The roles of parenting, church attendance, and depression in adolescent smoking

Tobacco Use Trajectories in Young Adults: Analyses of Predictors Across Systems Levels

INTRODUCTION

Research is needed to examine trajectories of tobacco use beyond cigarette smoking, particularly during emerging middle young adulthood, and to identify distinct multilevel influences of use trajectories.

AIMS AND METHODS

We examined (1) tobacco use trajectories over a 2-year period among 2592 young adult college students in a longitudinal cohort study and (2) predictors of these trajectories using variables from a socioecological framework, including intrapersonal-level factors (eg, sociodemographics, psychosocial factors [eg, adverse childhood experiences, depressive symptoms, and attention-deficit hyperactivity disorder symptoms], early-onset substance use), interpersonal factors (eg, social support, parental substance use), and community-level factors (eg, college type, rural vs. urban).

RESULTS

About 64.5% were female and 65.0% were white. From age 18 to 26, 27%-31% of participants reported past 30-day use of any tobacco product. We identified four trajectory classes: Abstainers/Dabblers who never or infrequently used (89.2%); Adult users who began using frequently around age 20 and continued thereafter (5.9%); College Smokers who began using before 19 but ceased use around 25 (2.5%); and Teenage users who used during their teenage years but ceased use by 22 (1.9%). Multinomial regression showed that, compared to Abstainers/Dabblers, significant predictors (p < .05) of being (1) Adult users included being male, earlier onset marijuana use, attending public universities or technical colleges (vs. private universities), and living in urban areas; (2) College users included being male, earlier onset marijuana use, and parental alcohol or marijuana use; and (3) Teenage users included only earlier onset marijuana use.

CONCLUSION

Distinct prevention and intervention efforts may be needed to address the trajectories identified.

IMPLICATIONS

Among young adult college students, the largest proportion of tobacco users demonstrate the risk of continued and/or progression of tobacco use beyond college. In addition, specific factors, particularly sex, earlier onset marijuana use, parental use of alcohol and marijuana, and contextual factors such as college setting (type of school, rural vs. urban) may influence tobacco use outcomes. As such, prevention and cessation intervention strategies are needed to address multilevel influences.

Protective Factors Buffer Life Stress and Behavioral Health Outcomes among High-Risk Youth

This study investigated internalizing problems, externalizing problems, and polydrug use among African-American youth residing in high-poverty neighborhoods, and tested the potential protective effects of religiosity, parental monitoring, and neighborhood collective efficacy on life stress and behavioral health outcomes (N = 576; 307 females; Mage = 16 years, SD = 1.44 years). A cumulative risk index reflected the combined effects of past year exposure to stressful life events, racial discrimination, and exposure to violence along with poor neighborhood ecology. Structural equation modeling revealed that cumulative risk significantly predicted internalizing problems, externalizing problems, and polydrug use. Interaction tests showed that the association of cumulative risk with internalizing problems was buffered by adolescent religiosity and neighborhood collective efficacy. The association of cumulative risk with externalizing problems was buffered by parental monitoring and collective efficacy. Adolescent sex further moderated these effects. The findings of the present study collectively highlight potential for protective factors to buffer effects of cumulative risk on behavioral health outcomes among youth residing in high-risk neighborhoods.

Examining the Association and Directionality between Mental Health Disorders and Substance Use among Adolescents and Young Adults in the U.S. and Canada-A Systematic Review and Meta-Analysis

Background: The purpose of this systematic review was to examine the association and directionality between mental health disorders and substance use among adolescents and young adults in the U.S. and Canada. Methods: The following databases were used: Medline, PubMed, Embase, PsycINFO, and Cochrane Library. Meta-analysis used odds ratios as the pooled measure of effect. Results: A total of 3656 studies were screened and 36 were selected. Pooled results showed a positive association between depression and use of alcohol (odds ratio (OR) = 1.50, 95% confidence interval (CI): 1.24–1.83), cannabis (OR = 1.29, 95% CI: 1.10–1.51), and tobacco (OR = 1.65, 95% CI: 1.43–1.92). Significant associations were also found between anxiety and use of alcohol (OR = 1.54, 95% CI: 1.19–2.00), cannabis (OR = 1.36, 95% CI: 1.02–1.81), and tobacco (OR = 2.21, 95% CI: 1.54–3.17). A bidirectional relationship was observed with tobacco use at baseline leading to depression at follow-up (OR = 1.87, CI = 1.23–2.85) and depression at baseline leading to tobacco use at follow-up (OR = 1.22, CI = 1.09–1.37). A unidirectional relationship was also observed with cannabis use leading to depression (OR = 1.33, CI = 1.19–1.49). Conclusion: This study offers insights into the association and directionality between mental health disorders and substance use among adolescents and young adults. Our findings can help guide key stakeholders in making recommendations for interventions, policy and programming.

