Do as I say: parent smoking, antismoking socialization, and smoking onset among children

Flavored combustible tobacco product initiation in two longitudinal youth cohorts in the US Population Assessment of Tobacco and Health Study: 2013-2016 and 2016-2019

INTRODUCTION

Flavored tobacco products increase appeal and lower barriers to nicotine addiction for young people. We compared environmental, psychosocial, behavioral, and demographic characteristics between youth who started with flavored and non-flavored (i.e., tobacco-flavored) combustible tobacco products (CTPs).

METHODS

We analyzed two representative US youth cohorts (baseline age 12-15) from the Population Assessment of Tobacco and Health (PATH) Study (Wave 1 Cohort (W1) 2013-2016; Wave 4 Cohort (W4) 2016-2019). We first assessed baseline characteristics associated with any subsequent CTP initiation among youth with baseline never CTP use (W1 n=5,946; W4 n=8,240). Then, for baseline CTP-naïve youth with subsequent CTP initiation (new experimentation; W1 n=519; W4 n=538), we assessed baseline characteristics associated with subsequent initiation with flavored CTPs versus non-flavored.

RESULTS

Most youth reporting new CTP experimentation initiated with flavored CTPs (W1:67.8%; W4:74.2%). Household norms, susceptibility, baseline experimentation with vaping, alcohol, and/or cannabis; and White race were associated with CTP experimentation. For both cohorts, frequent social media use was associated with flavored CTP initiation (W4 AOR:2.50, 95%CI:1.22,5.12) and Black youth (W4 AOR:0.12, 95%CI:0.06,0.25) were less likely to initiate with flavored CTPs than White youth. Among W1 Cohort youth, perceiving flavored product use as easier was positively associated with flavored CTP initiation (AOR:1.48, 95%CI:1.01,2.17). Among W4 Cohort youth, baseline vaping was negatively associated with flavored CTP initiation (AOR:0.10, 95%CI:0.05,0.20).

CONCLUSION

Frequent social media use was associated with flavored CTP initiation among youth who used CTPs. Youth who had ever vaped and Black youth were less likely to initiate with flavored CTPs.

Caregiver restrictions on child access to tobacco in the home and home Smoking/Vaping bans among Black/African American women caregivers who smoke and live in Resource-limited, rural areas

Objective

This study examined relationships between home smoking/vaping bans and caregiver restrictions on child access to tobacco in the home among rural, Black/African American caregivers who smoke.

Methods

Data were from the baseline survey of a randomized trial conducted in 2020-2022 among caregivers who smoke cigarettes and/or little cigars/cigarillos (N = 188). Logistic regressions examined associations between independent variables (tobacco product-specific and comprehensive home smoking/vaping bans) and dependent variables (caregiver keeps tobacco in the home; among caregivers with tobacco at home, caregiver restricts child tobacco access at home). Models were adjusted for caregiver tobacco use, income, and additional covariates based on stepwise selection.

Results

Compared to caregivers with no bans, caregivers with full bans on cigar smoking and vaping were less likely to keep cigars and e-cigarettes at home, respectively. Caregivers with full bans across all tobacco products and no/partial bans across some products were less likely than those with lesser bans to keep e-cigarettes and "other tobacco products" (hookah, pipe, smokeless tobacco, IQOS) at home. Among caregivers with cigarettes at home, those with partial cigarette smoking bans were more likely than those with no bans to restrict child cigarette access at home. Among caregivers with e-cigarettes at home, those with no/partial bans on some products were less likely than those with lesser bans to restrict child e-cigarette access at home.

Conclusions

Interventions addressing intergenerational tobacco use among socially-disadvantaged groups may benefit by supporting the implementation of home smoking/vaping bans and caregiver restrictions on child access to tobacco in the home.

Factors sustaining legitimacy of smoking in Vocational Education and Training (VET) schools: a qualitative needs assessment

BACKGROUND

Most adult smokers started smoking in their teenage years, which increases the risk of nicotine dependence. In Denmark, there is a high prevalence of youth smoking among students in Vocational Education and Training (VET). However, reducing and preventing smoking in this group is a major challenge. This article presents a needs assessment aimed to explore factors sustaining legitimacy of smoking in VET schools and consider the measures needed to prepare VET schools' implementation of smoking reduction and prevention interventions.

METHODS

Participant observations were conducted in four VET classes representing three VET schools in Denmark with a duration of four days each. Individual, semi-structured interviews were conducted with teachers, managers, and a student advisor, as well as four focus groups with a total of 20 students. Interviews were audio-taped, transcribed, and the data material was analyzed following Malterud's systematic text condensation.

FINDINGS

Factors that helped sustain legitimacy of smoking in VET schools included a positive and normalized attitude towards smoking at home and among friends, an understanding of smoking as an integral and expected practice in VET professions and schools, a perceived reliance on smoking as an icebreaker in new social relations and as a pedagogical tool, and smoking as a habit and a means to deal with boredom and stress relief.

CONCLUSIONS

The factors sustaining legitimacy of smoking in VET schools are reciprocal and call for smoking reduction and prevention intervention efforts which consider and address social influence, habitual behavior, and psychological needs, as well as changes at the policy level.

Health behavioral responses to parental myocardial infarction and impact on own risk of disease in the general population

Aims

A family history of coronary heart disease increases one's own risk of experiencing cardiovascular disease and death. An implication of the hereditary nature of the disease is that individuals are provided information about their own risk when a parent is affected, potentially leading them to engage in behaviors that reduce their own risk. In this study, we assessed how a 10-year risk of a cardiovascular event, measured by SCORE, changes for the offspring in response to a parent experiencing a myocardial infarction.

Methods

We analyzed 19,995 individuals from the general population in the Copenhagen City Heart Study of whom 2,071 had a parent, who suffered from a myocardial infarction during four decades of observation using fixed-effects regressions.

Results

Following a parental myocardial infarction, individuals reduced their 10-year risk by 0.16 percentage points constituting a 7.1% reduction of baseline risk. Male participants had the largest change in the risk SCORE following an event of the mother, with a 12.4% reduction from the baseline risk. The degree of response contingent on their own level of risk was found to be the largest for individuals with a 10-year risk between 5% and 10%, who also showed a reduction in systolic blood pressure following paternal myocardial infarction. Parental myocardial infarction was associated with an increased smoking rate in individuals with a baseline risk above 10%, while reductions in risk were seen for individuals with a lower baseline risk.

Conclusion

Following a parental event, individuals reduced their 10-year risk with the largest reductions in their own risk, as observed in men and individuals experiencing a maternal event. The response was the largest for individuals with a 10-year risk for myocardial infarction between 5 and 10%.

Youth risk profiles and their prediction of distal cannabis and tobacco co-use in the Population Assessment of Tobacco Health (PATH)

Background: Co-use of cannabis and tobacco is common and increases negative behavioral, physical and mental health consequences. This study aimed to describe latent profiles of youth internalizing and externalizing problems, sensation seeking, and family environment in the US and their relationships with substance co-use. Methods: Data come from the Population Assessment of Tobacco Health (PATH). Using latent profile analysis with a distal outcome, we conducted a secondary data analysis examining relationships between latent profiles and the distal outcome of cannabis/tobacco use and co-use one year later. Participants were a nationally representative sample of youth ages 12-17 (N = 13,651). Results: We identified five youth subgroups: (1;11%) Family Risk, (2;32%) Family Protection with Very Low Internalizing, (3;21%) Family Protection with High Youth Risk, (4;24%) Family Protection with Moderate Youth Risk, (5;12%) Family Risk with High Youth Risk. Relationships between group membership and tobacco/cannabis outcomes, one year later, indicated that the least likely tobacco/cannabis users were the Family Protection with Very Low Internalizing class (no lifetime use probability (PR)=0.86, standard error (SE)=0.007; no 30-day use PR = 0.96, SE = 0.004). In contrast, the Family Risk with High Youth Risk class had the highest probability of both co-use (lifetime co-use PR = 0.33; SE = 0.014; 30-day co-use PR = 0.10; SE = 0.010) and single substance use (probability of lifetime single substance use PR = 0.30; SE = 0.013; 30-day single substance use PR = 0.24; SE = 0.014). Conclusions: A "protective but reactive" risk buffering pattern effect of family factors on youth factors was observed in that the lowest rates of co-use were observed in the three classes with family protection. These findings highlight the need for interventions addressing multiple domains and focusing on youth and family risk factors.

