater integration of CBT with a risk environment perspective may yield more conclusive findings and more effective interventions in the future.

Moderated mediation regarding the sun-safe behaviors of U.S. Latinos: advancing the theory and evidence for acculturation-focused research and interventions

Recent studies revealed a negative association between acculturation and sun-safe behaviors, possibly mediated by education level, health status, and social networks. We sought to elucidate this relationship by exploring the moderating effects of gender and health insurance on each mediated path. We used data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Acculturation, assessed by a four-item index, was the primary predictor; use of sunscreen and protective clothing were the primary outcomes, assessed by frequency scales. Moderated mediation was tested with an established causal moderation method. The mediated association between acculturation, education level and sunscreen use might be stronger among women than men (P < 0.08). We found no evidence of moderated mediation for use of protective clothing. The findings suggest ways of refining the theoretical and empirical rationale for sun safety research and interventions with Latinos. Studies should replicate these models with longitudinal data.

Evaluating depressive symptom interactions on adolescent smoking prevention program mediators: a mediated moderation analysis

INTRODUCTION

Smoking prevention interventions have been shown to be effective in reducing smoking prevalence in the United States. Further work is needed to address smoking in China, where over one third of the world's current smokers reside. China, with more than 60% of the male population being smokers, also presents a unique opportunity to test cognitive processes involved in depression, social influences, and smoking. Adolescents at-risk for developing depression may process social information differently from low-risk counterparts.

METHODS

The Wuhan Smoking Prevention Trial was a school-based longitudinal randomized controlled trial aimed at preventing initiation and escalation of adolescent smoking behaviors. Thousand three hundred and ninety-one male seventh-grade students were assessed with a 200-item paper-and-pencil baseline survey, and it was readministered 1 year later following program implementation.

RESULTS

Friend prevalence estimates were significantly higher among 30-day smokers and among those at highest risk for depression symptoms. The program appeared to be successful in changing the perception of friend smoking prevalence only among adolescents with a comorbidity of high scores of depression symptoms and who have experimented previously with smoking. This Program x Comorbidity interaction on perceived friend smoking prevalence was significant in predicting 30-day smoking 1 year after program implementation.

CONCLUSIONS

This study provides evidence that those adolescents with high levels of depressive symptoms may be more sensitive to social influences associated with smoking prevalence. Individual Disposition x Social Environmental Influences may be important when developing future effective prevention programming.

Marijuana use among Latino adolescents: gender differences in protective familial factors

Given the important contextual function of family dynamics and traditional gender roles in Latino cultures, parental influences on substance use among Latino adolescents may differ across genders. This study examined associations between family factors (parental monitoring, parent-child communication, family cohesion, and familism) and marijuana use among 1,369 Latino adolescents in Southern California. Students from seven schools completed surveys in 9th and 11th grades. Longitudinal hierarchical linear regression analyses evaluated the associations between family factors in 9th grade and lifetime marijuana use in 11th grade, as well as gender differences in these associations. Girls reported higher levels of parental monitoring, parental communication, and familism than boys did, but there were no gender differences in family cohesiveness. In a regression model controlling for covariates and previous marijuana use, parent-child communication and family cohesion in 9th grade were each uniquely predictive of lower levels of marijuana consumption in 11th grade. Gender was a statistical moderator, such that higher levels of parent-child communication predicted lower marijuana use among boys, whereas girls' use was relatively low regardless of parent-child communication levels. Results are discussed in the light of the concurrent socialization processes of family and gender in Latino culture and its relation to preventing delinquent behaviors such as marijuana use.

Rethinking the concept of acculturation: implications for theory and research

This article presents an expanded model of acculturation among international migrants and their immediate descendants. Acculturation is proposed as a multidimensional process consisting of the confluence among heritage-cultural and receiving-cultural practices, values, and identifications. The implications of this reconceptualization for the acculturation construct, as well as for its relationship to psychosocial and health outcomes, are discussed. In particular, an expanded operationalization of acculturation is needed to address the "immigrant paradox," whereby international migrants with more exposure to the receiving cultural context report poorer mental and physical health outcomes. We discuss the role of ethnicity, cultural similarity, and discrimination in the acculturation process, offer an operational definition for context of reception, and call for studies on the role that context of reception plays in the acculturation process. The new perspective on acculturation presented in this article is intended to yield a fuller understanding of complex acculturation processes and their relationships to contextual and individual functioning.

Associations between family structure, family functioning, and substance use among Hispanic/Latino adolescents

This study examined the role of family structure and functioning in predicting substance use among Hispanic/Latino adolescents, surveyed in 9th and 10th grade. The sample (N = 1433) was half female, mostly of Mexican descent, and the majority was born in the United States. Living with a single father was associated with less parental monitoring and less family cohesion (gamma = -0.07, -0.06, respectively). Living with a single mother was associated with less parental monitoring (gamma = -0.10). Living with neither parent was associated with less communication (gamma = -0.08), less parental monitoring (gamma = -0.09), more family conflict (gamma = 0.06), and less family cohesion (gamma = -0.06). Less monitoring was associated with substance use at follow-up (beta = -0.17). Low rates of parental monitoring appear to mediate the association between parental family structure and substance use. Results suggest that improving basic parenting skills and offering additional social support and resources to assist parents in monitoring adolescents may help prevent substance use. These interventions may be particularly beneficial for single parents.

