The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change

Tobacco exposure associated with oral microbiota oxygen utilization in the New York City Health and Nutrition Examination Study

PURPOSE

The effect of tobacco exposure on the oral microbiome has not been established.

METHODS

We performed amplicon sequencing of the 16S ribosomal RNA gene V4 variable region to estimate bacterial community characteristics in 259 oral rinse samples, selected based on self-reported smoking and serum cotinine levels, from the 2013-2014 New York City Health and Nutrition Examination Study. We identified differentially abundant operational taxonomic units (OTUs) by primary and secondhand tobacco exposure, and used "microbe set enrichment analysis" to assess shifts in microbial oxygen utilization.

RESULTS

Cigarette smoking was associated with depletion of aerobic OTUs (Enrichment Score test statistic ES = -0.75, P = .002) with a minority (29%) of aerobic OTUs enriched in current smokers compared with never smokers. Consistent shifts in the microbiota were observed for current cigarette smokers as for nonsmokers with secondhand exposure as measured by serum cotinine levels. Differential abundance findings were similar in crude and adjusted analyses.

CONCLUSIONS

Results support a plausible link between tobacco exposure and shifts in the oral microbiome at the population level through three lines of evidence: (1) a shift in microbiota oxygen utilization associated with primary tobacco smoke exposure; (2) consistency of abundance fold changes associated with current smoking and shifts along the gradient of secondhand smoke exposure among nonsmokers; and (3) consistency after adjusting for a priori hypothesized confounders.

Trajectories of Tobacco and Nicotine Use Across Young Adulthood, Texas, 2014-2017

OBJECTIVES

To examine intraindividual change in polytobacco and individual tobacco and nicotine product use across young adulthood.

METHOD

Participants were 2711 students from 24 Texas colleges participating in a 6-wave online study, with 6 months between each wave. Participants were aged 18 to 25 years at baseline in fall 2014 or spring 2015 and aged 20 to 28 years at wave 6. We used growth curve modeling for an accelerated longitudinal design to examine change from ages 18 to 28 years in polytobacco use (use of 2 or more products) and in use of 5 individual products (cigarettes, smokeless tobacco or snus, large cigars, cigarillos, or little cigars, hookah, and electronic nicotine delivery systems [ENDS]).

RESULTS

There was a statistically significant decline in polytobacco use from ages 18 to 28 years. There were also statistically significant declines in ENDS, hookah, and cigar use but not in smokeless tobacco use, for which use was negligible, or in cigarette use. Importantly, cigarettes were the most used product at virtually all ages.

CONCLUSIONS

Young adults may mature out of polytobacco use with increasing age, but they may continue to use some products, most notably cigarettes, potentially the most toxic and addictive tobacco and nicotine product.

Trajectories of pre- and postnatal co-use of cannabis and tobacco predict co-use and drug use disorders in adult offspring

Co-use of cannabis and tobacco is increasingly common among women and is associated with tobacco and cannabis dependence and poorer cessation outcomes. However, no study has examined maternal patterns of co-use over time, or the impact of maternal co-use on co-use and drug problems in adult offspring. Pregnant women (M age = 23, range = 18-42; 52% African American, 48% White) were asked about substance use during each trimester of pregnancy, and at 8 and 18 months, 3, 6, 10, 14, 16, and 22 years postpartum. We examined patterns of any maternal cigarette and cannabis use during pregnancy and the postpartum years. As young adults (M age = 22.8 years, range = 21-26), 603 offspring completed the Diagnostic Interview Schedule (DIS). Growth mixture modeling (GMM) was used to identify four maternal trajectories through 16 years postpartum: (1) no co-use (66%), (2) decreasing co-use (16%), (3) postpartum-only co-use (11%), and (4) chronic co-use (7%). Offspring whose mothers were in the decreasing co-use group (co-users primarily during prenatal and preschool periods) were more likely to be co-users than the offspring of non-co-users. Offspring whose mothers were chronic co-users of cigarettes and cannabis were more than twice as likely to have a drug use disorder than young adults whose mothers were not co-users. The results of this study highlight the heterogeneity in maternal co-use of tobacco and cannabis over time, with some women quitting during pregnancy but resuming co-use in the postpartum, and other women co-using during pregnancy but desisting co-use over time. Maternal trajectories of co-use were associated with inter-generational transfer of risk for substance use and dependence in adult offspring.

Parent Education and Substance Use among Latin-American Early Adolescents

Objective

To examine the relationship between parent education, at individual- and school-level, and substance use behaviors (smoking, alcohol drinking, binge drinking, and illicit drug use) among young adolescents from Argentina and Mexico.

Methods

A cross-sectional, school-based survey of middle-school early adolescents from Mexico (N=10,123) and Argentina (N=3,172) queried substance use.

Results

After adjusting for age, sex and individual-level parent education, students from Mexican schools with lower parent education had higher likelihood of current smoking and drug use than those from schools with higher parent education. In Argentina, lower parent education at school-level was positively associated with all outcomes.

Conclusion

Disadvantageous contextual school characteristics contributes to substance use among early adolescents in Mexico and Argentina.

A longitudinal examination of US teen childbearing and smoking risk

BACKGROUND

Teenage motherhood and smoking have important health implications for youth in the United States and globally, but the link between teen childbearing and subsequent smoking is inadequately understood. The selection of disadvantaged young women into early childbearing and smoking may explain higher smoking levels among teen mothers, but teen motherhood may also shape subsequent smoking through compromised maternal depression or socioeconomic status, and race/ethnicity may condition these processes.

OBJECTIVE

This study examines the relationship between US teen childbearing and subsequent daily smoking, accounting for prior smoking and selection processes related to social disadvantage. Analyses investigate whether socioeconomic status and depression in young adulthood explained any relationship between teen childbearing and daily smoking, as well as examining racial/ethnic heterogeneity in these processes.

METHODS

Multivariate binary logistic regression analyses employ the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 7,529).

RESULTS

The highest daily smoking prevalence occurred among non-Hispanic White teen mothers, with lower prevalence among Hispanic and non-Hispanic Black teen mothers. Compared to other women, teenage mothers are 2.5 times as likely to smoke daily in young adulthood. Their greater likelihood of daily smoking is due in part to selection and is also mediated by socioeconomic status in ways that differ by race/ethnicity.

CONCLUSIONS

The findings suggest that preventing teen pregnancy or ameliorating its socioeconomic consequences may decrease daily smoking in this vulnerable population. Reducing teen smoking, especially during pregnancy, could improve teen, maternal, and infant health and thereby increase US health and longevity.

CONTRIBUTION

This study provides new, nationally representative information about selection, mediation, and heterogeneity processes in the relationship between teen childbearing and subsequent smoking.