Modeling the public health impact of e-cigarettes on adolescents and adults

Since the introduction of electronic cigarettes to the U.S. market in 2007, vaping prevalence has surged in both adult and adolescent populations. E-cigarettes are advertised as a safer alternative to traditional cigarettes and as a method of smoking cessation, but the U.S. government and health professionals are concerned that e-cigarettes attract young non-smokers. Here, we develop and analyze a dynamical systems model of competition between traditional and electronic cigarettes for users. With this model, we predict the change in smoking prevalence due to the introduction of vaping, and we determine the conditions under which e-cigarettes present a net public health benefit or harm to society.

Cerebrovascular disease at young age is related to mother's health during the pregnancy-The Northern Finland Birth Cohort 1966 study

BACKGROUND AND PURPOSE

For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers' general health during pregnancy and the offspring's risk of cerebrovascular disease in age of 15 to 52 years.

METHODS

Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother's ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother's health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders.

RESULTS

During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06-2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14-3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01-1.89).

CONCLUSIONS

The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.

Investigating the role of familial and peer-related factors on electronic nicotine delivery systems (ENDS) use among U.S. adolescents

INTRODUCTION

Tobacco use is a public health concern, and adolescents are at an increased risk of starting and continuing to use tobacco relative to other age groups. Parent involvement and other social environmental factors may influence the development and persistence of tobacco use behaviors in adolescence. This study used the nationally representative Population Assessment of Tobacco and Health (PATH) study data set, and responses from 7025 adolescent participants were analyzed to illustrate the longitudinal relationship between social environment influences and use of adolescent electronic nicotine delivery systems (i.e., ENDS).

METHODS

Social environmental factors were assessed at Wave 3 and then compared to electronic nicotine delivery systems (ENDS) status transitions (i.e., initiation, expansion, persistence) at follow-up. Survey-weighted multivariable logistic regression models were used to calculate adjusted odds ratios (AOR) and 95% confidence intervals (CI).

RESULTS

Initiation and persistence of ENDS use were associated with tobacco availability in the house, perception of having no adverse parent reaction to discovering ENDS use and having a best friend who uses ENDS. Initiation of ENDS use was further associated with having biological relatives who have ever been diagnosed with a substance use disorder (SUD) and persistence of ENDS use was also positively associated with lack of in-house rules. Parents talking about ENDS use with adolescents had no association across all three outcomes.

CONCLUSIONS

Findings suggest that parental and environmental factors alter the risk of initiation and persistence of ENDS and tobacco use in adolescents, and these should be considered when working with this at-risk population.

Behavioral and brain signatures of substance use vulnerability in childhood

The prevalence of risky behavior such as substance use increases during adolescence; however, the neurobiological precursors to adolescent substance use remain unclear. Predictive modeling may complement previous work observing associations with known risk factors or substance use outcomes by developing generalizable models that predict early susceptibility. The aims of the current study were to identify and characterize behavioral and brain models of vulnerability to future substance use. Principal components analysis (PCA) of behavioral risk factors were used together with connectome-based predictive modeling (CPM) during rest and task-based functional imaging to generate predictive models in a large cohort of nine- and ten-year-olds enrolled in the Adolescent Brain & Cognitive Development (ABCD) study (NDA release 2.0.1). Dimensionality reduction (n = 9,437) of behavioral measures associated with substance use identified two latent dimensions that explained the largest amount of variance: risk-seeking (PC1; e.g., curiosity to try substances) and familial factors (PC2; e.g., family history of substance use disorder). Using cross-validated regularized regression in a subset of data (Year 1 Fast Track data; n>1,500), functional connectivity during rest and task conditions (resting-state; monetary incentive delay task; stop signal task; emotional n-back task) significantly predicted individual differences in risk-seeking (PC1) in held-out participants (partial correlations between predicted and observed scores controlling for motion and number of frames [r_p]: 0.07-0.21). By contrast, functional connectivity was a weak predictor of familial risk factors associated with substance use (PC2) (r_p: 0.03-0.06). These results demonstrate a novel approach to understanding substance use vulnerability, which—together with mechanistic perspectives—may inform strategies aimed at early identification of risk for addiction.

Parental Awareness of Youth Tobacco Use and the Role of Household Tobacco Rules in Use Prevention

BACKGROUND AND OBJECTIVES

Noncigarette tobacco use is increasing. In this study, we reexamined (1) parental knowledge or suspicion of their children's tobacco use and (2) associations of household tobacco-free rules with youth initiation.

METHODS

Participants were youth (aged 12-17) in waves 1 to 4 (2013-2018) of the Population Assessment of Tobacco and Health Study. A pseudo cross-sectional time-series analysis (N = 23 170) was used to examine parent or guardian knowledge or suspicion of their child's tobacco use according to youth-reported use categories: cigarette only, electronic cigarette only, smokeless tobacco only, noncigarette combustible only, and poly use. A longitudinal analysis among wave 1 never users (n = 8994) was used to examine rules barring tobacco inside the home and whether parents talked with youth about not using tobacco as predictors of youth tobacco initiation after 1 to 3 years. Survey-weighted multivariable models were adjusted for tobacco use risk factors.

RESULTS

In all waves, parents or guardians much less often knew or suspected that their children used tobacco if youth only reported use of electronic cigarettes, noncigarette combustible products, or smokeless tobacco compared with cigarettes. Youth tobacco initiation was lower when youth and parents agreed that rules prohibited all tobacco use throughout the home (1-year adjusted odds ratio: 0.74; 95% confidence interval: 0.59-0.94) but not when parents talked with youth about tobacco (adjusted odds ratio: 1.08; 95% confidence interval: 0.94-1.23).

CONCLUSIONS

Many parents are unaware of their children's noncigarette tobacco use. Setting expectations for tobacco-free environments appears more effective at preventing youth tobacco initiation than parents advising children not to use tobacco.

Parental incarceration and youth tobacco product use: Implications for prevention and the e-cigarette epidemic

PURPOSE

Youth smokers have high rates of adverse childhood experiences, and particularly parental incarceration (PI). In Minnesota, 16% of youth have experienced PI, but 55% of daily smokers report PI. However, no research has examined how PI relates to a range of tobacco products, which is critical considering the current e-cigarette epidemic. There is also limited research on protective factors for tobacco use among youth with PI.

METHODS

Data came from 2016 Minnesota Student Survey (N = 111,091); 85% of Minnesota schools participated. We assessed 30-day use of cigarettes, non-cigarette combustible products, smokeless products, e-cigarettes, and dual/poly use. Using descriptive statistics and logistic regressions, we compared use across current, previous, and no PI experience. We also tested how protective factors related to tobacco use.

RESULTS

Youth with current PI experience used all products with higher frequency compared to youth with previous and no PI experience. Use prevalence among youth with current PI were 26.0% (95% CI = 24.1, 27.8) for e-cigarettes, 20.8% (95% CI = 19.1, 22.5) for dual/poly use, 17.8% (95% CI = 16.2, 19.5) for cigarettes, 17.4% (95% CI = 15.8, 19.0) for combustible non-cigarettes, and 9.9% (95% CI = 8.6, 11.2) for smokeless products. Nearly all protective factors were significantly and negatively related to use of all products, regardless of PI experience.