Overweight, body image, and depression in Asian and Hispanic adolescents

OBJECTIVES

To prospectively investigate associations between overweight and depressive symptoms in Asian and Hispanic adolescents.

METHODS

Data included 780 Hispanic and 375 Asian students. Structural equation model was used to prospectively explore moderation effects of gender, ethnicity, and acculturation on associations of overweight, body image dissatisfaction, and depressive symptoms.

RESULTS

Significant mediation effect was found only in Asian girls (mediation effect = 0.16, P < 0.05) and girls with high acculturation (mediation effect = 0.17, P < 0.05). Overweight significantly predicted higher body image dissatisfaction, which in turn was significantly related to depressive symptoms.

CONCLUSIONS

Our findings help understanding the association of overweight and experience of depressive symptoms.

A further look at the intergenerational transmission of violence: witnessing interparental violence in emerging adulthood

The intergenerational transmission (IGT) of violence has been a main the oretical consideration to explain the link between interparental aggression in the family of origin and intimate partner violence (IPV) in subsequent intimate relationships. Studies have examined this theoretical link based on self reports of interparental violence witnessed during childhood and adolescence. However, no study has examined whether emerging adults who currently witness interparental violence are more likely to exhibit violence in their own intimate relationships. Data were analyzed from undergraduate students (N = 223) attending an ethnically diverse Southern California uni versity. Multivariate linear regression analyses were used to examine the impact of witnessing interparental violence on the physical and psycho logical IPV experienced in emerging adult relationships. The joint effects of witnessing both forms of interparental violence were also tested. Support for the intergenerational transmission of violence was identified for specific types of violence. Future directions of study and implications for prevention and treatment are offered.

Heritability of smoking, alcohol use, and psychological characteristics among adolescent twins in Qingdao, China

BACKGROUND

Previous studies of genetic and environmental influences on adolescent substance use have been limited to Western samples.

METHODS

This study assesses genetic and environmental contributions to cigarette smoking, alcohol use, and psychological variables (depression, anxiety, aggression, hostility) among 602 pairs of adolescent twins, 11 to 19 years old, in Qingdao, China.

RESULTS

Heritable influences were more pronounced for alcohol use than cigarette smoking. In univariate analyses, no heritable effects were found for depression or aggression, and modest heritability was found for anxiety. Hostility was relatively more heritable in girls than boys. Bivariate associations between substance use and psychological measures could be attributed to a combination of common genetic and environmental factors.

CONCLUSIONS

Among Chinese adolescents, experimentation with tobacco is familial, and experimentation with alcohol is heritable. The genetic and environmental architecture of hostility differs by gender. Consistency of univariate results with Western adolescent samples appears limited to the alcohol use measures.

Evaluation of an overdose prevention and response training programme for injection drug users in the Skid Row area of Los Angeles, CA

BACKGROUND

Fatal opioid overdose is a significant cause of mortality among injection drug users (IDUs).

METHODS

We evaluated an overdose prevention and response training programme for IDUs run by a community-based organisation in Los Angeles, CA. During a 1-h training session participants learned skills to prevent, recognise, and respond to opioid overdoses, including: calling for emergency services, performing rescue breathing, and administering an intramuscular injection of naloxone (an opioid antagonist). Between September 2006 and January 2008, 93 IDUs were trained. Of those, 66 (71%) enrolled in the evaluation study and 47 participants (71%) completed an interview at baseline and 3-month follow-up.

RESULTS

Twenty-one percent of participants were female, 42% were white, 29% African American, and 18% Latino. Most were homeless or lived in temporary accommodation (73%). We found significant increases in knowledge about overdose, in particular about the use of naloxone. Twenty-two participants responded to 35 overdoses during the follow-up period. Twenty-six overdose victims recovered, four died, and the outcome of five cases was unknown. Response techniques included: staying with the victim (85%), administering naloxone (80%), providing rescue breathing (66%), and calling emergency services (60%). The average number of appropriate response techniques used by participants increased significantly from baseline to follow-up (p<0.05). Half (53%) of programme participants reported decreased drug use at follow-up.

CONCLUSION

Overdose prevention and response training programmes may be associated with improved overdose response behaviour, with few adverse consequences and some unforeseen benefits, such as reductions in personal drug use.

Menthol and non-menthol cigarette use among Black smokers in Southern California

INTRODUCTION

Menthol cigarette smoking is more prevalent among Blacks than among other groups in the United States. This study examined associations between demographic, psychological, attitudinal, social, and cultural factors and menthol smoking among Black adults.

METHODS

This study recruited 720 Black smokers from community intercept locations throughout Los Angeles County, California, and surveyed them by telephone.