Depressive Symptoms and Tobacco Use: Does Religious Orientation Play a Protective Role?

Many studies have established an association between depression and smoking. The main objective of this study was to determine whether religious orientation moderates the relationship between depressive symptoms and tobacco use. This study utilized a cross-sectional data collection strategy to examine the relationship among depressive symptoms, religious orientation, and tobacco use among undergraduate students (N = 349) at a midsize southeastern university. Participants completed a demographic questionnaire, the Center for Epidemiologic Studies Depression Scale, the Extrinsic/Intrinsic Religious Orientation Scale-Revised and the Drinking and Drug Habits Questionnaire. Analyses using hierarchical linear regression indicate a significant interaction effect (depressive symptoms × extrinsic religious orientation) on tobacco use. Additional moderation analyses reveal a significant interaction effect between depressive symptoms and the extrinsic-personal religious orientation on tobacco use. Results suggest that having an extrinsic religious orientation, and specifically, the extrinsic-personal subtype, can protect against the effects of depressive symptoms. In this regard, individuals who turn to religion for solace or comfort may be less likely to engage in tobacco use when experiencing depressive symptoms. Limitations, future directions, and implications are discussed.

Cigarette use trajectories in young adults: Analyses of predictors across system levels

BACKGROUND

Cigarette smoking escalates most in early to middle young adulthood. However, little research has examined a range of multilevel factors in relation to smoking trajectories during this time.

METHODS

We examined: 1) trajectories of cigarette smoking among 2967 US college students (aged 18-25) in a two-year, six-wave longitudinal study (using growth mixture modeling); and 2) intrapersonal- (i.e., other substance use, depressive symptoms, ADHD symptoms,); interpersonal- (i.e., adverse childhood events, social support, parental tobacco and marijuana use), and community-level (i.e., type of college, rural vs. urban setting) predictors of differing trajectories (using multinomial logistic regression).

RESULTS

We identified three trajectory classes: 1) Dabblers, who used cigarettes at one point in their life or not at all (85.6%); 2) College Onset Smokers, who began smoking regularly during the college years (6.2%); and 3) Later Onset Smokers, who began smoking during the mid- to late-20 s (8.2%). Multinomial regression (with Dabblers as the reference group) showed that predictors of being College Onset Smokers included being male (p = .031); Asian (p = .001) but not Black (p = .008; Ref: White); early onset smokers (i.e., initiation before age 15; p = .006); past 30-day users of little cigars/cigarillos (p = .024), alcohol (p < .001), and marijuana (p = .008); children of tobacco users (p = .050); and public (p = .031) or a technical college students (p < .001; Ref: private college); predictors of being Later Onset Smokers were being male (p = .019) and technical college students (p = .005).

CONCLUSIONS

Despite some young adults' smoking initiating/escalating in middle young adulthood, few risk factors were documented. This understudied period warrants greater examination to inform intervention.

Racial/ethnic differences in the relationship among cigarette use, religiosity, and social norms for U.S. adolescents

This study investigated the racial/ethnic differences in the role of social norms in the protective relationship between religiosity and cigarette smoking. The 2009 National Survey on Drug Use and Health was used to investigate the relationships between smoking, religiosity, and social norms of U.S. adolescents (N = 13,278). Significant indirect effects between religiosity and smoking were found through social norms for non-Hispanic White adolescents. Findings were mixed for non-Hispanic Black adolescents. Mechanisms driving the religiosity-smoking association differ across subpopulations. Smoking prevention efforts and messaging campaigns that include partnerships with religious communities may require consideration of these racial/ethnic differences when planning prevention strategies.

Perceived benefits of smoke-free homes, the process of establishing them, and enforcement challenges in Shanghai, China: a qualitative study

BACKGROUND

We examined reasons for establishing smoke-free home policies, interpersonal processes by which they are established, and challenges in enforcing them in Shanghai, China.

METHODS

In 2013, we conducted 30 in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from urban and a suburban communities in Shanghai.

RESULTS

Reasons for adopting a smoke-free home included family's health, being a role model for children, cleaner environment, and potential impact on smoking behavior. Wives were credited with initiating discussion regarding the implementation of a smoke-free home most often and were reported to have decision-making authority. Some households had not discussed such a rule. Common responses to asking to establish a smoke-free home among husbands were agreeing not to smoke at home or in front of family members, ignoring the request, temporarily acquiescing, insisting on smoking in the home anyway, and devaluing the benefits of smoke-free homes. Challenges to enforcement included weather, social situations, the smoker being home alone, ineffective harm reduction behaviors such as smoking near windows, and addiction were challenges in enforcement.