Identifying demographic and psychosocial factors related to the escalation of smoking behavior among Mexican American adolescents

Cigarette smoking is the leading preventable cause of death in the United States; smoking in Mexican American adolescents, a rapidly growing population, remains a major concern. Factors associated with escalation or progression along the smoking trajectory have not been studied in adolescent Mexican Americans. A better understanding of escalation is needed for cancer prevention and overall health. N=1,328 Mexican American adolescents joined a cohort in 2005-06. At baseline participants provided demographic, acculturation and psychosocial data, and reported their smoking status using the Minnesota Smoking Index. Those that never tried a cigarette or only had a few puffs in their life were included in this study. The primary outcome of interest, escalation in smoking status, was defined as moving up the Minnesota Smoking Index by 2010-2011. The current analysis is based on 973 participants of whom 48.2% were male, mean age=11.8 (SD=0.8), and 26.0% were born in Mexico. By 2010-2011, 283 (29%) escalated their smoking status and 690 (71%) remained the same. Being older (OR=1.30; CI=1.07-1.57), male (OR=1.88, CI=1.40-2.53), having higher levels of anxiety (OR=1.03, CI=1.02-1.05), intending to smoke (OR=1.70, CI=1.18-2.46), having friends who smoke (OR=1.73, CI=1.12-2.70) and having parents' friends who smoke (OR=1.38, CI=1.02-1.88) increased risk for smoking escalation. Higher levels of subjective social status (OR=0.91, CI=0.83-0.99) were protective against smoking escalation. Contrasting previous work in smoking experimentation, parents' friends influence was a stronger predictor than the family household influence. Preventative interventions for Mexican American youth could address this risk factor to reduce smoking escalation.

E-cigarette use, perceptions, and cigarette smoking intentions in a community sample of young adult nondaily cigarette smokers

E-cigarettes have been suggested as a strategy for reducing harm from cigarettes. Although e-cigarettes could be a less-harmful alternative to cigarettes for those trying to quit, there may also be costs that outweigh any benefits of reduction. The purpose of the present study was to prospectively investigate perceptions of e-cigarettes, cigarette smoking intentions, and their associations with e-cigarette use over time. Community participants (N = 348, 57% male) aged 18 to 24 years were recruited for a longitudinal study of tobacco use. Inclusion criteria included nondaily cigarette smoking for ≥ 6 months with no history of daily smoking. Participants reported e-cigarette use over the past 14 days at baseline, and for the past 9 days at 3, 6, and 9 months. Assessments were completed online or via mobile phone. Across the 4 assessments, 22% to 33% of participants reported recent e-cigarette use. Intent to quit smoking cigarettes and intent to maintain smoking were unrelated to e-cigarette frequency. E-cigarette frequency was positively associated with perceiving e-cigarettes as less harmful than cigarettes and more positive e-cigarette expectancies (ps < .05). E-cigarette use was also more frequent among those who smoked cigarettes frequently and who used e-cigarettes to circumvent cigarette bans more often (ps < .05). The combination of these findings suggests that, at least among nondaily smoking young adults, other factors may influence frequency of e-cigarette use more than harm reduction. Findings instead seem consistent with the hypothesis that e-cigarettes are more often used to complement ongoing cigarette smoking. (PsycINFO Database Record

Expectancies for and use of e-cigarettes and hookah among young adult non-daily smokers

INTRODUCTION

Understanding predictors of e-cigarette and hookah use among young adults is important in light of their increasing prevalence, particularly in younger populations. The purpose of this study was to test the hypothesis that young adult non-daily cigarette smokers' use of e-cigarettes and hookah would be positively associated with their expectancies about these products.

METHODS

Young adults (n=377, 58.0% male) aged 18-24years (M=20.5, SD=1.8) who had been non-daily smokers for at least six months but had never been daily smokers completed a baseline assessment online or via mobile phone as part of a larger, longitudinal study.

RESULTS

Approximately one in three participants reported any e-cigarette (34.0%) and/or hookah (33.4%) use in the past 14days; 37% of those who used either product reported using both. More positive e-cigarette expectancies were associated with higher odds of any e-cigarette use and with heavier use in the past two weeks. Similarly, more positive expectancies for hookah use predicted greater odds of any use as well as more frequent use of hookah (all ps<0.001). Cigarette expectancies were correlated with ANTP expectancies, but did not account for the latter's association with ANTP use.

CONCLUSIONS

Findings suggest that expectancies play a role in determining whether young adult cigarette smokers also use these nicotine products. These data also suggest use of e-cigarettes and/or hookah may be as common as not among young adult nondaily smokers.

Levels of physical dependence on tobacco among adolescent smokers in Cyprus

PURPOSE

The purpose of this study is to assess tobacco dependence among Cypriot adolescents and examine its association to cigarette consumption and attitudes towards smoking.

METHODS

The current study used cross-sectional data from the 2011 Cyprus Global Youth Tobacco Survey which adopted multistage cluster sampling methods to select adolescents registered in middle and high schools in Cyprus. Tobacco use, physical dependence on tobacco, and attitudes towards tobacco use were measured in 187 adolescents aged 13-18years old who reported that they had smoked at least once in the preceding 30days. Physical dependence was assessed using the Levels of Physical Dependence scale.

RESULTS

Physical dependence was present in 86% of the adolescent smokers. The mean latency to needing among smokers in the highest dependence group was 101h. Significant associations were observed between physical dependence and the perceived difficulty in quitting (OR=13.1, 95% CI: 4.0, 43.0) as well as the expectation to continue smoking for the next five years (OR=3.3, 95% CI: 1.3, 8.4). Significant associations were also observed between physical dependence and the number of smoking days per month, daily smoking, daily cigarette consumption, lifetime cigarette consumption, and perceived difficulty in abstaining from smoking for one week.

CONCLUSIONS

Physical dependence provides a symptom-based approach to assess dependence and it is a strong predictor of adolescents' perceptions of their ability to quit or to refrain from smoking for a week. Physical dependence on tobacco was highly prevalent among adolescent smokers in Cyprus and it was associated with greater perceived difficulty in quitting. Interventions targeting adolescent smoking must account for the high prevalence of physical dependence.

Cigarette smoking and ADHD: An examination of prognostically relevant smoking behaviors among adolescents and young adults

Attention-deficit/hyperactivity disorder (ADHD) is associated with health risks in adolescence which includes the potential for smoking cigarettes, early smoking initiation, and rapid progression to daily smoking. Much less is known, however, about prognostically relevant smoking behaviors among individuals with childhood ADHD. Further research in this area is important for identifying individuals at pronounced risk for nicotine addiction, and for developing effective interventions for this population. This study examined initiation of cigarette smoking, progression to regular smoking, quantity of use, indicators of tobacco dependence, and quit rates among adolescents and young adults with (n = 364) and without (n = 240) childhood ADHD. Individuals with, versus without, ADHD histories were significantly more likely to become daily smokers independent of conduct disorder (CD). They were also more likely to initiate smoking at younger ages and to progress to regular smoking more quickly. There were no significant group differences in cigarettes smoked per day, Fagerström Test of Nicotine Dependence (FTND), or Nicotine Dependence Syndrome Scale (NDSS) scores or in smoking within 30 min of waking. However, smokers with ADHD reported more intense withdrawal and craving during periods of abstinence than non-ADHD smokers. There were no significant group differences in number of quit attempts. Lastly, there were no significant differences among symptom persisters and desisters in daily smoking and amount. Individuals with ADHD histories are at high risk for persistent smoking given their early onset, rapid course, and abstinence characteristics. Smoking cessation programs may need to be adapted or otherwise intensified for those with ADHD. (PsycINFO Database Record