RESULTS

Fifty-seven percent of respondents were menthol-only smokers, 15% were regular-only smokers, and 28% smoked both menthols and regular cigarettes (combined smokers). In bivariate models, menthol-only and combined smokers had stronger beliefs in the medicinal effects of menthols relative to regular-only smokers. Menthol-only smokers held stronger beliefs, relative to regular-only smokers, that menthols were less harmful than regular cigarettes. Menthol-only smokers preferred the menthol taste/sensation more than combined smokers, who preferred the menthol taste/sensation more than regular-only smokers. Menthol-only and combined smokers had more menthol smokers in their current social networks compared with regular-only smokers. In multivariate analyses, preference for menthol taste/sensation, belief in medicinal effects of menthols, and menthol smokers in current social network differentiated menthol-only and combined smokers from regular-only smokers, controlling for confounding variables. Correlates of menthol smoking varied across genders and age groups.

DISCUSSION

Health education efforts are needed to dispel the myth that menthol cigarettes are more medicinal and less harmful than regular cigarettes. Prevention and cessation efforts in Black communities can be tailored to reflect predictors of menthol smoking to reduce tobacco-related morbidity and mortality. In the era of Food and Drug Administration regulation of cigarettes, research is needed to prevent health disparities associated with menthol cigarette smoking.

Perceived discrimination and substance use among Latino adolescents

OBJECTIVE

To examine perceived discrimination and substance use among Latino high school students.

METHODS

Latino 9(th) graders (N = 1332) completed self-report measures of perceived discrimination and substance use behavior.

RESULTS

Perceived discrimination was associated with lifetime use measures of smoking (OR = 1.73, P < 0.01), alcohol (OR = 1.53, P < 0.01), marijuana (OR = 1.70, P < 0.01), and inhalants (OR = 1.50, P < 0.05); and past 30 day measures of smoking (OR = 2.54, P < 0.01), alcohol (OR = 1.63, P < 0.01), marijuana (OR = 1.95, P < 0.01), and inhalants (OR = 1.64, P < 0.01), and binge drinking (OR = 1.84, P < 0.01).

CONCLUSIONS

Latino adolescents who have higher perceptions of discrimination are at risk for substance use. Interventions to help Latino adolescents cope with feelings of discrimination may be a useful addition to substance use prevention programs.

Psychological determinants of emotional eating in adolescence

Emotional eating is conceptualized as eating in response to negative affect. Data from a larger study of physical activity was employed to examine the associations among specific emotions/moods and emotional eating in an adolescent sample. Six-hundred and sixty-six students of diverse backgrounds from 7 middle schools in Los Angeles County participated. Cross-sectional analysis revealed no gender differences in emotional eating, and showed that perceived stress and worries were associated with emotional eating in the total sample. Gender stratified analyses revealed significant associations of perceived stress, worries and tension/anxiety to emotional eating for girls, while only confused mood was related to emotional eating in boys. These findings bear potential implications for the treatment and prevention of pediatric obesity and eating disorders because they suggest that interventions would benefit from incorporation of stress-reduction techniques and promotion of positive mood.

Parent-child acculturation patterns and substance use among Hispanic adolescents: a longitudinal analysis

Acculturation discrepancy theory predicts that conflicting cultural preferences between adolescents and their parents will increase the adolescents' risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1683 Hispanic students in Southern California who completed surveys in 9th and 10th grade. Measures included the students' own cultural orientations and their perceptions of their parents' preference for their cultural orientations ("Perceived Parental Cultural Expectations"--PPCE). Hispanic PPCE in 9th grade was a risk factor for lifetime, but not past-month, cigarette, alcohol, and marijuana use in 10th grade. The adolescents' own Hispanic orientation in 9th grade was protective against lifetime and past-month smoking and marijuana use and lifetime alcohol use in 10th grade. The effects of the acculturation variables did not vary according to generation in the U.S. Change in acculturation between 9th and 10th grade was statistically significant but small in magnitude. Increases in parent-child Hispanic acculturation discrepancy (i.e., the difference between the adolescents' own cultural orientations and their PPCE, with adolescents perceiving that their parents wanted them to be more Hispanic oriented than they actually were) from 9th to 10th grade were associated with an increased risk of substance use. Family-based interventions for acculturating Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.

An ecological perspective on smoking among Asian American college students: the roles of social smoking and smoking motives

Using electronic diaries, the present study examined the roles of social smoking and smoking motives in relation to cigarette use patterns among Asian American college smokers. Multilevel modeling results showed that participants smoked more cigarettes when smoking with peers than when smoking alone. Participants' coping (but not social) motives moderated the within-person associations between smoking with peers and the cigarettes smoked during a smoking episode. The findings support the utility of an ecological perspective in examining the dynamic interaction between smoking motives and the social settings of cigarette use, and call for further research on the social smoking behaviors in diverse populations.

Acculturation and sun-safe behaviors among US Latinos: findings from the 2005 Health Information National Trends Survey

OBJECTIVES

We examined the relationship between acculturation and sun safety among US Latinos.

METHODS

We used linear regression models to analyze data from 496 Latino respondents to the 2005 Health Information National Trends Survey. Using sunscreen, seeking shade, and wearing protective clothing were the primary outcomes and were assessed by frequency scales. Acculturation was assessed with a composite index.

