Tobacco use and smoking intentions among U.S. fifth-grade students

Challenging Assumptions About Race/Ethnicity, Socioeconomic Status, and Cigarette Smoking Among Adolescents

BACKGROUND

Previous research indicates that differences in cigarette smoking exist among those of different race/ethnicity and varying levels of socioeconomic status. However, most research has examined the influence of these factors separately on cigarette smoking despite their observed covariation. To examine the interaction of race/ethnicity and socioeconomic status on adolescent tobacco use and behaviors, this study tests whether or not the social gradient holds for smoking patterns and perceptions of smoking among African American, American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents.

METHODS

Using data from the 2018 National Survey on Drug Use and Health, the sample included African American/Black (Black), American Indian/Alaska Native (AIAN), Asian, Hispanic, and White adolescents (N = 12,474), ages 12-17 years old. Measures included race/ethnicity, annual household income, age, gender, cigarette smoking, perceptions of peer use, parental attitudes, and health risks of smoking; logistic regression analyses were conducted.

RESULTS

Findings indicated significant interactions between high income and Black and Hispanic race/ethnicity for having ever smoked a cigarette indicating a difference in comparison to high-income White adolescents (p's < 0.05). We also found that the interaction between high income and AIAN race/ethnicity for disapproval of peers smoking was significant compared to White adolescents at the same income levels (p < 0.05). No differences were found for smoking health risk perceptions.

CONCLUSIONS

The relationship between race/ethnicity, income, and smoking may be more complex than previously thought with these results having important preventative implications for identification of adolescents who may be most at risk for tobacco use.

Influence of gender on initiation of tobacco and nicotine containing product use among U.S. Air Force trainees

Military personnel are a subgroup of young adults at risk for tobacco and nicotine containing product (TNCP) use. This study of US Air Force (USAF) trainees who were never users of TNCPs examined gender, peer tobacco use, and tobacco use intentions as predictors of TNCP initiation after Basic Military Training (BMT). We used a longitudinal cohort assessment study design with baseline and 1-year surveys completed (2011-2016) among 2393 USAF trainees: 73% men, 95% aged 18-25 years, 36% racial minorities. Overall, initiation of any TNCP use at 1-year was 23% (20% women, 24% men). From a multivariable multinomial logistic regression model predicting TNCP use at 1-year follow-up, significant 2-way interactions were detected between gender and number of close friends using tobacco before BMT (p = 0.015), and between gender and tobacco use intentions (p < 0.0001). Women reporting almost all or many close friends used tobacco were more likely to report TNCP use compared to women with none (Odds ratio [OR] = 5.8, 95% CI 2.5-13.5, Bonferroni corrected p < 0.0001). Having close friends using tobacco had little influence on TNCP use among men. Men with tobacco use intentions were more likely to report TNCP use compared to men having no intentions (OR = 8.0, 95% CI: 4.7-13.6, Bonferroni corrected p < 0.001), but tobacco use intentions had little influence among women. In this sample of USAF trainees, the study provides novel prospective findings on TNCP initiation, and how men and women are influenced differently by peer tobacco use and tobacco use intentions. Gender-specific prevention efforts focused on uptake of TNCPs appear warranted.

Influence of gender and peer tobacco use on tobacco use intentions after a period of involuntary tobacco abstinence among U.S. Air Force trainees

This study examined gender, prior tobacco use, and social-environmental factors as predictors of intentions to use tobacco (cigarette smoking and/or smokeless tobacco [ST]) after a forced period of abstinence among U.S. Air Force (USAF) trainees. Trainees completed 8½ weeks of basic military training (BMT), then 4 weeks of Technical Training; both required abstinence from tobacco. A cross-sectional survey of 13,514 USAF trainees (73% male, 90% age 18–24, 43% prior tobacco use) was conducted at the beginning of the 4-week Technical Training period. Overall, 17% of the sample reported future tobacco use intentions. Intentions for future tobacco use were less prevalent among non-tobacco users before BMT (1%) than those reporting any tobacco use (37%). From a multivariable logistic regression model predicting intentions to use any tobacco after Technical Training, significant two-way interaction effects were detected between gender, and tobacco use prior to BMT (p = 0.0001), and number of close friends who smoked cigarettes (p = 0.018), and number of close friends who used ST (p = 0.029). Among non-tobacco users before BMT, females were more than twice as likely as males to report tobacco intentions (Odds Ratio = 2.2, Bonferroni corrected 95% CI: 1.14.4, p = 0.011); no gender differences were detected among tobacco users. For females, but not males, having more friends who smoked was associated with greater likelihood of tobacco intentions (Bonferroni corrected p ≤ 0.05). In contrast, for males, but not females, having more friends using ST was associated with greater likelihood of tobacco intentions (Bonferroni corrected p < 0.05). In this sample of USAF trainees, the study provides novel findings on how males and females are influenced differently by their prior tobacco use and peers' tobacco use in predicting tobacco intentions. Prevention efforts focused on uptake and resumption of tobacco use, along with gender-specific strategies, may be warranted.

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Prior tobacco use predicts tobacco use intentions among U.S. Air Force trainees.

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Male and female trainees are influenced differently by their peers' tobacco use.

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Gender-specific strategies targeting social norms about tobacco may be warranted.