Do stronger school smoking policies make a difference? Analysis of the health behaviour in school-aged children survey

Background: Associations of the strength of school smoking policies with cigarette, e-cigarette and cannabis use in Wales were examined. Methods: Nationally representative cross-sectional survey of pupils aged 11–16 years (N=7376) in Wales. Senior management team members from 67 schools completed questionnaires about school smoking policies, substance use education and tobacco cessation initiatives. Multi-level, logistic regression analyses investigated self-reported cigarette, e-cigarette and cannabis use, for all students and those aged 15–16 years. Results: Prevalence of current smoking, e-cigarette use and cannabis use in the past month were 5.3%, 11.5% and 2.9%, respectively. Of schools that provided details about smoking policies (66/67), 39.4% were strong (written policy applied to everyone in all locations), 43.9% were moderate (written policy not applied to everyone in all locations) and 16.7% had no written policy. There was no evidence of an association of school smoking policies with pupils’ tobacco or e-cigarette use. However, students from schools with a moderate policy [OR = 0.47; 95% (confidence interval) CI: 0.26–0.84] were less likely to have used cannabis in the past month compared to schools with no written policy. This trend was stronger for students aged 15–16 years (moderate policy: OR = 0.42; 95% CI: 0.22–0.80; strong policy: OR = 0.45; 95% CI: 0.23–0.87). Conclusions: School smoking policies may exert less influence on young people’s smoking behaviours than they did during times of higher adolescent smoking prevalence. Longitudinal studies are needed to examine the potential influence of school smoking policies on cannabis use and mechanisms explaining this association.

Adolescents' Attitudes on Smoking Are Related to Experimentation with Smoking, Daily Smoking and Best Friends' Smoking in Two Karelias in Finland and in Russia

PURPOSE

Becoming a smoker usually starts during adolescence and is a dynamic process involving experimentation before the establishment of daily smoking. It has been suggested that adolescents who smoke differ from those who do not in their attitudes to smoking. The purpose of this study was to find out whether attitudes related to smoking legislation and restrictions, social pressures in smoking and image of smokers are associated with smoking experimentation, daily smoking and best friends' smoking.

METHOD

The data were gathered with a self-administered questionnaire in North Karelia, Eastern Finland and in the Pitkyaranta district, Republic of Karelia, Russia. The respondents were 15-year-old 9th grade pupils in local schools. In Pitkyaranta, the data analyses covered pupils in all eight schools in the area (n = 179). In North Karelia, the data analyses comprised of selected eight schools (n = 601). Data were analysed with exploratory factor analysis.

RESULTS

The models revealed that attitudes related to restrictions and social pressure were significantly associated with experimenting with smoking [OR (95 % CI) 7.923 (5.787-10.847)], daily smoking [OR (95 % CI) 9.575 (6.727-13.628)] and the likelihood of best friends' smoking [OR (95 % CI) 3.154 (2.579-3.858)]. The stronger the young peoples' attitudes and opinions, for example, towards restrictions and with more difficulties in refusing smoking, the higher the likelihood for smoking experimentations, daily smoking as well as the likelihood for their best friends' smoking. The country and factor interactions were not associated with smoking experimentations, daily smoking or best friends' smoking.

CONCLUSION

Regardless of cultural background, adolescents who smoke have more positive attitudes to smoking, and perceive more social support for smoking, than do adolescents who do not smoke. The study stresses the similarity of the results in both Karelia's despite the enormous differences in culture, economy and public policy.

Local spatial clustering in youths' use of tobacco, alcohol, and marijuana in Boston

BACKGROUND

Understanding geographic variation in youth drug use is important for both identifying etiologic factors and planning prevention interventions. However, little research has examined spatial clustering of drug use among youths by using rigorous statistical methods.

OBJECTIVES

The purpose of this study was to examine spatial clustering of youth use of tobacco, alcohol, and marijuana.

METHODS

Responses on tobacco, alcohol, and marijuana use from 1,292 high school students ages 13-19 who provided complete residential addresses were drawn from the 2008 Boston Youth Survey Geospatial Dataset. Response options on past month use included "none," "1-2," "3-9," and "10 or more." The response rate for each substance was approximately 94%. Spatial clustering of youth drug use was assessed using the spatial Bernoulli model in the SatScan™ software package.

RESULTS

Approximately 12%, 36%, and 18% of youth reported any past-month use of tobacco, alcohol, and/or marijuana, respectively. Two clusters of elevated past tobacco use among Boston youths were generated, one of which was statistically significant. This cluster, located in the South Boston neighborhood, had a relative risk of 5.37 with a p-value of 0.00014. There was no significant localized spatial clustering in youth past alcohol or marijuana use in either the unadjusted or adjusted models.

CONCLUSION

Significant spatial clustering in youth tobacco use was found. Finding a significant cluster in the South Boston neighborhood provides reason for further investigation into neighborhood characteristics that may shape adolescents' substance use behaviors. This type of research can be used to evaluate the underlying reasons behind spatial clustering of youth substance and to target local drug abuse prevention interventions and use.

Life course SES and cardiovascular risk: Heterogeneity across race/ethnicity and gender

We examine four life course models as they relate to adolescent SES, adult SES, and cardiovascular risk--the sensitive period, pathways, accumulation, and social mobility models. Accounting for race/ethnic and gender differences in life course processes, we analyzed Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of individuals enrolled in grades 7-12 when they were first interviewed in 1994/5. We restricted our sample to whites, blacks, and Latinos who were interviewed in Waves I and IV and provided biomarker data (n = 11,397). The cardiovascular risk score at Wave IV combined waist circumference, blood pressure, hemoglobin A1c, and C-reactive protein. We found evidence for each of the four life course models for white women, whereas the sensitive period was indicated for white men. Upward mobility was also associated with higher CVD risk among white men as compared to those who were socio-economically advantaged at both time points. The pathway model was significant for Latino women. No life course models were significant for black men or women or Latino men. Our findings demonstrate the importance of applying an intersectional lens to understanding CVD risk over the life course.

FDA cigarette warning labels lower craving and elicit frontoinsular activation in adolescent smokers

Cigarette smoking is an economically and epidemiologically expensive public health concern. Most adult smokers become addicted during adolescence, rendering it a crucial period for prevention and intervention. Although litigation claims have delayed implementation, graphic warning labels proposed by the U.S. Food and Drug Administration (FDA) may be a promising way to achieve this goal. We aimed to determine the efficacy of the labels in reducing in-scanner craving and to characterize the neurobiological responses in adolescent and adult smokers and non-smokers. While undergoing functional magnetic resonance imaging, thirty-nine 13- to 18-year-old adolescent and forty-one 25- to 30-year-old adult smokers and non-smokers rated their desire to smoke when presented with emotionally graphic warning labels and comparison non-graphic labels. Compared with adult smokers, adolescent smokers exhibited greater craving reduction in response to the warning labels. Although smokers evinced overall blunted recruitment of insula and dorsolateral prefrontal cortex (DLPFC) relative to non-smokers, an effect that was stronger in adolescent smokers, parametrically increasing activation of these regions was associated with greater craving reduction. Functional connectivity analyses suggest that greater DLPFC regulation of limbic regions predicted cigarette craving. These data underscore a prominent role of frontoinsular circuitry in predicting the efficacy of FDA graphic warning labels in craving reduction in adult and adolescent smokers.