CONCLUSIONS

Youth with PI experience are at high risk for using multiple tobacco products. These disparities were most pronounced for e-cigarettes, demonstrating the e-cigarette epidemic is disproportionately occurring among youth with current and previous PI experience. All examined protective factors buffer risks for this population of youth.

Targeting cognitive and emotional regulatory skills for smoking prevention in low-SES youth: A randomized trial of mindfulness and working memory interventions

Research to date provides striking evidence that youth from low socio-economic status (SES) households are at an increased risk for smoking. Converging evidence from developmental studies, psychopathology studies, intervention studies, and basic research on self-control abilities have identified working memory and distress tolerance as potential crucial modifiable risk factors to prevent smoking onset in this cohort. To confirm the value of these mechanistic targets, this randomized trial was designed to evaluate the influence of working memory and distress tolerance interventions on risk of smoking initiation. Recruiting primarily from low-income community afternoon programs, we randomized 93 adolescents to one of three intervention conditions, all of which were a prelude to a smoking-prevention informational intervention: (1) a working memory intervention, (2) a mindfulness training intervention to target distress tolerance, and (3) a wellness-focused control condition. Despite a number of adherence efforts, engagement in treatment was limited, and under these conditions no significant evidence was found either for differential efficacy for smoking prevention or for intervention effects on mechanistic targets. However, working memory capacity and distress tolerance were found to be negatively related to smoking propensity. As such, our mechanistic targets-working memory and distress tolerance--may well be processes undergirding smoking, despite the fact that our interventions did not adequately engage these targets.

Parental and life-course influences on symptomatic airflow obstruction

Few studies have examined the contribution of life-course factors in explaining familial aggregation of chronic lung conditions. Using data from the 1958 British Birth Cohort, a life-course approach was used to examine whether, and how, exposure to risk factors through one's life explained the association between parental respiratory disease history and symptomatic airflow obstruction (AO). Cohort participants (n=6212) were characterised in terms of parental respiratory disease history and symptomatic AO at 45 years. Life-course factors (e.g. smoking, asthma and early-life factors) were operationalised as life period-specific and cumulative measures. Logistic regression and path analytic models predicting symptomatic AO adjusted for parental respiratory disease history were used to test different life-course models (critical period, accumulation- and chain-of-risks models). While some life-course factors (e.g. childhood passive smoking and occupational exposure) were individually associated with parental respiratory disease history and symptomatic AO, asthma (OR 6.44, 95% CI 5.01-8.27) and persistent smoking in adulthood (OR 5.42, 95% CI 4.19-7.01) had greater impact on the association between parental respiratory disease history and symptomatic AO. A critical period model provided a better model fit compared with an accumulation-of-risk model and explained 57% of the effect of parental respiratory disease history on symptomatic AO. Adulthood asthma and smoking status explained around half of the effect of parental respiratory disease history on chronic obstructive pulmonary disease. Beyond smoking history, the combination of parental respiratory disease history and adulthood asthma may provide an opportunity for early diagnosis and intervention.

Risk factors associated with early smoking onset in two large birth cohorts

We use prospective data from the ongoing British Cohort Study (BCS) and Millennium Cohort Study (MCS) to: 1) document changes in the prevalence of childhood smoking onset; 2) assess whether broad historic shifts in key risk factors, such as maternal education, parental smoking, and peer childhood smoking, explain observed cohort changes in childhood smoking; and 3) evaluate whether inequalities in onset have narrowed or widened during this period. The children in these two studies were born 31 years apart (i.e., BCS in 1970; MCS in 2001), and were followed from infancy through early adolescence (n = 23,506 children). Our outcome variable is child self-reports of smoking (ages 10, 11). Early life risk factors were assessed via parent reports in infancy and age 5. Findings reveal that the odds of childhood smoking were over 12 times greater among children born in 1970 versus 2001. The decline in childhood smoking by cohort was partly explained by increases in maternal education, decreases in mothers' and fathers' smoking, and declines in the number of children whose friends smoked. Results also show that childhood smoking is now more linked to early life disadvantages, as MCS children were especially likely to smoke if their mother had low education or used cigarettes, or if the child had a friend who smoked. Although the prevalence of child and adult smoking has dropped dramatically in the past three decades, policy efforts should focus on the increased social inequality resulting from the concentration of early life cigarette use among disadvantaged children.

Household Implementation of Smoke-Free Rules in Homes and Cars: A Focus on Adolescent Smoking Behavior and Secondhand Smoke Exposure

PURPOSE

This study addresses the dearth of population-based research on how comprehensive household smoke-free rules (ie, in the home and car) relate to tobacco use and secondhand smoke (SHS) exposure among adolescents.

DESIGN

Analysis of 2014 Minnesota Youth Tobacco Survey.

SETTING

Representative sample of Minnesota youth.

PARTICIPANTS

A total of 1287 youth who lived with a smoker.

MEASURES

Measures included household smoke-free rules (no rules, partial rules-home or car, but not both-and comprehensive rules), lifetime and 30-day cigarette use, 30-day cigarette and other product use, and SHS exposure in past 7 days in home and car.

ANALYSIS

Weighted multivariate logistic, zero-inflated Poisson, and zero-inflated negative binomial regressions were used.

RESULTS

Compared to comprehensive rules, partial and no smoke-free rules were significantly and positively related to lifetime cigarette use (respectively, adjusted odds ratio [AOR] = 1.80, 95% confidence interval [CI] = 1.24-2.61; AOR = 2.87, 95% CI = 1.93-4.25), and a similar significant pattern was found for 30-day cigarette use (respectively, AOR = 2.20, 95% CI = 1.21-4.02; AOR = 2.45, 95% CI = 1.34-4.50). No smoke-free rules significantly predicted using cigarettes and other tobacco products compared to comprehensive rules. In both descriptive and regression analyses, we found SHS exposure rates in both the home and car were significantly lower among youth whose household implemented comprehensive smoke-free rules.

CONCLUSIONS

Comprehensive smoke-free rules protect youth from the harms of caregiver tobacco use. Relative to both partial and no smoke-free rules, comprehensive smoke-free rules have a marked impact on tobacco use and SHS exposure among youth who live with a smoker. Health promotion efforts should promote comprehensive smoke-free rules among all households and particularly households with children and adolescents.

Rescuing cognitive and emotional regulatory skills to aid smoking prevention in at-risk youth: A randomized trial

Adolescence is a vulnerable period for smoking initiation, with disadvantaged teens particularly at risk. In addition, emotional and cognitive dysregulation is associated with an increased risk of smoking and makes it particularly challenging to benefit from standard substance use prevention interventions. The goal of the current study is to investigate the extent to which interventions designed to improve cognitive (working memory) and emotional (distress tolerance) regulatory processes enhance the effectiveness of a standard smoking prevention informational intervention. We will study adolescents (12-16 years of age) predominantly from racial/ethnic-minority and low-income households. Proximal smoking-risk outcome measures are used to allow testing of prevention models outside a full longitudinal study. We hope to generate new insights and approaches to smoking prevention among adolescents from lower socio-economic status (SES) by documenting the influence of working memory training and distress tolerance (mindfulness) interventions on cognitive/affective targets that place individuals at risk for smoking initiation and maintenance.

CLINICAL TRIALS REGISTRATION

NCT03148652.

Providing Antismoking Socialization to Children After Quitting Smoking: Does It Help Parents Stay Quit?