RESULTS

In bivariate models, acculturation was negatively associated with use of shade and protective clothing and positively associated with sunscreen use (all, P < .004). In adjusted models, acculturation was negatively associated with seeking shade and wearing protective clothing across gender and region of residence (all, P < .05).

CONCLUSIONS

Our results demonstrated both adverse and beneficial effects of acculturation on Latinos' risk behaviors relating to skin cancer. Education about sun safety is needed for all Latinos and should be tailored to different levels of acculturation. Initiatives for Latinos who are not yet acculturated could focus on reinforcing existing sun-safe behaviors and presenting new ones, such as use of sunscreen; initiatives for highly acculturated Latinos might require more resources because the objective is behavior modification.

The role of acculturation, parenting, and family in Hispanic/Latino adolescent substance use: findings from a qualitative analysis

Focus groups were conducted with adolescents and parents as part of a larger study to understand the connection between acculturation and Hispanic/Latino adolescent substance use. Parents (n = 18) were all mothers and had an average age of 42 years. Students (n = 16) were 62% female and had an average age of 14 years. Results are summarized in five categories: culture/ethnic identity, acculturation, parent-child conflict/relationships, gender, and adolescent substance use. Parents and adolescents held similar views in some areas (e.g., pride in ethnic identity and changes in language use), but diverged in others (e.g., indicators of acculturation, gender differences in parenting, and ideas of freedom and independence). Participants in the focus groups did not endorse the association between acculturation and substance use that has been detected in quantitative studies. Implications for substance use prevention and treatment programs are discussed.

Effects of parental monitoring, parent-child communication, and parents' expectation of the child's acculturation on the substance use behaviors of urban, Hispanic adolescents

This cross-sectional study was conducted on 1,936 Hispanic adolescents of mean age 14.0 years (standard deviation= 0.4) from seven Los Angeles area schools. The effects of perceived parental monitoring and parent-child communication on the adolescents' self-reported past thirty day cigarette smoking and alcohol and marijuana use behaviors were analyzed. In addition, the relationships between parents' expectations of the child's acculturation and adolescents' drug use behaviors were examined. Parental monitoring and parent-child communication were found to have statistically significant inverse associations with all three drug types when controlling for one another and the demographic variables assessed in the study. Parents' expectation of the child's acculturation to the U.S. was found to be inversely related with alcohol use. Parental monitoring and parent-child communication were not found to mediate the relationship between parents' expectation of the child's acculturation and alcohol use.

Comorbidity between depression and smoking moderates the effect of a smoking prevention program among boys in China

Smoking prevention programs based on social influences have reduced smoking prevalence among youth. However, these effects have not been replicated consistently. It is possible that individuals and populations with different dispositional and behavioral characteristics will experience different program effects. This study explored a possible moderation of program effect by comorbidity between depression and smoking (CoM). Data for this analysis were from 2,450 seventh-grade youth (51% boys) who participated in the Wuhan (China) Smoking Prevention Trial (WSPT). WSPT was a randomized, controlled, 14-session, middle-school-based smoking prevention trial. Baseline and 1-year follow-up surveys were administered. The moderation effect between the program and CoM was tested on 1-year change in recent smoking. The CoM indicator was defined dichotomously as monthly cigarette use and high in depression level (among the top 20% in the sample). At baseline, a total of 26 girls and 60 boys were identified to have CoM. Among boys (but not girls), CoM significantly moderated the program effect on recent smoking (p = .01). The program effect among boys with CoM was 4.17 (95% CI 1.47-11.76) times larger than those without CoM. Among boys with CoM, the odds ratio of recent smoking was 0.18 (95% CI 0.06-0.55) for program vs. control condition. Among those without CoM, the program did not reduce the odds of recent smoking significantly (OR = 0.74, 95% CI 0.37-1.48). The study demonstrated that smoking prevention program effects can vary with individual characteristics, in this case comorbidity between depression and smoking. These findings may help explain the inconsistency in program effects across studies and populations. The findings also may contribute to the design of future programs to address the needs of defined populations and individuals with specific characteristics.

Risk factors for adolescent smoking in urban and rural China: findings from the China seven cities study

Cigarette smoking is rising among urban Chinese adolescents and poses a significant public health concern. The majority of Chinese youth live in rural areas, but most research on the risk factors for smoking has been conducted in urban areas of China. This study examined the associations between parental smoking, peer smoking, and low refusal self-efficacy and smoking among urban and rural Chinese youth. This analysis used a cross-sectional sample of 3412 ninth grade students in urban and rural areas under the administrative jurisdiction of seven large cities in China. Multilevel logistic regression models were used to associate the risk factors with lifetime and current smoking, separately in boys and girls. Adolescent smoking was not strongly associated with parental smoking. However it was strongly associated with peer smoking and low refusal self-efficacy across both the urban and rural samples. Students with lower refusal self-efficacy were approximately 5-17 times more likely to be lifetime or current smokers than those with higher refusal self-efficacy. Smoking prevention interventions in China may need to focus on raising adolescents' refusal self-efficacy.