Validation of the Waterpipe Tolerance Questionnaire Among Jordanian School-Going Adolescent Waterpipe Users

Introduction:

Waterpipe use among adolescents has been increasing progressively. Yet no studies were reported to assess the validity and reliability of nicotine dependence scale. The current study aims to assess the validity and reliability of an Arabic version of the modified Waterpipe Tolerance Questionnaire WTQ among school-going adolescent waterpipe users.

Methods:

In a cross-sectional study conducted in Jordan, information on waterpipe use among 333 school-going adolescents aged 11-18 years was obtained using the Arabic version of the WTQ. An exploratory factor analysis and correlation matrices were conducted to assess validity and reliability of the WTQ.

Results:

The WTQ had a 0.73 alpha of internal consistency indicating moderate level of reliability. The scale showed multidimensionality with items loading on two factors, namely waterpipe consumption and morning smoking.

Conclusion:

This study report nicotine dependence level among school-going adolescents who identify themselves as waterpipe users using the WTQ.

Longitudinal associations between smoking and depressive symptoms among adolescent girls

Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depressive symptoms, or both. Collectively, there have been mixed findings; however, studies have been limited by (1) cross-sectional or short-term longitudinal data or (2) the use of methods that test associations, or only one direction in the associations, rather than a fully-reciprocal model to examine directionality. This study examined the associations between smoking and depressive symptoms in a sample of adolescent girls using latent dual change scores to model (1) the effect of smoking on change in depressive symptoms, and simultaneously (2) the effect of depressive symptoms on change in smoking across ages 11-20. Data were from a cohort-sequential prospective longitudinal study (N = 262). Girls were enrolled by age cohort (11, 13, 15, and 17 years) and were primarily White (61 %) or African American (31 %). Data were restructured by age. Every 6 months, girls reported depressive symptoms and cigarette use. Results indicated that controlling for sociodemographic characteristics, higher levels of smoking predicted a greater increase in depressive symptoms across adolescence. These findings suggest that a higher level of cigarette smoking does contribute to more depressive symptoms, which has implications for prevention of depression and for intervention and future research.

Family-based programmes for preventing smoking by children and adolescents

BACKGROUND

There is evidence that family and friends influence children's decisions to smoke.

OBJECTIVES

To assess the effectiveness of interventions to help families stop children starting smoking.

SEARCH METHODS

We searched 14 electronic bibliographic databases, including the Cochrane Tobacco Addiction Group specialized register, MEDLINE, EMBASE, PsycINFO, CINAHL unpublished material, and key articles' reference lists. We performed free-text internet searches and targeted searches of appropriate websites, and hand-searched key journals not available electronically. We consulted authors and experts in the field. The most recent search was 3 April 2014. There were no date or language limitations.

SELECTION CRITERIA

Randomised controlled trials (RCTs) of interventions with children (aged 5-12) or adolescents (aged 13-18) and families to deter tobacco use. The primary outcome was the effect of the intervention on the smoking status of children who reported no use of tobacco at baseline. Included trials had to report outcomes measured at least six months from the start of the intervention.

DATA COLLECTION AND ANALYSIS

We reviewed all potentially relevant citations and retrieved the full text to determine whether the study was an RCT and matched our inclusion criteria. Two authors independently extracted study data for each RCT and assessed them for risk of bias. We pooled risk ratios using a Mantel-Haenszel fixed effect model.

MAIN RESULTS

Twenty-seven RCTs were included. The interventions were very heterogeneous in the components of the family intervention, the other risk behaviours targeted alongside tobacco, the age of children at baseline and the length of follow-up. Two interventions were tested by two RCTs, one was tested by three RCTs and the remaining 20 distinct interventions were tested only by one RCT. Twenty-three interventions were tested in the USA, two in Europe, one in Australia and one in India.The control conditions fell into two main groups: no intervention or usual care; or school-based interventions provided to all participants. These two groups of studies were considered separately.Most studies had a judgement of 'unclear' for at least one risk of bias criteria, so the quality of evidence was downgraded to moderate. Although there was heterogeneity between studies there was little evidence of statistical heterogeneity in the results. We were unable to extract data from all studies in a format that allowed inclusion in a meta-analysis.There was moderate quality evidence family-based interventions had a positive impact on preventing smoking when compared to a no intervention control. Nine studies (4810 participants) reporting smoking uptake amongst baseline non-smokers could be pooled, but eight studies with about 5000 participants could not be pooled because of insufficient data. The pooled estimate detected a significant reduction in smoking behaviour in the intervention arms (risk ratio [RR] 0.76, 95% confidence interval [CI] 0.68 to 0.84). Most of these studies used intensive interventions. Estimates for the medium and low intensity subgroups were similar but confidence intervals were wide. Two studies in which some of the 4487 participants already had smoking experience at baseline did not detect evidence of effect (RR 1.04, 95% CI 0.93 to 1.17).Eight RCTs compared a combined family plus school intervention to a school intervention only. Of the three studies with data, two RCTS with outcomes for 2301 baseline never smokers detected evidence of an effect (RR 0.85, 95% CI 0.75 to 0.96) and one study with data for 1096 participants not restricted to never users at baseline also detected a benefit (RR 0.60, 95% CI 0.38 to 0.94). The other five studies with about 18,500 participants did not report data in a format allowing meta-analysis. One RCT also compared a family intervention to a school 'good behaviour' intervention and did not detect a difference between the two types of programme (RR 1.05, 95% CI 0.80 to 1.38, n = 388).No studies identified any adverse effects of intervention.

AUTHORS' CONCLUSIONS

There is moderate quality evidence to suggest that family-based interventions can have a positive effect on preventing children and adolescents from starting to smoke. There were more studies of high intensity programmes compared to a control group receiving no intervention, than there were for other compairsons. The evidence is therefore strongest for high intensity programmes used independently of school interventions. Programmes typically addressed family functioning, and were introduced when children were between 11 and 14 years old. Based on this moderate quality evidence a family intervention might reduce uptake or experimentation with smoking by between 16 and 32%. However, these findings should be interpreted cautiously because effect estimates could not include data from all studies. Our interpretation is that the common feature of the effective high intensity interventions was encouraging authoritative parenting (which is usually defined as showing strong interest in and care for the adolescent, often with rule setting). This is different from authoritarian parenting (do as I say) or neglectful or unsupervised parenting.