PURPOSE

To test whether an antismoking parenting program provided to parents who had quit smoking for ≥24 hours increased parents' likelihood of remaining abstinent 2 and 3 years postbaseline.

DESIGN

Two-group randomized controlled trial with 3-year follow-up.

SETTING

Eleven states (Colorado, Indiana, Michigan, Minnesota, Montana, New York, Ohio, Pennsylvania, South Dakota, Utah, and Vermont).

PARTICIPANTS

Five hundred seventy-seven adults (286 treatment and 291 control) who had smoked ≥10 cigarettes daily at baseline, had quit smoking for ≥24 hours after calling a Quitline, and were parents of an 8- to 10-year-old child; 358 (62%) completed the 2-year follow-up interview, and 304 (53%) completed the 3-year follow-up interview.

INTERVENTION

Theory-driven, home-based, self-help parenting program.

MEASURES

Sociodemographic, smoking history, and 30-day point prevalence.

ANALYSIS

Multivariable regression analyses tested for group differences in 30-day abstinence. Attriters were coded as having relapsed.

RESULTS

Between-group differences in abstinence rates were 5.6% and 5.9% at 2 and 3 years, respectively. Treatment group parents had greater odds of abstinence, an effect that was significant only at the latter time point (odds ratio [OR] = 1.49, P = .075 at 2 years; OR = 1.70, P = .026 at 3 years).

CONCLUSIONS

This study obtained preliminary evidence that engaging parents who recently quit smoking as agents of antismoking socialization of children has the potential to reduce the long-term odds of relapse.

What parents can do to keep their children from smoking: A systematic review on smoking-specific parenting strategies and smoking onset

AIM

To provide a systematic overview of longitudinal studies on different smoking-specific parenting practices (i.e., perceived parental norms and influences, smoking-specific monitoring, availability of cigarettes at home, household smoking rules, non-smoking agreements, smoking-specific communication, and parental reactions) as useful tools in the prevention of youth smoking.

METHOD

MEDLINE and PsychINFO search identified 986 studies published from 1990 to December 2016. Two independent researchers identified eligible studies. Study quality was assessed using Newcastle Ottawa Scale (NOS).

RESULTS

The systematic search resulted in 1 to 14 longitudinal studies per parenting practice. Studies scored between 4 and 9 on the NOS, indicating an overall moderate quality. The results of complete smoking house rules showed a preventive effect on smoking onset. Furthermore, availability of cigarettes, frequency and quality of communication, parental reaction (i.e., conflict engagement) and norms showed significant and non-significant effects. Significant results were in line with expectations: availability of cigarettes and frequent communication about smoking predicted smoking, whereas a high quality of communication, negative reactions or punishments and setting norms by parents showed a preventive effect. No effects were found for non-smoking agreements. The number of studies was too limited to draw conclusions about other parenting strategies. More research on (1) reliable and valid instruments, (2) other stages of smoking in addition to onset, and (3) potential moderators and mediators is warranted.

CONCLUSION

While evidence supports the effectiveness of smoking-specific parenting, further research is required.

The assessment of status of tobacco smoking among urban primary schoolchildren in Madagascar

The prevalence of tobacco smoking among adolescents aged 13-15 years old in Madagascar was previously reported to be higher than the average in other African regions. A preventive approach is urgently needed to avoid the initiation of early tobacco smoking. Therefore, the aims of this study were to evaluate the status of tobacco smoking among primary schoolchildren in Madagascar and explore the factors associated with initiation of tobacco smoking in the young. This study was conducted in the Mahajanga region of Madagascar. Three primary schools in this region and children of both genders between the ages of nine to 12 years old were randomly selected and approached to participate in this study. A self-administered questionnaire modified from the Global Youth Tobacco Survey Core Questionnaire 2007 was used to assess the status of tobacco smoking among primary schoolchildren. A total of 150 schoolchildren (14.0%) declared that they had smoked tobacco, with 30% starting to smoke tobacco at the age of seven or younger. The prevalence of tobacco smoking was lower among schoolchildren with non-smoking parents (p < 0.001) or non-smoking close friends (p < 0.001). Furthermore, schoolchildren's antismoking intention (p < 0.001) and their knowledge about the harmfulness of tobacco (p = 0.009) had significant effects on the prevalence of tobacco smoking. The results of this study indicate that tobacco smoking among schoolchildren in Madagascar may be influenced by peers, or parents, as well as smoking intention and knowledge about the harmfulness of tobacco use.

Technology-assisted intervention for parents of adolescents in residential substance use treatment: protocol of an open trial and pilot randomized trial

BACKGROUND

Adolescents in residential substance use disorder (SUD) treatment have poor outcomes post-discharge, with follow-up studies suggesting that most adolescents relapse within 90 days. Parenting practices directly influence adolescent SUD outcomes, but parents of adolescents with SUDs are difficult to engage in traditional behavioral treatments. The current study adapts and evaluates a technology-assisted intervention for parents of adolescents in residential SUD treatment. Based on pilot qualitative data with parents, adolescents, and residential staff, we augment an existing computerized intervention (Parenting Wisely; PW) with four in-person coaching sessions, personalized text messages, and an expert-moderated online parent message board. We hypothesize that parents will find enhanced PW (PW+) both feasible and acceptable, and that adolescents whose parents receive PW+ will have better post-discharge outcomes than adolescents who receive standard care (SC) only.

METHODS/DESIGN

A two phase approach is used to adapt and evaluate PW+. Phase 1 consists of an open trial with 10 parents of adolescents (age 12-17) in residential SUD treatment. Post-discharge qualitative and quantitative data from parents and adolescents will support PW+ refinement. Phase 2 is a randomized pilot trial with 60 parents testing the effectiveness of adding PW+ to SC. Adolescents and parents will complete assessments at baseline, 6-, 12-, and 24-weeks post-discharge. Primary outcomes will be measures of feasibility and acceptability. Secondary outcomes will include adolescent substance use, truancy, high-risk sexual behavior, and criminal involvement. Two parenting processes (monitoring and communication) are examined as potential mediators of change.

DISCUSSION

This study will adapt and evaluate a technology-assisted parenting intervention as a means of improving adolescent outcomes following residential SUD treatment. Results have the potential to advance the field by: addressing a high-risk population, improving parental engagement; targeting parenting practices (putative mediators of change) that have been linked to adolescent outcomes; and developing a highly disseminable approach.

Engaging parents of children with and without asthma in smoking-specific parenting: results from a 3-year Randomized Controlled Trial evaluation

The present study evaluated long-term effects of a home-based smoking prevention program targeting smoking-specific parenting in families with children with and without asthma. A total of 1398 non-smoking children (mean age 10.1) participated, of which 197 (14.1%) were diagnosed with asthma. Families were blinded to group assignment. The intervention group (n = 684) received booklets with assignments that actively encouraged parents to engage in smoking-specific parenting strategies. Control families (n = 714) received booklets containing basic information about youth smoking. Latent growth curve modeling was used to calculate intercepts and slopes to examine whether there was change in the different parenting aspects over the study period. Regression analyses were used to examine whether a possible change was different for intervention and control condition families with and without a child with asthma. For those smoking-specific parenting aspects that changed over time, families in the intervention and control condition increased similarly. Families with a child with asthma did not engage in parenting at higher levels due to the intervention program than parents of non-asthmatic children. This prevention program did not affect smoking-specific parenting in the Netherlands. Future prevention research could focus on other risk factors for smoking initiation among adolescents with asthma.

TRIAL REGISTRATION

Netherlands Trial Register NTR1465.