CONCLUSIONS

Specific factors (e.g. family's health) could be highlighted to assist women, men, and children in adopting and enforcing smoke-free home policies.

The Growth of Protestantism in Brazil and Its Impact on Male Earnings, 1970-2000

Protestantism has expanded rapidly in Brazil in recent decades. The question we tackle in this paper is whether Protestantism has had a positive influence on male earnings in this setting, either through its influence on health and productivity, by way of social networks or employer favor and reduced discrimination, or through other mechanisms. We tackle the problem of the selectivity of religious conversion and affiliation using microdata from the Brazilian censuses of 1970, 1980, 1991, and 2000, and analyzing the association between Protestantism and earnings at the group rather than the individual level. Our results show a strong association between the proportion of Protestants in a region, and the earnings of men in one educational group: those with less than five years of education. Upon introducing race into our models, we found that the association between religion and the earnings of less educated men is concentrated in regions in which there is a substantial non-white population. The relationships we have uncovered contribute to the literature on racial inequality and discrimination in Brazil, which to date has given little space to the role of religion in moderating the pernicious effect of race on economic outcomes in Brazil. The substantial association we found between religion and earnings contrasts with much of the research that has been carried out on the influence of religion on earnings in the United States.

Using Peer Injunctive Norms to Predict Early Adolescent Cigarette Smoking Intentions

The present study investigated the importance of the perceived injunctive norm to predict early adolescent cigarette smoking intentions. A total of 271 6^th graders completed a survey that included perceived prevalence of friend smoking (descriptive norm), perceptions of friends' disapproval of smoking (injunctive norm), and future smoking intentions. Participants also listed their five best friends, in which the actual injunctive norm was calculated. Results showed that smoking intentions were significantly correlated with the perceived injunctive norm but not with the actual injunctive norm. Secondly, the perceived injunctive norm predicted an additional 3.4% of variance in smoking intentions above and beyond the perceived descriptive norm. These results demonstrate the importance of the perceived injunctive norm in predicting early adolescent smoking intentions.

Attitudes and beliefs regarding depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females

Individuals' attitudes and beliefs toward behaviors are key indicators of behavioral performance. The purposes of this study were to elucidate attitudes and beliefs about depression, HIV/AIDS, and HIV risk-related sexual behaviors among clinically depressed African American adolescent females and to develop an understanding of their context for HIV risk. For this descriptive qualitative inquiry, semistructured interviews and surveys were employed (N = 24). The narratives reveal that behavioral sequelae of depression (i.e., loneliness) can produce risk for HIV. These findings may guide psychiatric nurse educators, scientists, and practitioners to modify HIV risk among clinically depressed African American adolescent females.

Health-risk behaviors among a sample of US pre-adolescents: types, frequency, and predictive factors

BACKGROUND

Children as young as 10 years old report curiosity and participation in health-risk behaviors, yet most studies focus upon adolescent samples.

OBJECTIVE

To document the types and frequencies of health risk behavior among pre-adolescents and to examine the child, family, and environment factors that predict them.

METHOD

A sample of 297 pre-adolescents (mean age=10.5, SD=0.6) from two Midwestern US cities and their parents (child-parent dyads) provided data about demographic characteristics, health risk behavior participation, child self-esteem, child pubertal development, child and adult perception of their neighborhood, and parent monitoring. Their participation was at intake to a 5-year clustered randomized controlled trial.

RESULTS

Pre-adolescents participated in an average of 3.7 health-risk behaviors (SD=2.0), primarily those that lead to unintentional (helmet and seatbelt use) and intentional (feeling unsafe, having something stolen, and physical fighting) injury. Factors predictive of unintentional injury risk behavior were self-esteem, pubertal development, parent monitoring, and parent perception of the neighborhood environment. Boys were 1.8 times less likely than girls to use helmets and seatbelts. Pre-adolescents whose parents were not partnered were 2.8 times more likely than pre-adolescents whose parents were partnered to report intentional risk behavior.

RECOMMENDATIONS

These data demonstrate trends that cannot be ignored. We recommend, focused specifically upon boys and non-partnered families that (a) developmentally appropriate, appealing prevention messages be developed and delivered for parents and pre-adolescents and community interventions targeting both parent and pre-adolescent together be provided to help them establish and monitor behavioral expectations and (b) organized nursing endorse policy in the US and globally that assures adequate family environments for children.