Cigarette smoking, problem-gambling severity, and health behaviors in high-school students

Introduction

Smoking and gambling are two significant public health concerns. Little is known about the association of smoking and gambling in adolescents. The current study of high-school adolescents examined: (1) smoking behavior by problem-gambling severity and (2) health-related variables by problem-gambling severity and smoking status.

Methods

Analyses utilized survey data from 1591 Connecticut high-school students. Adolescents were classified by problem-gambling severity (Low-Risk Gambling [LRG], At-Risk/Problem Gambling [ARPG]) and smoking status (current smoker, non-smoker). Analyses examined the smoking behavior of ARPG versus LRG adolescents as well as the smoking-by-problem-gambling-severity interactions for health and well-being measures (e.g., grades, substance use). Chi-square and logistic regression analyses were used; the latter controlled for gender, race/ethnicity, school grade, and family structure.

Results

More adolescents with ARPG than LRG reported regular smoking, heavy smoking, early smoking onset, no smoking quit attempts, and parental approval of smoking. ARPG and LRG adolescents who smoked were more likely to report poor grades, lifetime use of marijuana and other drugs, current heavy alcohol use, current caffeine use, depression, and aggressive behaviors and less likely to report participation in extracurricular activities. The association between not participating in extracurricular activities and smoking was statistically stronger in the LRG compared to the ARPG groups. Post-hoc analyses implicated a range of extracurricular activities including team sports, school clubs, and church activities.

Conclusions

Smoking was associated with poorer health-related behaviors in both ARPG and LRG groups. Interventions with adolescents may benefit from targeting both smoking and gambling.

•

We examined adolescent health behaviors by smoking status and gambling severity.

•

Smoking was associated with poorer health behaviors for adolescent gamblers.

•

Considering smoking may be helpful in interventions with adolescent gamblers.

Association between genetic variants on chromosome 15q25 locus and several nicotine dependence traits in Polish population: a case-control study

Tobacco smoking continues to be a leading cause of disease and mortality. Recent research has confirmed the important role of nicotinic acetylcholine receptor (nAChR) gene cluster on chromosome 15q 24-25 in nicotine dependence and smoking. In this study we tested the association of smoking initiation, age at onset of daily smoking, and heaviness of smoking with five single nucleotide polymorphisms (SNPs) within the CHRNA5-CHRNA3-CHRNB4 cluster. The group of 389 adult subjects of European ancestry from the north of Poland, including 212 ever (140 current and 72 former) and 177 never smokers with mean age 49.26, was genotyped for rs16969868, rs1051730, rs588765, rs6495308, and rs578776 polymorphisms. Distributions of genotypes for rs16969868 and rs1051730 were identical so they were analyzed together. Further analysis revealed the association between rs16969868-1051730 (OR = 2.66; 95% CI: 1.30–5.42) and number of cigarettes smoked per day (CPD) with heaviness of nicotine addiction measured by the Fagerström Test for Nicotine Dependence (FTND) (OR = 2.60; 95% CI: 1.24–5.43). No association between these polymorphisms and other phenotypes was found. Similarly, the association between rs588765, rs6495308, rs578776, and analyzed phenotypes was not confirmed. This study provides strong evidence for the role of the CHRNA5-CHRNA3-CHRNB4 cluster in heaviness of nicotine addiction.

A risk prediction model for smoking experimentation in Mexican American youth

BACKGROUND

Smoking experimentation in Mexican American youth is problematic. In light of the research showing that preventing smoking experimentation is a valid strategy for smoking prevention, there is a need to identify Mexican American youth at high risk for experimentation.

METHODS

A prospective population-based cohort of 1,179 adolescents of Mexican descent was followed for 5 years starting in 2005-06. Participants completed a baseline interview at a home visit followed by three telephone interviews at intervals of approximately 6 months and additional interviews at two home visits in 2008-09 and 2010-11. The primary endpoint of interest in this study was smoking experimentation. Information about social, cultural, and behavioral factors (e.g., acculturation, susceptibility to experimentation, home characteristics, and household influences) was collected at baseline using validated questionnaires.

RESULTS

Age, sex, cognitive susceptibility, household smoking behavior, peer influence, neighborhood influence, acculturation, work characteristics, positive outcome expectations, family cohesion, degree of tension, ability to concentrate, and school discipline were found to be associated with smoking experimentation. In a validation dataset, the proposed risk prediction model had an area under the receiver operating characteristic curve (AUC) of 0.719 (95% confidence interval, 0.637-0.801) for predicting absolute risk for smoking experimentation within 1 year.

CONCLUSIONS

The proposed risk prediction model is able to quantify the risk of smoking experimentation in Mexican American adolescents.

IMPACT

Accurately identifying Mexican American adolescents who are at higher risk for smoking experimentation who can be intervened will substantially reduce the incidence of smoking and thereby subsequent health risks.

Teacher Involvement as a Protective Factor from the Association between Race-Based Bullying and Smoking Initiation

Experiencing bullying as a victim is associated with negative health and health behavior outcomes, including substance use, among adolescents. However, understandings of protective factors - factors that enhance adolescents' resilience to the negative consequences of bullying - remain limited. The current study investigates whether teacher involvement protects adolescent students from the association between being bullied due to race and smoking initiation. Students were recruited from 12 Kindergarten through 8^th grade schools in an urban school district in the Northeast United States. The analytic sample included 769 students who responded to surveys in 5^th or 6^th grade (2009), and two years later in 7^th or 8^th grade (2011). Students primarily identified as Latino and/or Black, and 90% were eligible for free or reduced lunch. Fifty-four (7%) students initiated smoking between survey time points. Among students reporting lower teacher involvement, race-based bullying was associated with higher likelihood of smoking initiation (OR = 1.69, p = .03). In contrast, among students reporting higher teacher involvement, racebased bullying was not associated with higher likelihood of smoking initiation (OR = 0.95, p = .81). Results suggest that teacher involvement may protect students from the association between race-based bullying and smoking initiation. Enhancing teacher involvement among students experiencing race-based bullying in schools may limit smoking initiation.

Smoking habits among italian adolescents: what has changed in the last decade?

Tobacco use, alcohol abuse, overweight and obesity are risk factors for numerous diseases in Italy as elsewhere. However, children and adolescents are not usually included in official national surveys although it is at this stage of life when unhealthy habits are often established. Italian participation in HBSC and GYTS surveys allows our country to implement standardized surveillance systems providing reliable information on tobacco-related behaviors of this population. Data from three HBSC surveys (2002-2010) show that following the drop in the first half of the decade, prevalence of tobacco use stabilized in the second half. The decline was significant for younger age groups, while prevalence of regular tobacco use remained stable among 15-year-olds. Many adolescents reported being exposed to secondhand smoke, to have at least one parent who smokes, and having seen teachers and students smoking at school. Although the sale of tobacco products to minors is prohibited, the vast majority had no trouble in buying cigarettes. Data from GYTS and HBSC surveys provide a wealth of information about attitudes and behaviors of Italian adolescents with respect to smoking. Despite some progress, sizeable gaps remain in meeting standard recommendations for discouraging smoking initiation and motivating adolescent smokers to quit the habit.