The Effects of Parental Health Shocks on Adult Offspring Smoking Behavior and Self-Assessed Health

An important avenue for smoking deterrence may be through familial ties if adult smokers respond to parental health shocks. In this paper, we merge the Original Cohort and the Offspring Cohort of the Framingham Heart Study to study how adult offspring smoking behavior and subjective health assessments vary with elder parent smoking behavior and health outcomes. These data allow us to model the smoking behavior of adult offspring over a 30-year period contemporaneously with parental behaviors and outcomes. We find strong 'like father, like son' and 'like mother, like daughter' correlations in smoking behavior. We find that adult offspring significantly curtail their own smoking following an own health shock; however, we find limited evidence that offspring smoking behavior is sensitive to parent health, with the notable exception that women significantly reduce both their smoking participation and intensity following a smoking-related cardiovascular event of a parent. We also model the subjective health assessment of adult offspring as a function of parent health, and we find that women report significantly worse health following the smoking-related death of a parent. Copyright © 2015 John Wiley & Sons, Ltd.

Smoking and Looked-After Children: A Mixed-Methods Study of Policy, Practice, and Perceptions Relating to Tobacco Use in Residential Units

Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population.

Smoke-Free Homes and Youth Smoking Behavior in Italy: Findings From the SIDRIAT Longitudinal Study

INTRODUCTION

Few studies have explored whether smoke-free homes (SFH) can promote reductions of smoking onset in children, particularly in households with smoking parents. The aim of this study was to determine whether youths living in SFH were less likely to progress to smoking.

METHODS

We conducted a longitudinal, 11-year, two-wave study on 778 children aged 6-7 years and 985 adolescents aged 13-14 in 2002. At baseline, youths were asked whether or not adults smoked at home (SFH); at follow-up, in 2012-2014, whether a household smoking ban (HSB) had been implemented during the course of the study. Logistic regression was used to investigate SFH effects on youth smoking behaviors.

RESULTS

Sixty-nine percent of children and 54% of adolescents reported SFH at baseline; 80% of children and 71% of adolescents reported HSB at follow-up. Youths living in non-SFH at baseline were twice as likely to become established smokers at follow-up compared with those living in SFH (children + adolescents: odds ratio [OR] = 1.99; 95% confidence interval [CI] = 1.39-2.94; adolescents: OR = 2.15; 95% CI = 1.36-3.42; children: OR = 1.69; 95% CI = 0.80-3.56), either for youths living with nonsmoking parents at baseline and follow-up (OR for both children and adolescents = 3.06; 95% CI = 1.70-5.51) or for youths with ≥1 smoking parent at baseline and follow-up (OR = 2.12, 95% CI = 1.01-4.46). The effect was greater in youths living in the worst situation (non-SFH at baseline + non-HSB at follow-up) compared with those in the best situation (SFH at baseline + HSB at follow-up; children: OR = 3.20; 95% CI = 1.10-9.35; adolescents: OR = 5.41; 95% CI = 2.66-10.97).

CONCLUSIONS

Household smoke-free policies had a significant impact in protecting youths from becoming established smokers.

IMPLICATIONS

The results of the SIDRIAT longitudinal study showed that youths living in homes where people smoked at baseline were twice as likely to become established smokers 11 years later at follow-up, compared with youths living in SFH. The lower number of established smokers among youths living in SFH at baseline was recorded not only in households with nonsmoking parents but also in those with smoking parents. Implementing a home smoking ban is recommended in all households. Living in homes with no ban may be a risk factor for smoking initiation, which is independent of having smoking parents.

Within-Family Discussion on Harmful Effects of Smoking and Intention to Initiate Smoking Among European Adolescents

OBJECTIVE

The main objective of this study was to determine the impact of discussion within family about the harmful effects of smoking on intention to initiate smoking in the long term among nonsmoking adolescents.

METHODS

Data from Global Youth Tobacco Survey for 25 European countries were used. The outcomes of interest were, therefore, the intention to initiate smoking 1 and 5 years after the survey. Discussion within family about harmful effect of smoking was the main predictor with age, sex, and smoking status of parents, friends, and classmates as covariates. The association between predictors and outcomes was assessed through multiple regression analysis.

RESULTS

A total of 118,703 nonsmoking adolescents were included. Within-family discussion significantly reduced the odds of intention to initiate smoking 1 and 5 years later. Intention to initiate smoking also was significantly associated with the smoking status of friends, classmates, and parents, except for father's smoking status, which was not associated with intention to initiate 1 year later.

CONCLUSIONS

This study demonstrated that within-family discussion about the harmful effects of smoking may contribute to reduce the intention to start smoking among adolescents in the long term. Such a discussion was associated with reduced intention to smoke even when adjusting for parent/friend and classmate smoking.

Smoke-free homes, smoking susceptibility and familial smoking among never-smoking high school students: a cross-sectional analysis

BACKGROUND

Research has shown that living in a smoke-free home has a positive effect on adolescents' perceived acceptance of smoking. However, the relationship between smoke-free homes and adolescent smoking behaviours remains unclear. The aim of this study was to examine the association between smoke-free homes and smoking susceptibility among high school students, and to determine whether these associations persist when analyses are stratified by familial smoking status.

METHODS

We conducted a random cross-sectional survey (2012/2013 Youth Smoking Survey) of primary, junior and high school students in Canada (n = 47 203). Multivariable logistic regression analyses were used to examine the associations between smoke-free homes and susceptibility to smoking among never-smoking high school students, with and without stratification by familial smoking.

RESULTS

Analyses showed that adolescents living in a smoke-free home had reduced odds of being susceptible to smoking (odds ratio [OR] 0.582, 95% confidence interval [CI] 0.428-0.791) compared with their peers living in households where smoking was permitted. When adolescents had other family members who were smokers, having a smoke-free home was not significantly associated with reduced smoking susceptibility (OR 0.878, 95% CI 0.721-1.071).

INTERPRETATION

Our results suggest that smoke-free homes may influence future smoking initiation. Optimal success in preventing youth smoking uptake necessitates having a coherent antismoking message between the home smoking environment and familial smoking behaviour.

Intergenerational Patterns of Smoking and Nicotine Dependence Among US Adolescents

OBJECTIVES

We examined associations between parental and adolescent smoking and nicotine dependence in the United States.

METHODS

We used data from the 2004 to 2012 National Survey on Drug Use and Health, which ascertained smoking behaviors of 1 parent and 1 adolescent aged 12 to 17 years in 35 000 dyads. We estimated associations between parental and adolescent smoking behaviors, adjusted for covariates.

RESULTS

Parental current dependence was strongly associated with adolescents' lifetime smoking (adjusted odds ratio [AOR] = 2.96; 95% confidence interval [CI] = 2.47, 3.55), whereas parental current nondependent smoking (AOR = 2.26; 95% CI = 1.92, 2.67) and former smoking (AOR = 1.51; 95% CI = 1.31, 1.75) were less strongly associated. Only parental nicotine dependence was associated with adolescent nicotine dependence (AOR = 1.66; 95% CI = 1.00, 2.74). Associations between parental and adolescent smoking did not differ by race/ethnicity. Parents' education, marital status, and parenting and adolescents' mental health, beliefs about smoking, perception of schoolmates' smoking, and other substance use predicted adolescent smoking and dependence.

CONCLUSIONS

Reducing parental smoking would reduce adolescent smoking. Prevention efforts should encourage parental smoking cessation, improve parenting, address adolescent mental health, and reinforce adolescents' negative beliefs about smoking.