Translation of Health Programs for American Indians in the United States

American Indian and Alaska Native (AI/AN) cultures in the United States include a diverse group of indigenous cultures that have been affected by their contact with European Americans and have suffered adverse psychological, physical, and economic consequences. AI/AN adolescents have the highest prevalence of cigarette smoking of all U.S. ethnic groups. Culturally competent health promotion programs are needed to enhance their resiliency and help them avoid recreational, addictive use of commercial tobacco. The authors describe the diverse AI/AN populations and their unique health and social issues, including adolescent smoking. They present examples of smoking prevention programs tailored or adapted for AI/AN adolescents and make recommendations for implementation and evaluation of prototype programs. Recommendations include involving the community, respecting tribes' wishes for confidentiality, being aware of IRB issues, beginning with formative and qualitative research, using culturally appropriate measures, understanding the diversity of AI/AN cultures, and involving multiple generations of the family.

Country Prototypes and Translation of Health Programs

This article introduces the topic of international translation of health programs. Different perspectives toward the study of national-level variables that are relevant to translation of evidence-based programming developed outside of or in a country are discussed. Concepts including national prototypes, national stereotypes, country clusters, knowledge incompatibility, and absorptive capacity are introduced. The ideas expressed in this article serve to provide direction when considering developing a health behavior program for a country, using previous programmatic knowledge from elsewhere.

BMI as a moderator of perceived stress and emotional eating in adolescents

Emotional eating has often been linked to overweight and/or obesity. Multiple group SEM analyses were conducted using cross-sectional data from 517 minority students in Los Angeles County. Results showed no differences in emotional eating between normal weight and overweight students. Perceived stress was indeed a significant correlate of emotional eating, independent of BMI status, as indicated by the lack of a modifying effect of BMI status. Findings highlight the fact that emotional eating is not an issue only for overweight and obese persons. This study shows that some children in this population at increased risk for obesity and related chronic disease have already incorporated emotional eating as a learned response to stress by the time that they enter adolescence.

A longitudinal analysis of stressful life events, smoking behaviors, and gender differences in a multicultural sample of adolescents

Many studies have addressed the associations between stressful life events and adolescent smoking. Few studies, however, have examined gender differences, specifically with multicultural samples. This longitudinal study examines the relationship between 6 stress subscales and smoking behaviors 716 multicultural U.S. adolescents living in the greater Los Angeles area in 2000-2001. At baseline the ethnic break-down of the sample was 63% Latino and 26% Asian/PI and 70% were 11 years of age. Negative personal events were associated with lifetime smoking and negative school events were associated with intentions to smoke. Stratification of the sample by gender indicated that gender confounded the relationship between negative personal stress and lifetime smoking and negative school stress, positive personal stress and intentions to smoke. Two significant interactions were found. Findings indicate there are differential effects of stressful events between genders which may lead to smoking experimentation or intentions to smoke. Implications and limitations are discussed.

Variation in family structure among urban adolescents and its effects on drug use

Family structure is one factor that can help explain drug use among adolescents. In 2005 a study was conducted with 255 ninth-grade students from an urban, predominantly Latino Los Angeles area high school. Students were 83% Latino, 58% female, and from mostly low SES households. Half of all students reported having ever used alcohol, 30% had ever smoked a cigarette, and 18% had ever used marijuana. Family structure was measured using a single open-ended question and logistic regression was employed to determine the effects of various family structures on the use of alcohol, cigarettes, and marijuana. The presence of older siblings in the home was associated with alcohol and marijuana use, and living with a cousin was associated with marijuana use. Results suggest that influential others, including siblings and cousins, should be included in measures of family structure. Study limitations are noted.

The influence of acculturation on drug and alcohol use in a sample of adolescents

This article reports on the associations between acculturation and substance use among 198 ninth-grade Southern California adolescents (mean age=13.8 years). Substance use measures included 30-day (current) and lifetime use of alcohol and other drugs. Acculturation was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) acculturation scale, a multi-dimensional acculturation scale yielding four acculturation strategy scores. Linear regression analyses evaluated the association between acculturation on alcohol and drug use, adjusting for several covariates. Results revealed that the assimilation acculturation strategy was significantly, but negatively associated with current alcohol use, especially among males. The separation acculturation strategy was significantly and positively associated with current alcohol use, especially among females. Marginalization was associated with greater risk for lifetime alcohol and drug use, especially among males, and a greater risk of current drug use among females. The social influence covariates were predictive of both current and lifetime alcohol and drug use. Future studies should incorporate multidimensional acculturation scales in adolescent substance use to understand how different acculturation strategies impact different populations.

Peer acceleration: effects of a social network tailored substance abuse prevention program among high-risk adolescents

OBJECTIVE

To test whether a social network tailored substance abuse prevention program can reduce substance use among high-risk adolescents without creating deviancy training (iatrogenic effects).