Gender, depressive symptoms, and daily cigarette use

OBJECTIVE

It is widely known that cigarette use and depressive symptoms co-occur during adolescence and young adulthood and that there are gender differences in smoking initiation, progression, and co-occurrence with other drug use. Given that females have an earlier onset of depressive symptoms while males have an earlier onset of cigarette use, this study explored the possible bidirectional development of cigarette use and depressive symptoms by gender across the transition from adolescence to young adulthood. Gender differences in the stability and crossed effects of depressive symptoms and cigarette smoking during the transition to young adulthood, controlling for other known risk factors, were examined using a nationally representative longitudinal sample.

METHODS

A bivariate autoregressive multi-group structural equation model examined the longitudinal stability and crossed relationships between a latent construct of depressive symptoms and cigarette smoking over four waves of data. Data for this study came from four waves of participants (N = 6,501) from the National Longitudinal Survey of Adolescent Health. At each of four waves, participants completed a battery of measures including questions on depressive symptoms and an ordinal measure of number of cigarettes smoked per day.

RESULTS

The best-fitting bivariate autoregressive models were gender-specific, included both crossed and parallel associations between depressive symptoms and cigarette use during the transition to adulthood, and controlled for wave-specific parental smoking, alcohol use, and number of friends who smoke. For females, greater depressive symptoms at each wave, except the first one, were associated with greater subsequent cigarette use. There were bidirectional associations between depressive symptoms and cigarette use only for females during young adulthood, but not for males.

CONCLUSIONS

The development of depressive symptoms and cigarette use from adolescence and into young adulthood follows similar patterns for males and females. Controlling for the correlation and stability between initial levels of depressive symptoms and cigarette use from adolescence into young adulthood, there remains a crossed association between cigarette use and depressive symptoms specific to females during young adulthood. The findings suggest that prevention interventions focused on mental health should include warnings that cigarette use may exacerbate depressive symptoms.

Smoking in European adolescents: relation between media influences, family affluence, and migration background

Seeing smoking depictions in movies has been identified as a determinant of smoking in adolescents. Little is known about how such media influences interact with other social risk factors. Differences in smoking rates in different socio-economic status groups might be explainable by differences in media exposure. There might also be differences in the average response to movie smoking exposure. We tested this hypothesis within a cross-national study conducted in six European countries. A total of 16,551 pupils from Germany, Iceland, Italy, Netherlands, Poland, and Scotland with a mean age of 13.4years (SD=1.18) were recruited from 114 state funded schools. Using previously validated methods, exposure to smoking depictions in movies was estimated for each student and related to ever smoking. The analysis was stratified by level of family affluence (low, medium, high) and migration history of parents (yes vs. no), controlling for a number of covariates like age, gender, school performance, television screen time, sensation seeking and rebelliousness and smoking within the social environment (peers, parents, siblings). We found a significant association for each category of family affluence and ethnicity between ever smoking and movie smoking exposure, also significant adjusted odds ratios for age, school performance, sensation seeking, peer smoking, mother smoking, and sibling smoking. This relationship between movie smoking and adolescent smoking was not moderated by family affluence or ethnicity. Although we used a very broad measure of economic status and migration history, the results suggest that the effects of exposure to movie smoking can be generalized to the population of youths across European countries.

Cultural and social influences on adolescent smoking dissipate by emerging adulthood among Hispanics in Southern California

The aim of the present study was to identify risk factors for smoking among Hispanic adolescents and determine whether these factors continued to influence smoking into emerging adulthood. Data were drawn from 932 Hispanics in the greater Los Angeles area who were surveyed in high school in 2007 and then again in emerging adulthood from 2010 to 2012. Logistic regression assessed the associations between predictors in adolescence and smoking in adolescence while an order one transition logistic model assessed predictors in adolescence and smoking in emerging adulthood. Adult and sibling smoking status, perceptions of smoking, perceived discrimination, and fatalism all influenced smoking in adolescence but not in emerging adulthood. Once Hispanics reach emerging adulthood different tactics to reduce smoking will be needed and are where future research should be directed.

Smoking experimentation among elementary school students in China: influences from peers, families, and the school environment

The aim of this study was to investigate experimentation with smoking among primary school students in China. Data were acquired from a recent survey of 4,073 students in grades 4 to 6 (ages 9–12) in 11 primary schools of Ningbo City. The questions were adapted from the Global Youth Tobacco Survey (GYTS). Results suggest that although the Chinese Ministry of Education (MOE) encourages smoke-free schools, experimentation with cigarettes remains a serious problem among primary school students in China. Peers, family members, and the school environment play important roles in influencing smoking experimentation among students. Having a friend who smoked, seeing a family member smoke, and observing a teacher smoking on campus predicted a higher risk of experimentation with smoking; the exposure to anti-tobacco materials at school predicted a lower risk of experimentation with smoking. The evidence suggests that public health practitioners and policymakers should seek to ensure the implementation of smoke-free policies and that intervention should target young people, families, and communities to curb the commencement of smoking among children and adolescents in China.

Effect of neuronal nicotinic acetylcholine receptor genes (CHRN) on longitudinal cigarettes per day in adolescents and young adults

INTRODUCTION

Few studies have sought to identify specific genetic markers associated with cigarettes per day (CPD) during adolescence and young adulthood, the period of greatest vulnerability for the development of nicotine dependence.

METHODS

We used a longitudinal design to investigate the effect of neuronal nicotinic acetylcholine receptor (CHRN) subunit genes on CPD from 15 to 21 years of age in young smokers of European descent (N = 439, 59% female). The number of CPD typically smoked during the previous 30 days was self-reported. Single nucleotide polymorphisms (SNPs) from CHRN genes were genotyped using DNA extracted from saliva samples collected at the 5-year assessment. Mixed-model analyses of SNP effects were computed across age at the time of assessment using log-transformed CPD as the phenotype. Data from the 1000 Genomes Project were used to clarify the architecture of CHRN genes to inform SNP selection and interpretation of results.

RESULTS

CPD was associated with a CHRNB3A6 region tagged by rs2304297, with CHRNA5A3B4 haplotype C (tagged by rs569207), and with the CHRNA2 SNP rs2271920, ps < .004. The reliability of single-SNP associations was supported by the correspondence between a more extensive set of SNP signals and the underlying genetic architecture. The 3 signals identified in this study appear to make independent contributions to CPD, and their combined effect accounts for 5.5% of the variance in log-transformed CPD.

CONCLUSIONS

Level of CPD during adolescence and young adulthood is associated with CHRNB3A6, CHRNA5A3B4, and CHRNA2.

Personal and Family Factors Affecting Life time Cigarette Smoking Among Adolescents in Tehran (Iran): A Community Based Study

OBJECTIVES

The prevalence of smoking among adolescents varies in different parts of the world. The current study aims to survey the socio-demographic and family characteristics related to adolescent lifetime cigarette smoking among 1201 Iranian adolescents aged 15-18 years old.

METHODS

This study is a population-based cross-sectional survey conducted using the multistage random cluster sampling method in Tehran, Iran in the summer of 2010.