Adverse childhood events and current depressive symptoms among women in Hawaii: 2010 BRFSS, Hawaii

Research on the association between adverse childhood events (ACEs) and depression among women in Hawaii is scarce. ACEs have been linked to unfavorable health behaviors such as smoking and binge drinking which are more prevalent in the state compared to the US overall. The concomitant presence of ACEs with smoking or binge drinking may explain the excess depression prevalence in Hawaii compared to the national average. Using data of women residing in the state (2010 Hawaii Behavioral Risk Factor Surveillance System Survey), we examined the association between ACEs count or type (household dysfunction and physical, verbal and sexual abuse) and current depressive symptoms (CDS), in addition to modification by current smoking status (smoked >100 cigarettes in a lifetime and currently smoke) and binge drinking (consumed ≥4 alcoholic beverage within the past month and in ≥1 occasion(s)). Evaluation of ACEs before age 18 consisted of 11 indicators. Eight indicators of the Patient Health Questionnaire (PHQ-8) were used to assess CDS. All analyses utilized logistic regression taking into account sampling design. The odds ratio of having CDS between those with versus without ACEs increased per increasing number of ACEs (1 ACE: OR = 2.11, CI = 1.16-3.81; 2 ACEs: OR = 2.90, CI = 1.51-5.58; 3 or 4 ACEs: OR = 3.94, CI = 2.13-7.32; 5+ ACEs: OR = 4.04, CI = 2.26-7.22). Household dysfunction (OR = 2.10, CI = 1.37-3.23), physical abuse (OR = 1.67, CI = 1.08-2.59), verbal abuse (OR = 3.21, CI = 2.03-5.09) and sexual abuse (OR = 1.68, CI = 1.04-2.71) were all positively associated with CDS. Verbal abuse had the strongest magnitude of association. Neither current smoking status nor binge drinking modified the relationship between ACEs count (or type) and CDS. In conclusion, the presence of ACEs among women in Hawaii was indicative of CDS in adulthood, notably verbal abuse. Further, a dose response existed between the number of ACEs and the odds for CDS. The concomitant exposure to ACEs and current smoking status or binge drinking did not elevate odds for CDS.

Parent voices guide smoking intervention development

Purpose

– While parents’ influence on their children’s smoking behaviour is widely recognised, little is known about parents of four to eight year olds’ attitudes and beliefs around smoking cessation and how they communicate with their children about smoking. The purpose of this paper is to explore parents’ perceptions of quitting smoking and their beliefs and actions related to the use of parenting practices to discourage smoking by their children.

Design/methodology/approach

– Four focus groups and 17 interviews were conducted with parents (n=46) of four to eight year old children in Perth, Western Australia.

Findings

– Many parents indicated their children strongly influenced their quitting behaviours, however, some resented being made to feel guilty about their smoking because of their children. Parents were divided in their beliefs about the amount of influence they had on their children’s future smoking. Feelings of hypocrisy appear to influence the extent to which parents who smoked talked with their child about smoking. Parents recommended a variety of resource options to support quitting and talking with their child about smoking.

Practical implications

– Interventions aimed at parents who smoke and have young children should: reinforce parents’ importance as role models; highlight the importance of talking to children about smoking when they are young and provide strategies for maintaining ongoing communication; be supportive and avoid making parents feel guilty; and emphasise that quitting smoking is the best option for their child’s health (and their own), while also providing effective harm minimisation options for parents who have not yet quit.

Originality/value

– Parents of children of lower primary school age can be highly influential on their children’s later smoking behaviours, thus, effective interventions that address the current beliefs and practices of these parents may be particularly advantageous.

A latent growth curve analysis of alcohol-use specific parenting and adolescent alcohol use

This study investigates how changes in alcohol use-specific parenting were associated with adolescent drinking trajectories. Three waves of data from a longitudinal study investigating adolescent substance use were used. The community sample (N=378) was aged 10-13 at the first wave of assessment. Our findings show that over time, parents are less likely to discipline their adolescents' drinking, more likely to grant their adolescent permission to drink, and less likely to communicate the consequences of alcohol use. Moreover, these changes are associated with escalation in adolescent alcohol use. Parental efficacy at preventing alcohol use declined, but did not relate to changes in adolescent drinking.

Adoption of cardiovascular risk reduction guidelines: a cluster-randomized trial

BACKGROUND AND OBJECTIVES

Cardiovascular disease (CVD) and underlying atherosclerosis begin in childhood and are related to CVD risk factors. This study evaluates tools and strategies to enhance adoption of new CVD risk reduction guidelines for children.

METHODS

Thirty-two practices, recruited and supported by 2 primary care research networks, were cluster randomized to a multifaceted controlled intervention. Practices were compared with guideline-based individual and composite measures for BMI, blood pressure (BP), and tobacco. Composite measures were constructed by summing the numerators and denominators of individual measures. Preintervention and postintervention measures were assessed by medical record review of children ages 3 to 11 years. Changes in measures (pre-post and intervention versus control) were compared.

RESULTS

The intervention group BP composite improved by 29.5%, increasing from 49.7% to 79.2%, compared with the control group (49.5% to 49.6%; P < .001). Intervention group BP interpretation improved by 61.1% (from 0.2% to 61.3%), compared with the control group (0.4% to 0.6%; P < .001). The assessment of tobacco exposure or use for 5- to 11-year-olds in the intervention group improved by 30.3% (from 3.4% to 49.1%) versus the control group (0.6% to 21.4%) (P = .042). No significant change was seen in the BMI or tobacco composites measures. The overall composite of 9 measures improved by 13.4% (from 48.2% to 69.8%) for the intervention group versus the control group (47.4% to 55.2%) (P = .01).

CONCLUSIONS

Significant improvement was demonstrated in the overall composite measure, the composite measure of BP, and tobacco assessment and advice for children aged 5 to 11 years.

Design of a school-based randomized trial to reduce smoking among 13 to 15-year olds, the X:IT study

BACKGROUND

Adolescent smoking is still highly prevalent in Denmark. One in four 13-year olds indicates that they have tried to smoke, and one in four 15-year olds answer that they smoke regularly. Smoking is more prevalent in socioeconomically disadvantaged populations in Denmark as well as in most Western countries. Previous school-based programs to prevent smoking have shown contrasting results internationally. In Denmark, previous programs have shown limited or no effect. This indicates a need for developing a well-designed, comprehensive, and multi-component intervention aimed at Danish schools with careful implementation and thorough evaluation.This paper describes X:IT, a study including 1) the development of a 3-year school-based multi-component intervention and 2) the randomized trial investigating the effect of the intervention. The study aims at reducing the prevalence of smoking among 13 to 15-year olds by 25%.

METHODS/DESIGN

The X:IT study is based on the Theory of Triadic Influences. The theory organizes factors influencing adolescent smoking into three streams: cultural environment, social situation, and personal factors. We added a fourth stream, the community aspects. The X:IT program comprises three main components: 1) smoke-free school premises, 2) parental involvement including smoke-free dialogues and smoke-free contracts between students and parents, and 3) a curricular component. The study encompasses process- and effect-evaluations as well as health economic analyses. Ninety-four schools in 17 municipalities were randomly allocated to the intervention (51 schools) or control (43 schools) group. At baseline in September 2010, 4,468 year 7 students were eligible of which 4,167 answered the baseline questionnaire (response rate = 93.3%).

DISCUSSION

The X:IT study is a large, randomized controlled trial evaluating the effect of an intervention, based on components proven to be efficient in other Nordic settings. The X:IT study directs students, their parents, and smoking prevention policies at the schools. These elements have proven to be effective tools in preventing smoking among adolescents. Program implementation is thoroughly evaluated to be able to add to the current knowledge of the importance of implementation. X:IT creates the basis for thorough effect and process evaluation, focusing on various social groups.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN77415416.

Protecting children from taking up smoking: parents' views on what would help

ISSUE ADDRESSED

The present study investigated what factors the parents of children in low-income areas of Auckland, New Zealand, thought could help protect their children from smoking initiation.