METHODS

A classroom randomized controlled trial comparing control classes with those receiving an evidence-based substance use prevention program [Towards No Drug Abuse (TND)] and TND Network, a peer-led interactive version of TND. Students (n = 541, mean age 16.3 years) in 75 classes from 14 alternative high schools completed surveys before and approximately 1 year after curriculum delivery. Past-month use of tobacco, alcohol, marijuana and cocaine were assessed.

RESULTS

Overall, TND Network was effective in reducing substance use. However, the program effect interacted with peer influence and was effective mainly for students who had peer networks that did not use substances. Students with classroom friends who use substances were more likely to increase their use.

CONCLUSIONS

A peer-led interactive substance abuse prevention program can accelerate peer influences. For students with a peer environment that supports non-use, the program was effective and reduced substance use. For students with a peer environment that supports substance use, an interactive program may have deleterious effects.

Parent-child acculturation discrepancies as a risk factor for substance use among Hispanic adolescents in Southern California

Theories of acculturation predict that discrepancies in cultural orientation between adolescents and their parents will increase the adolescents' risk for behavior problems such as substance use. This study evaluated this hypothesis in a sample of 1772 Hispanic 9th grade students in Southern California. Parent-child discrepancy in U.S. orientation (defined as the difference between the child's U.S. orientation and the child's perception of the parents' U.S. orientation) was a risk factor for past-month smoking, lifetime and past-month alcohol use, and lifetime and past-month marijuana use. Parent-child discrepancy in Hispanic orientation (defined as the difference between the child's Hispanic orientation and the child's perception of the parents' Hispanic orientation) was a risk factor for lifetime and past-month alcohol and marijuana use. The adolescents' own Hispanic orientation was protective against lifetime and past-month smoking and marijuana use, but not alcohol use. In an analysis of mediation, U.S. acculturation discrepancy was associated with lower levels of family cohesion, which in turn was associated with higher levels of substance use. Results suggest that family-based interventions for acculturating and bicultural Hispanic families may be useful in decreasing the likelihood of substance use among Hispanic adolescents.

The prognostic value of pretreatment 2-(18F)-fluoro-2-deoxy-D-glucose positron emission tomography scan in women with cervical cancer

There is substantial risk that prognosis determined with routine clinical staging for cervical cancer may be inaccurate. This is primarily due to understaging due to the lack of detection of nodal disease. This is particularly true for para-aortic nodal metastases. Treatment based on such staging may also be inadequate for the same reason. Positron emission tomography (PET) has been demonstrated to be useful in the staging of cervical cancer and superior to either computed tomography or magnetic resonance imaging in the detection of nodal disease. Our objective was to determine the prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) PET scan in women with cervical cancer. We reviewed the records of 56 women with cervical cancer who underwent FDG PET scan prior to treatment. The primary outcome was the effect of abnormal FDG uptake consistent with metastatic nodal disease on 20-month disease-free survival. The pretreatment PET scan demonstrated abnormal FDG uptake in the pelvic nodes alone in 14 (25%) women, in pelvic and para-aortic nodes in 10 (17.9%), and in neither pelvic nor para-aortic nodes in 32 (57.1%). Women with positive pelvic nodes by PET as well as women with positive para-aortic nodes had significantly poorer 20-month disease-free survival compared to women with negative nodes (P= 0.0003 and P= 0.0017, respectively). We conclude that pretreatment FDG PET scan revealing abnormal FDG uptake consistent with nodal disease is a robust predictor of disease recurrence and may alter the therapeutic management of some patients.

Stressful life events and smoking behaviors in Chinese adolescents: a longitudinal analysis

The associations between stressful life events and smoking have been established among adolescents in the United States. However, whether these relationships are similar in adolescents from other non-Western cultures is unknown. Understanding these relationships in adolescents may help to provide opportunities to reduce the smoking rates in those cultures by providing positive coping methods that do not include smoking. In this longitudinal study, the associations between nine stressful life events scales and smoking behaviors were examined in a sample of Chinese adolescents. Six of these scales, positive school-related, negative school-related, positive family-related, positive peer-related, negative peer-related, and negative health-related had significantly different means among females and males. Among males, positive school-related stress was a protective factor for smoking susceptibility. Among females, positive school-related stress was a protective factor and negative school-related stress was a risk factor for lifetime smoking, and negative family-related stress was a risk factor for smoking susceptibility. Findings indicate that smoking among male adolescents in China may not be the result of stress; however, in females stress may contribute to the decision to smoke. Future directions are discussed.

Sociocultural correlates of menthol cigarette smoking among adult African Americans in Los Angeles

Nearly 70% of adult African American smokers smoke menthol cigarettes. More information is needed about the psychological, social, and cultural factors that influence their overwhelming preference for menthol cigarettes. This study examined variables associated with menthol vs. nonmenthol cigarette use among 432 adult African American smokers in Los Angeles, California. Menthol smoking was most prevalent among women, 18-30-year-olds, and employed respondents. Controlling for age and employment, we found that the significant correlates of menthol use among women were parents' menthol smoking, the belief that most African American smokers smoke menthols, and disagreement with the belief that smoking menthol cigarettes is a "Black thing." Among men, the only significant correlate of menthol smoking was the belief that most African American smokers smoke menthols. Results indicate that menthol smoking among adult African Americans is at least partly a consequence of a complex set of social and cultural norms. Further research is needed to understand the reasons why so many African Americans select menthols, as well as the health consequences of these choices.