RESULTS

The prevalence of lifetime cigarette use amongst boys (30.2%) was about 1.5 times that of girls (22.2%), (p=0.002). Older age, low parental control, very little parental supervision in the adolescent's selection of friends, and having a friend or family member who smokes were associated with lifetime cigarette use among male adolescents. Moreover, the use of verbal punishment by the parents was a protective factor for female lifetime cigarette use. Smoking has become one of the great health threats among Iranian adolescents.

CONCLUSIONS

As a result, health promotion programs should be gender based whilst educational and interventional programs for preventing tobacco use should begin before adolescence.

Members, isolates, and liaisons: meta-analysis of adolescents' network positions and their smoking behavior

Existing research finds that peer networks play an important role in adolescents' smoking behaviors. To evaluate this research, meta-analysis was utilized to investigate the relationship between social positions (e.g., group members vs. isolates vs. liaisons) in friendship networks and smoking behaviors. The results (N = 5,067, k = 8) showed that adolescents from multiple countries who are isolated in friendship networks are more likely to report smoking behaviors than those with friends (members or liaisons). The results also show that these differential odds of smoking based on network position has decreased over the past 15 years.

Socioeconomic differences in adolescent health-related behavior differ by gender

BACKGROUND

Many studies of adolescent health-related behaviors have assessed the effects of gender and parental socioeconomic position (SEP) but not their mutual modification. We investigated socioeconomic differences in health-related behaviors among Slovak adolescents and the potential modification of those differences by gender.

METHODS

Data were collected in 2006 (n = 3547; 49.4% boys; mean [SD] age, 14.3 [0.6] years; response rate, 93.5%). The sample comprised students in the eighth and ninth grades of randomly selected elementary schools in Slovakia. Gender-specific prevalence rates for 9 types of health-related behaviors, including nutritional behavior, physical activity and substance use, were calculated for 3 socioeconomic groups, which were defined by the highest educational level attained by both parents. Gender differences in socioeconomic gradients for health-related behaviors were tested.

RESULTS

Socioeconomic differences were found in nutritional behavior, physical activity, and smoking. Adolescents with lower parental education behaved less healthily. The largest relative socioeconomic difference was no daily vegetable consumption among girls (90.3% of those with high SEP vs 95.2% of those with middle SEP; odds ratio, 2.33). Regarding no daily fruit consumption, differences among girls were 1.51 times and 1.92 times as large as those among boys for children with medium and low SEP, respectively, as compared with those with high SEP.

CONCLUSIONS

Socioeconomic differences in health-related behavior were small, especially for nutritional behavior and physical activity. Interventions that aim to improve health-related behaviors among adolescents with lower SEP should focus on these 2 behaviors, particularly on healthy nutrition in girls with low SEP.

Young adult smoking cessation: predictors of quit attempts and abstinence

We examined young adult smoking cessation behaviors, coding cessation behavior as no attempt, quit attempt (< 30 days), or abstinence (≥ 30 days) during follow-up from July 2005 through December 2008, observed in 592 young adult smokers from the Ontario Tobacco Survey. One in 4 young adults made an attempt; 14% obtained 30-day abstinence. Cessation resources, prior attempts, and intention predicted quit attempts, whereas high self-efficacy, using resources, having support, and low addiction predicted abstinence, indicating that young adult smokers require effective and appropriate cessation resources.

Relationship of self-reported and acute stress to smoking in emerging adult smokers

OBJECTIVE

In the current study, we examined subjective and objective measures of stress and their relationship to baseline and future cigarette smoking behaviors over a 1-year follow-up in young adult experimental smokers.

METHOD

Participants (N = 56) completed two laboratory sessions to determine subjective and objective responses to a controlled laboratory stressor versus a control task. Baseline measures included drug use and smoking histories and a self-report measure of habitual stress (i.e., daily hassles). They were re-contacted 1 year after the laboratory sessions to determine smoking status.

RESULTS

There was wide variability in smoking trajectories, with 34% of participants increasing their smoking over the course of the year. Contrary to predictions, neither daily hassles nor stress reactivity was related to smoking at baseline or change over the year.

CONCLUSIONS

These preliminary findings suggest that daily stress or responses to acute social stress are not strong predictors of progression in emerging adult smokers.

The Yin and Yang of Nicotine: Harmful during Development, Beneficial in Adult Patient Populations

Nicotine has remarkably diverse effects on the brain. Being the main active compound in tobacco, nicotine can aversively affect brain development. However, it has the ability to act positively by restoring attentional capabilities in smokers. Here, we focus on nicotine exposure during the prenatal and adolescent developmental periods and specifically, we will review the long-lasting effects of nicotine on attention, both in humans and animal models. We discuss the reciprocal relation of the beneficial effects of nicotine, improving attention in smokers and in patients with neuropsychiatric diseases, such as schizophrenia and attention deficit/hyperactivity disorder, vs. nicotine-related attention deficits already caused during adolescence. Given the need for research on the mechanisms of nicotine's cognitive actions, we discuss some of the recent work performed in animals.

Adolescent nicotine exposure transiently increases high-affinity nicotinic receptors and modulates inhibitory synaptic transmission in rat medial prefrontal cortex

Adolescence is a critical developmental period during which most adult smokers initiate their habit. Adolescents are more vulnerable than adults to nicotine's long-term effects on addictive and cognitive behavior. We investigated whether adolescent nicotine exposure in rats modifies expression of nicotinic acetylcholine receptors (nAChRs) in medial prefrontal cortex (mPFC) in the short and/or long term, and whether this has functional consequences. Using receptor binding studies followed by immunoprecipitation of nAChR subunits, we showed that adolescent nicotine exposure, as compared with saline, caused an increase in mPFC nAChRs containing α4 or β2 subunits (24 and 18%, respectively) 24 h after the last injection. Nicotine exposure in adulthood had no such effect. This increase was transient and was not observed 5 wk following either adolescent or adult nicotine exposure. In line with increased nAChRs expression 1 d after adolescent nicotine exposure, we observed a 34% increase in amplitude of nicotine-induced spontaneous inhibitory postsynaptic currents in layer II/III mPFC pyramidal neurons. These effects were transient and specific, and observed only acutely after adolescent nicotine exposure, but not after 5 wk, and no changes were observed in adult-exposed animals. The acute nicotine-induced increase in α4β2-containing receptors in adolescents interferes with the normal developmental decrease (37%) of these receptors from early adolescence (postnatal day 34) to adulthood (postnatal day 104) in the mPFC. Together, this suggests that these receptors play a role in mediating the acute rewarding effects of nicotine and may underlie the increased sensitivity of adolescents to nicotine.

Analysis of detailed phenotype profiles reveals CHRNA5-CHRNA3-CHRNB4 gene cluster association with several nicotine dependence traits

INTRODUCTION

The role of the nicotinic acetylcholine receptor gene cluster on chromosome 15q24-25 in the etiology of nicotine dependence (ND) is still being defined. In this study, we included all 15 tagging single nucleotide polymorphisms (SNPs) within the CHRNA5-CHRNA3-CHRNB4 cluster and tested associations with 30 smoking-related phenotypes.