METHODS

Participants in a large quasi-experimental trial that tested a community-, school- and family-based smoking-initiation intervention were asked in a questionnaire 'What could we do to help you protect your children from smoke and taking up smoking?' Free-text responses were divided into distinct meaning units and categorised independently by two of the researchers.

RESULTS

1806 participants (70% of parents who returned the questionnaire) completed the question. The majority of respondents (80%) were either Pacific Island or Māori mothers and 25% were current smokers. Five main categories of suggested strategies for preventing smoking initiation were identified: building children's knowledge of the ill-effects of smoking; denormalising smoking; reducing access to tobacco; building children's resilience; and health promotion activities. The most common suggestion was to educate children about smoking.

CONCLUSION

Building children's knowledge of smoking risks was the main strategy parents proposed. There was some support for banning smoking in most public areas and for tougher moves to stop tobacco sales to minors. Few parents suggested innovative or radical strategies, such as banning the sale of tobacco, fining children for smoking or use of competitions. So what? To ensure reductions in smoking initiation for lower socioeconomic and Māori and Pacific Island people, further research should engage Māori, Pacific Island and lower socioeconomic parents in a process that elicits innovative thinking about culturally acceptable strategies.

Women's experience of abuse in childhood and their children's smoking and overweight

BACKGROUND

Smoking and overweight are principal determinants of poor health for which individual-level interventions are at best modestly effective. This limited effectiveness may be partly because these risk factors are patterned by parents' experiences preceding the individual's birth.

PURPOSE

To determine whether women's experience of abuse in childhood was associated with smoking and overweight in their children.

METHODS

In 2012, data were linked from two large longitudinal cohorts of women (Nurses' Health Study II [NHSII], n=12,666) and their children (Growing Up Today [GUTS] Study, n=16,774), 1989-2010. ORs of children following higher-risk smoking trajectories and risk ratios (RRs) of children's overweight and obesity by their mother's childhood experience of physical, emotional, and sexual abuse were calculated. The extent to which mother's smoking and overweight, socioeconomic indicators, family characteristics, and child's abuse exposure accounted for possible associations was ascertained.

RESULTS

Children of women who experienced severe childhood abuse had greater likelihood of higher-risk smoking trajectories (OR=1.40, 95% CI=1.21, 1.61), overweight (RR=1.21, 95% CI=1.11, 1.33), and obesity (RR=1.45, 95% CI=1.21, 1.74) across adolescence and early adulthood compared with children of women who reported no abuse. Mother's smoking and overweight and children's abuse exposure accounted for more than half of the elevated risk of following the highest-risk smoking trajectory and overweight in children of women abused.

CONCLUSIONS

These findings raise the possibility that childhood abuse may not only adversely affect the health of the direct victim but may also affect health risk factors in her children decades after the original traumatic events.

Familial aggregation of tobacco use behaviors among Amish men

INTRODUCTION

Tobacco use is a complex behavior. The Old Order Amish community offers unique advantages for the study of tobacco use because of homogenous ancestral background, sociocultural similarity, sex-specific social norms regarding tobacco use, and large family size. Tobacco use in the Old Order Amish community is almost exclusively confined to males.

METHODS

We examined characteristics of tobacco use and familial aggregation among 1,216 Amish males from cross-sectional prospectively collected data. Outcomes examined included ever using tobacco regularly, current use, quantity of use, duration of use, and frequency of use.

RESULTS

Sixteen percent of Amish men were current tobacco users, with the majority reporting cigar use only. Higher rates of tobacco use were found among sons of fathers who smoked compared with sons of fathers who did not smoke (46% vs. 22%, p < .001) as well as among brothers of index cases who smoked compared with brothers of index cases who did not smoke (61% vs. 29%, p < .001). After controlling for shared household effects and age, heritability accounted for 66% of the variance in ever smoking regularly (p = .045).

CONCLUSIONS

The familial patterns of tobacco use observed among Amish men highlight the important role of family in propagating tobacco use and support the usefulness of this population for future genetic studies of nicotine addiction.

Explaining socio-economic differences in intention to smoke among primary school children

BACKGROUND

Smoking prevalence is higher among low socio-economic status (LSES) groups, and this difference may originate from a higher intention to smoke in childhood. This study aims to identify factors that explain differences in intention to smoke between children living in high socio-economic status (HSES) and LSES neighbourhoods.

METHODS

Cross-sectional data were derived from the baseline assessment of a smoking prevention intervention study. Dutch primary school children, aged 10-11 years (N = 2,612), completed a web-based questionnaire about their attitude, subjective norm, self-efficacy expectations, modelling and intention to smoke. Linear and logistic regression analyses were performed to assess potential individual cognitive (attitude, subjective norm and self-efficacy) and social environmental (modelling) mediators between SES and intention to smoke.

RESULTS

Multiple mediation models indicated that modelling mediated the association between SES (B = -0.09 (p < 0.01)) and intention to smoke (B = 1.06 (p < 0.01)). Mainly the father, mother and other family members mediated this association. Gender did not moderate the association between SES and intention to smoke and the potential mediators indicating that there are no differences in mediating factors between boys and girls.

CONCLUSIONS

This study indicates that future smoking prevention studies may focus on the social environment to prevent smoking onset. However, replication of this study is warranted.

TRIAL REGISTRATION

This study was approved by the Medical Ethics Committee of the Atrium-Orbis-Zuyd Hospital (NL32093.096.11 / MEC 11-T-25) and registered in the Dutch Trial Register (NTR3116).

Transitions in smoking behavior during emerging adulthood: a longitudinal analysis of the effect of home smoking bans

OBJECTIVES

We studied the effect of home smoking bans on transitions in smoking behavior during emerging adulthood.

METHODS

We used latent transition analysis to examine movement between stages of smoking from late adolescence (ages 16-18 years) to young adulthood (ages 18-20 years) and the effect of a home smoking ban on these transitions. We used data from the Minnesota Adolescent Community Cohort study collected in 2004 to 2006.

RESULTS

Overall, we identified 4 stages of smoking: (1) never smokers, (2) experimental smokers, (3) light smokers, and (4) daily smokers. Transition probabilities varied by stage. Young adults with a home ban during late adolescence were less likely to be smokers and less likely to progress to higher use later. Furthermore, the protective effect of a home smoking ban on the prevalence of smoking behavior was evident even in the presence of parental smoking. However, this effect was less clear on transitions over time.

CONCLUSIONS

In addition to protecting family members from exposure to secondhand smoke, home smoking bans appear to have the additional benefit of reducing initiation and escalation of smoking behavior among young adults.

Do Actions Speak Louder Than Words?: Adolescent Interpretations of Parental Substance Use

Parents are powerful socialization agents for children and as children reach adolescence parental role models, among other sources of influence, become particularly salient in adolescents' decision-making regarding initiation of substance use. Open parent-adolescent communication about substances is associated with less substance use by adolescents; however, it is unclear how youth interpret anti-drug use messages from their parents, especially if the parents engage in legal and/or illicit substance use themselves. Framed by social learning theory and social constructionism, this study analyzed in-depth interviews with 108 adolescents about personal experiences with substance use, family communication about substance use, and adolescent interpretations of parental use. Emergent themes in the data include: positive parental influence, parentalcontradictions, and negative outcomes of use. Prevalence of parental use-regardless of legality, rarity of explicit communication about parental use, and various interpretations of parental use are discussed.

Do people serve as cues to smoke?

INTRODUCTION

Recent research has identified that the environments in which smoking has previously occurred can alone, in the absence of any explicit smoking stimuli (e.g., cigarettes, lighters), serve as cues that induce robust craving to smoke. The goal of the present study was to determine if people can similarly function as smoking and nonsmoking cues capable of directly affecting smokers' cue-induced craving.