Smoking, substance use, and mental health correlates in urban adolescent girls

This study examined the associations among smoking tobacco and/or cannabis with alcohol use, depression, disordered eating and healthy behaviors among adolescent girls enrolled in an HIV prevention intervention randomized trial. Baseline self-reported behaviors from 744 sexually active, low-income, urban participants were collected using an audio computer assisted self interview. Girls ranged in age from 15 to 19 years old with a mean age of 16.5. Over 16% of girls reported smoking cigarettes, 41% smoked cannabis and 12% used both substances. Girls who smoked either substance had higher scores for depression symptoms, alcohol use and disordered eating when compared to nonsmokers. Girls who used both substances were at a higher risk for alcohol use, depression symptoms and disordered eating. The association of cannabis and tobacco with the other health related issues differed depending on age, indicating that assessment and targeting of health behavior interventions may differ depending on a girl's age. Disordered eating, depressive symptoms and cannabis use were higher among these adolescent girls than previously documented in the literature, suggesting that to improve the health of this population multi-focused interventions must target girls before they have engaged in smoking.

College student reactions to smoking bans in public, on campus and at home

We examined college student reactions to a statewide public smoke-free policy, campus policies and private restrictions through an online survey among 2260 students at a 2-year college and a university and 12 focus groups among smokers. Among survey participants, 34.6% smoked in the past month (35.0% daily, 65.0% non-daily). Correlates of receptivity to public policies included attending the university, not living with smokers and non-smoker status (versus daily and non-daily smoking). Correlates of receptivity to outdoor campus policies included being a university student, unmarried, without children, from homes where parents banned indoor smoking and a non-smoker. Correlates of having home restrictions included not living with smokers, no children, parents banning indoor smoking and non-smoker status. Correlates of having car restrictions included attending the university, not living with smokers, having children, parents banning indoor smoking and non-smoker status. Qualitative findings indicated support for smoke-free policies in public (albeit greater support for those in restaurants versus bars) and on campus. Participants reported concern about smokers' and bar/restaurant owners' rights, while acknowledging several benefits. Overall, 2-year college students and smokers (non-daily and daily) were less supportive of smoke-free policies.

Social Norms and the Relationship Between Cigarette Use and Religiosity Among Adolescents in the United States

This study investigated the social dynamics that underlie the negative association between religiosity and cigarette use among U.S. adolescents. Using data from the 2007 National Survey on Drug Use and Health, the authors used a theory-based conceptual model (vicarious learning networks [VLN]) to examine the role that key reference group norms play in the religiosity—smoking relationship. This relationship is partially mediated by parents’ and close friends’ perceived disapproval for smoking. However, religiosity maintains a strong negative association with smoking. Consistent with the VLN model, cigarette use varied substantively based on reference group normative configurations. To the extent that the protective effects of religiosity arise from its influence in structuring the social milieu, some of religiosity’s benefits could potentially be leveraged through interventions that promote healthy norms among reference groups within the social network. The VLN model may be a useful tool for conceptualizing the transmission of health behavior through social learning processes.

Psychological distress and smoking behavior: the nature of the relation differs by race/ethnicity

OBJECTIVE

We explored how the relation between psychological distress and smoking behavior differed as a function of race/ethnicity of respondents to a representative national survey.

METHODS

Data from the 2007 Health Information National Trends Survey were analyzed. Participants reported experiences of psychological distress in the past 30 days, race/ethnicity, current smoking status (smoker/nonsmoker), and number of cigarettes smoked per day. Logistic regression and linear regression analyses were used to examine the influence of race, distress, and their interaction on smoking behavior using survey weighting techniques to account for sampling strategy and nonresponse.

RESULTS

For current smoking status, there was a significant interaction between race and psychological distress. Follow-up analyses indicated that psychological distress was related to smoking status for White but not for Black or Hispanic respondents. Similar results were found for number of cigarettes smoked per day among current smokers.

CONCLUSIONS

The results suggest that the often-reported association between psychological distress and smoking is relatively specific to White individuals. The relation does not appear to characterize either Black or Hispanic individuals.

Stress and tobacco use among African-American adolescents: the buffering effect of cultural factors

Tobacco is a leading contributor to morbidity and mortality and a primary reason for health disparities among African Americans. In this study we explore the role of stress in smoking and cultural factors that protect against stress among African-American adolescents. Our sample consisted of 239 youth who were recruited into the study while enrolled in 8th and 12th grade. Measures of risk factors (stress, school transition stress, and community disorganization), moderator or protective factors (religious support and intergenerational connections), and 30-day tobacco use were collected. Hierarchical multiple regression analyses were conducted. Intergenerational connections moderated the effect of stress on past 30-day tobacco use. Religious support moderated the effect of neighborhood disorganization on past 30-day tobacco use. Religious support also moderated the effect of stress on past 30-day tobacco use. The findings have implications for prevention efforts to consider religious beliefs and practices and also to link youth with supportive adults in their community.