Why Smoking Prevention Programs Sometimes Fail. Does Effectiveness Depend on Sociocultural Context and Individual Characteristics?

BACKGROUND

School-based smoking prevention programs sometimes fail in unexpected ways. This study tests the hypotheses that both social/cultural contexts and individual dispositional characteristics may interact with program content to produce effects that are variable in potentially predictable ways.

METHODS

Students in 24 culturally heterogeneous or primarily Hispanic/Latino middle schools (N = 3,157 6th graders) received a multicultural collectivist-framed social influences (SI) program, an individualist-framed SI program, or a control condition. Three-way linear and nonlinear interactions, program frame x social context x dispositional phenotype, were tested.

RESULTS

Three-way interactions were found for the dispositional phenotypes of depression and hostility with social context and program content/frame. In predominantly Hispanic/Latino schools, larger program effects were observed for high depressed and high hostile youth in both the collectivist and individualist framed programs. In culturally mixed schools, prevention effects were greatest for low depressed and low hostile youth, especially in the individualist framed program. In culturally mixed schools, there may have been a negative treatment effect for both programs among adolescents scoring high on depression and hostility.

DISCUSSION

Prevention program effects can vary by combination of program content, social setting, and individual dispositional characteristics. The results suggest that prevention program design and implementation should be sensitive to population characteristics at both the individual and sociocultural levels.

Utility of the theory of reasoned action and theory of planned behavior for predicting Chinese adolescent smoking

One third of smokers worldwide live in China. Identifying predictors of smoking is important for prevention program development. This study explored whether the Theory of Reasoned Action (TRA) and Theory of Planned Behavior (TPB) predict adolescent smoking in China. Data were obtained from 14,434 middle and high school students (48.6% boys, 51.4% girls) in seven geographically varied cities in China. TRA and TPB were tested by multilevel mediation modeling, and compared by multilevel analyses and likelihood ratio tests. Perceived behavioral control was tested as a main effect in TPB and a moderation effect in TRA. The mediation effects of smoking intention were supported in both models (p<0.001). TPB accounted for significantly more variance than TRA (p<0.001). Perceived behavioral control significantly interacted with attitudes and social norms in TRA (p<0.001). Therefore, TRA and TPB are applicable to China to predict adolescent smoking. TPB is superior to TRA for the prediction and TRA can better predict smoking among students with lower than higher perceived behavioral control.

Socioeconomic correlates of smoking among an ethnically diverse sample of 8th grade adolescents in Southern California

OBJECTIVE

Socioeconomic status (SES) has been associated with smoking among adolescents, but it is not known which attributes of SES are responsible for the added risk, or whether these associations are consistent in ethnically diverse samples.

METHODS

This study investigated the associations between SES variables and smoking behavior among an ethnically diverse sample of 1847 8th grade adolescents in Southern California in 2002. Several aspects of SES were examined: an objective composite measure of family and neighborhood SES, the adolescent's spending money, and the adolescent's perception of SES (family's ability to afford basic necessities, wealth relative to others, and wealth relative to last year).

RESULTS

After controlling for demographic characteristics, smoking behavior of parents and friends, and parental monitoring, low scores on the objective SES index and large amounts of pocket money were associated with an increased risk of smoking. The subjective measures of perceived SES were not associated with smoking.

CONCLUSIONS

Results indicate that increased smoking prevention efforts are needed in low-SES areas, and that limiting adolescents' pocket money may be an effective strategy for preventing smoking.

Dietary correlates of emotional eating in adolescence

To better understand the relation between emotional eating and dietary choices, dietary correlates of emotional eating were investigated in an adolescent sample. Participants were 617 predominantly Latino middle school students from seven schools in Los Angeles County. Analyses of cross-sectional data revealed that emotional eating was associated with increased frequency of intake of sweet high energy-dense foods, such as cake and ice cream, salty high energy-dense foods like chips, and soda. Gender stratified analyses revealed an association between emotional eating and more frequent fruit and vegetable intake in boys only, and a positive association between emotional eating and salty high energy-dense intake in both boys and girls. These data support previous literature that reports a preference for high energy-dense food in emotional eating, and shows that this association may be generalizable to Latino youth. Considering that emotional eating may lead to overeating because it often takes place in the absence of hunger, it may be appropriate to develop interventions to teach youth healthier substitutions and regulate mood by means other than eating in order to reduce risk for obesity, especially in high risk populations, such as Latinos.