METHODS

Smokers (N = 72) borrowed cameras to take photos of the people in their lives around whom they do and do not smoke ("personal" smoking and nonsmoking people, PS and PN, respectively). Self-report and physiological cue reactivity to those photos were compared with smokers' reactivity to photos of people unknown to them ("standard" smoking and nonsmoking people, SS and SN, respectively).

RESULTS

Results suggest that the people around whom smokers regularly smoke (PS) can alone function as cues capable of eliciting patterns of reactivity similar to that evoked by proximal and environment smoking cues, namely, increased craving to smoke, negative affect, and excitement. In contrast, the people around whom smokers do not smoke become associated with not smoking (PN) and serve a potential protective function by reducing craving and increasing calm.

CONCLUSIONS

This novel investigation and its results have implications for promoting smoking cessation by developing strategies to manage a smoker's social environment.

Parent and child cigarette use: a longitudinal, multigenerational study

OBJECTIVES

Using longitudinal data from the multigenerational Youth Development Study (YDS), this article documents how parents' long-term smoking trajectories are associated with adolescent children's likelihood of smoking. Prospective data from the parents (from age 14-38 years) enable unique comparisons of the parents' and children's smoking behavior, as well as that of siblings.

METHODS

Smoking trajectories are constructed using latent class analysis for the original YDS cohort (n = 1010). Multigenerational longitudinal data from 214 parents and 314 offspring ages 11 years and older are then analyzed by using logistic regression with cluster-corrected SEs.

RESULTS

Four latent smoking trajectories emerged among the original cohort: stable nonsmokers (54%), early-onset light smokers who quit/reduce (16%), late-onset persistent smokers (14%), and early-onset persistent heavy smokers (16%). Although 8% of children of stable nonsmokers smoked in the last year, the other groups' children had much higher percentages, ranging from 23% to 29%. Multivariate logistic regression models confirm that these significant differences were robust to the inclusion of myriad child- and parent-level measures (for which child age and grade point average [GPA] are significant predictors). Older sibling smoking, however, mediated the link between parental heavy smoking and child smoking.

CONCLUSIONS

Even in an era of declining rates of teenage cigarette use in the United States, children of current and former smokers face an elevated risk of smoking. Prevention efforts to weaken intergenerational associations should consider parents' long-term cigarette use, as well as the smoking behavior of older siblings in the household.

Reconciling parenting and smoking in the context of child development

In this article we explore the micro-social context of parental tobacco use in the first years of a child's life and early childhood. We conducted individual interviews with 28 mothers and fathers during the 4 years following the birth of their child. Using grounded theory methods, we identified the predominant explanatory concept in parents' accounts as the need to reconcile being a parent and smoking. Desires to become smoke-free coexisted with five types of parent-child interactions: (a) protecting the defenseless child, (b) concealing smoking and cigarettes from the mimicking child, (c) reinforcing smoking as bad with the communicative child, (d) making guilt-driven promises to the fearful child, and (e) relinquishing personal responsibility to the autonomous child. We examine the agency of the child in influencing parents' smoking practices, the importance of children's observational learning in the early years, and the reciprocal nature of parent-child interactions related to parents' smoking behavior.

Smoking-specific parenting and smoking onset in adolescence: the role of genes from the dopaminergic system (DRD2, DRD4, DAT1 genotypes)

Although only few studies have shown direct links between dopaminergic system genes and smoking onset, this does not rule out the effect of a gene-environment interaction on smoking onset. Therefore, the aim of this study was to examine the associations between smoking-specific parenting (i.e., frequency and quality of communication and house rules) and smoking onset while considering the potential moderating role of dopaminergic system genes (i.e., DRD2, DRD4, and DAT1 genotypes). Data from five annual waves of the 'Family and Health' project were used. At time 1, the sample comprised 365 non-smoking adolescents (200 younger adolescents, mean age = 13.31, SD = .48; 165 older adolescents, mean age = 15.19, SD = .57). Advanced longitudinal analyses were used (i.e., logistic regression analyses, (dual) latent growth curves, and cross-lagged path models). The results showed a direct effect of quality of communication on smoking onset. No direct effects were found for frequency of communication and house rules. Furthermore, no direct and moderating effects of the DRD2, DRD4, or DAT1 genotypes were found. In conclusion, the findings indicated that the effects of smoking-specific parenting on smoking are similar for adolescent carriers and non-carriers of the dopaminergic system genes.

A multiple indicators and multiple causes model of alternative tobacco use

OBJECTIVE

To examine the relationship between adolescents' cigarette smoking experiences and alternative tobacco product (ATP) use.

METHODS

Multiple indicators and multiple causes (MIMIC) models estimated simultaneously the relationship between cigarette smoking experiences and ATP use among high school students (N=1827) completing the 2009 Virginia Youth Tobacco Survey.

RESULTS

Overall, ATP use was associated with adolescents' ever use of cigarettes, early onset of cigarette smoking, cigarettes smoked per day, and peer smoking; however, important model differences between racial/ethnic groups were observed.

CONCLUSIONS

Prevention and cessation programs might reduce adolescent ATP use by targeting specific characteristics of cigarette smoking.

Short-term effects of a home-based smoking prevention program on antismoking socialization and smoking-related cognitions: a cluster randomized controlled trial

OBJECTIVE

This study aims to evaluate the short-term effects of a home-based smoking prevention program called 'Smoke-free Kids' on antismoking socialization and smoking-related cognitions and the moderating role of parental smoking.

PARTICIPANTS AND METHODS

A cluster randomized controlled trial was carried out using one intervention condition compared with a control condition. A total of 1,398 never-smoking children (mean age 10.11 years, SD 0.78) participated. Intention-to-treat and completers-only analyses were performed. Participants in the intervention condition (n=728) received 5 activity modules by mail at 4-week intervals. Modules included communication sheets for their mothers. Participants in the control condition (n=750) received a fact-based intervention only. The main outcomes were the frequency and quality of communication, nonsmoking agreement, house rules, availability of cigarettes, perceived maternal influence, anticipated maternal reactions, attitude, self-efficacy and social norms.

RESULTS

Significant effects of the program were found for frequency of communication (B=0.11, p<0.001), nonsmoking agreement (B=0.07, p<0.01), perceived maternal influences (B=0.09, p<0.05), self-efficacy (B=-0.09, p<0.05) and social norms of friends (B=-0.08, p=0.05) and best friends (B=-0.11, p<0.05). Parental smoking had no moderating effect.

CONCLUSIONS

The Smoke-free Kids program shows promising short-term effects on antismoking socialization and cognitions. Long-term follow-up on the effects of smoking behavior are needed.

Parent-child communication and marijuana initiation: evidence using discrete-time survival analysis

This study supplements existing literature on the relationship between parent-child communication and adolescent drug use by exploring whether parental and/or adolescent recall of specific drug-related conversations differentially impact youth's likelihood of initiating marijuana use. Using discrete-time survival analysis, we estimated the hazard of marijuana initiation using a logit model to obtain an estimate of the relative risk of initiation. Our results suggest that parent-child communication about drug use is either not protective (no effect) or - in the case of youth reports of communication - potentially harmful (leading to increased likelihood of marijuana initiation).

Factors Associated with Growth in Daily Smoking among Indigenous Adolescents

North American Indigenous adolescents smoke earlier, smoke more, and are more likely to become regular smokers as adults than youth from any other ethnic group yet we know very little about their early smoking trajectories. We use multilevel growth modeling across five waves of data from Indigenous adolescents (aged 10 to 13 years at Wave 1) to investigate factors associated with becoming a daily smoker. Several factors, including number of peers who smoked at Wave 1 and meeting diagnostic criteria for major depressive episode and conduct disorder were associated with early daily smoking. Only age and increases in the number of smoking peers were associated with increased odds of becoming a daily smoker.