Breast Cancer among Immigrants: A Systematic Review and New Research Directions

This paper highlights the relationship between migration and female breast cancer. A comprehensive review aimed at identifying risk and protective factors that cut across races and ethnicities was performed. A total of 79 studies (1971-2005) from 16 countries were reviewed. The findings are consistent with existing knowledge about the importance of potentially modifiable environmental and behavioral determinants of risk, acting both pre- and post-migration. While the acculturation-based risk transition model is strong, it is not always supported. As a new direction for migrant studies, we extrapolate the review findings to the experience of Eastern European (EE) immigrants. Health data on this population, typically characterized by low health motivation and passive receipt of preventive efforts, are largely unavailable. Based on relevant theory, empirical and qualitative studies, two breast cancer prevention models for the EE immigrant population are proposed and the need for future research using ethnically disaggregated data is discussed.

Tobacco use among youth and adults in Mainland China: the China Seven Cities Study

OBJECTIVE

The China Seven Cities Study (CSCS) monitors geographic and temporal trends in tobacco use among adolescents and adults in seven cities throughout Mainland China: Harbin, Shenyang, Wuhan, Chengdu, Kunming, Hangzhou, and Qingdao. This article presents the methodology and prevalence data from the baseline survey of the CSCS, conducted in 2002.

METHODS

Stratified random samples of middle schools, high schools, and colleges were selected within each city. Students and their parents completed self-report surveys of their tobacco use. Data were obtained from 6138 middle school students, 5848 academic high school students, 2448 vocational high school students, 2556 college students, and 25 697 parents.

RESULTS

Smoking prevalence varied across age groups, school types, genders, and cities. Past-month smoking prevalence was 9% among middle school students, 8% among academic high school students, 26% among vocational high school students, 21% among college students, and 40% among parents. Smoking prevalence was higher among males than among females, with larger gender disparities among adults than among youth. Smoking also varied across cities, with higher smoking prevalence in southwestern cities and lower prevalence in coastal cities. Intraclass correlations of students within schools are presented to inform statistical power estimates for further research in China.

CONCLUSIONS

These results provide a baseline for future longitudinal studies of smoking in these cities and identify demographic groups at risk for tobacco-related disease. Effective smoking prevention programmes for youth and smoking cessation programmes for adults are needed in China, especially in the lower-income southwestern cities and in vocational high schools throughout the country.

Gender differences in determinants of smoking initiation and persistence in California twins

OBJECTIVE

To determine the effects of genetic versus environmental influences on smoking initiation (SI) and smoking persistence (SP).

METHODS

Native California twins (32,359 pairs), who completed a questionnaire in 1992 or 1998 to 2001, were studied. Standard epidemiologic and genetic analyses were conducted using multiple logistic regression and biometric models to determine factors related to smoking phenotype.

RESULTS

The strongest influence on SI was having a co-twin who ever smoked; the adjusted odds ratio was 9.7 [95% confidence limits (CL), 8.8-10.6] among monozygotic twins and 5.7 (95% CL, 5.2-6.2) among dizygotic like-sex pairs. The risk of SP was also increased if the co-twin currently smoked [adjusted odds ratios, 3.5 (95% CL, 3.0-4.1) for monozygotic twins and 2.3 (95% CL, 2.0-2.7) for like-sex dizygotic pairs]. The proportions of variance due to genetic effects, shared environment, and individual environment for SI were 31.6% (24.2-39.1), 47.5% (41.1-53.7), and 20.9% (18.8-23.1) for females, and 71.2% (66.7-75.4), 12.0% (8.7-15.7), and 16.7% (15.0-18.7) for males. For SP, estimates were identical by gender: 54.6% (43.6-65.5), 8.6% (0-17.1), and 36.8% (32.9-40.9). Modification of SI by closeness between twins was found, but little difference was seen for SP by closeness, birth cohort, or age.

CONCLUSIONS

Gender differences in the pattern of genetic and environmental determinants of SI indicate that gender-specific approaches may be needed for smoking prevention efforts. Modification of genetic effects by closeness between twins and birth cohort suggests that environmental interventions could reduce a heritable propensity to smoke. However, the apparently heritable tendency to continue smoking is unaffected by gender, age, birth cohort, or closeness between twins.

Age-related smoking progression among adolescents in China

PURPOSE

This study examined the differences in smoking progression between middle and upper school students.

METHODS

The China Seven Cities Study (CSCS) is a longitudinal cohort study. The current sample consists of subjects with both baseline and one-year follow-up measures collected between October 2002 and December 2003. There were 4842 students from 62 middle schools and 5806 students from 83 upper schools. Multilevel random-coefficient modeling techniques were applied.

RESULTS

Among male never or lifetime ever smokers, middle school students were susceptible to transitioning more rapidly than upper school students (never--RR: 1.272, 95% confidence interval [CI]: .985-1.642; lifetime ever--RR: 1.497, 95% CI: .979-2.290). Among female lifetime ever smokers, middle school students were more likely to progress than upper school students (RR: 1.353, 95% CI: 1.038-1.763).

CONCLUSION

This longitudinal study is the first to explore differences in smoking progression among adolescents in China. The results revealed that over a one-year interval, there was greater progression across smoking trajectories during early adolescence (corresponding to middle school) than later adolescence (upper school). This is consistent with the neurological development hypothesis, but does not rule out alternative explanations. These findings are important to consider relative to the content and timing of prevention interventions in China where smoking rates approach 70% in adult males and are increasing rapidly in women.