METHODS

The study sample was ascertained from the Finnish Twin Cohort study. Twin pairs born 1938-1957 and concordant for a history of cigarette smoking were recruited along with their family members (mainly siblings), as part of the Nicotine Addiction Genetics consortium. The study sample consisted of 1,428 individuals (59% males) from 735 families, with mean age 55.6 years.

RESULTS

We detected multiple novel associations for ND. DSM-IV ND symptoms associated significantly with the proxy SNP Locus 1 (rs2036527, p = .000009) and Locus 2 (rs578776, p = .0001) and tolerance factor of the Nicotine Dependence Syndrome Scale (NDSS) showed suggestive association to rs11636753 (p = .0059), rs11634351 (p = .0069), and rs1948 (p = .0071) in CHRNB4. Furthermore, we report significant association with DSM-IV ND diagnosis (rs2036527, p = .0003) for the first time in a Caucasian population. Several SNPs indicated suggestive association for traits related to ages at smoking initiation. Also, rs11636753 in CHRNB4 showed suggestive association with regular drinking (p = .0029) and the comorbidity of depression and ND (p = .0034).

CONCLUSIONS

We demonstrate novel associations of DSM-IV ND symptoms and the NDSS tolerance subscale. Our results confirm and extend association findings for other ND measures. We show pleiotropic effects of this gene cluster on multiple measures of ND and also regular drinking and the comorbidity of ND and depression.

Classroom norms and individual smoking behavior in middle school

OBJECTIVES

To investigate whether smoking prevalence in grade-level networks influences individual smoking, suggesting that peers are important social multipliers in teen smoking.

METHODS

We measured gender-specific, grade-level recent and life-time smoking among urban middle-school students who participated in Project Northland Chicago in a longitudinal cohort design.

RESULTS

Within schools, grade-level recent smoking had comparable effects on girls' and boys' individual-level smoking. Grade-level lifetime smoking had a greater effect on girls' smoking.

CONCLUSION

Interventions can target middle school classes and schools broadly, without making the identification of friendship networks a concern.

Emotional reactivity to emotional and smoking cues during smoking abstinence: potentiated startle and P300 suppression

Negative affect is thought to be an important factor in the maintenance of cigarette smoking, and thus it is important to further develop objective measures of smoking-related emotional responses. Nonsmokers, non abstinent smokers, and abstinent smokers participated in a cue reactivity task where eyeblink startle amplitude and startle probe P300 (P3) suppression were measured during the presentation of emotional pictures.During unpleasant pictures, the amplitude of both measures was smaller in non abstinent smokers than in nonsmokers or abstinent smokers. P3 suppression, but not startle amplitude, was larger in abstinent smokers than in nonsmokers. Abstinence-induced increases in cigarette craving were associated with P3 suppression during tobacco-related pictures. Results suggest that tobacco abstinence increases emotional reactivity to unpleasant stimuli, which is consistent with negative reinforcement models of tobacco addiction.

Gene expression in accumbens GABA neurons from inbred rats with different drug-taking behavior

Inbred Lewis and Fisher 344 rat strains differ greatly in drug self-administration; Lewis rats operantly self-administer drugs of abuse including nicotine, whereas Fisher self-administer poorly. As shown herein, operant food self-administration is similar. On the basis of their pivotal role in drug reward, we hypothesized that differences in basal gene expression in GABAergic neurons projecting from nucleus accumbens (NAcc) to ventral pallidum (VP) play a role in vulnerability to drug-taking behavior. The transcriptomes of NAcc shell-VP GABAergic neurons from these two strains were analyzed in adolescents, using a multidisciplinary approach that combined stereotaxic ionotophoretic brain microinjections, laser-capture microdissection (LCM) and microarray measurement of transcripts. Laser-capture microdissection enriched the gene transcripts detected in gamma-aminobutyric acid (GABA) neurons compared to the residual NAcc tissue: a ratio of neuron/residual >1 and false discovery rate (FDR) <5% yielded 6623 transcripts, whereas a ratio of >3 yielded 3514. Strain-dependent differences in gene expression within GABA neurons were identified; 322 vs. 60 transcripts showed 1.5-fold vs. 2-fold differences in expression (FDR < 5%). Classification by gene ontology showed that these 322 transcripts were widely distributed, without categorical enrichment. This is most consistent with a global change in GABA neuron function. Literature mining by Chilibot found 38 genes related to synaptic plasticity, signaling and gene transcription, all of which determine drug abuse; 33 genes have no known association with addiction or nicotine. In Lewis rats, upregulation of Mint-1, Cask, CamkII , Ncam1, Vsnl1, Hpcal1 and Car8 indicates that these transcripts likely contribute to altered signaling and synaptic function in NAcc GABA projection neurons to VP.

Development of the motivational system during adolescence, and its sensitivity to disruption by nicotine

The brain continues to develop during adolescence, and exposure to exogenous substances such as nicotine can exert long-lasting adaptations during this vulnerable period. In order to fully understand how nicotine affects the adolescent brain it is important to understand normal adolescent brain development. This review summarizes human and animal data on brain development, with emphasis on the prefrontal cortex, for its important function in executive control over behavior. Moreover, we discuss how nicotine exposure during adolescence can disrupt brain development bearing long-term consequences on executive cognitive function in adulthood.

Contingency management in the 21st century: technological innovations to promote smoking cessation

Information technology represents an excellent medium to deliver contingencies of reinforcement to change behavior. Recently, we have linked the Internet with a science-based, behavioral treatment for cigarette smoking: abstinence reinforcement therapy. Under abstinence reinforcement interventions, incentives are provided for objective evidence of abstinence. Several studies suggest that the intervention is effective in initiating abstinence. The intervention addresses limitations (access, cost, sustainability, and dissemination potential) inherent in traditional abstinence reinforcement delivery models. It can also be applied to vulnerable, at-risk populations, and to other behavior to promote health. Information technologies offer unprecedented and rapidly expanding opportunities to facilitate behavior change.

Smoking cessation advantage among adult initiators: does it apply to black women?

INTRODUCTION

Smokers who initiate as adults are more likely to quit than those who initiate as adolescents. Black women are more likely than White women to initiate smoking in adulthood and are less likely to quit. There is a paucity of research examining whether the smoking cessation advantage among adult initiators applies to Black women. The study objective is to examine race differences in the effect of developmental stage of smoking initiation on number of years until cessation among Black and White women.

METHODS

Data were extracted from the National Longitudinal Survey of Young Women, a national cohort of women between the ages of 49 and 61 years in 2003. The analytic sample comprised 1,008 White women and 271 Black women with a history of smoking. Survival analysis procedures were utilized to address the study objective.

RESULTS

Racial disparities in smoking cessation were most evident among women who initiated smoking as adults. White young adult initiators had a 31% increased hazard of smoking cessation advantage (adjusted hazards ratio [HR]: 1.31, 95% CI: 1.04-1.65) over adolescent initiators, whereas Black young adult initiators had no smoking cessation advantage (adjusted HR: 0.85, CI: 95% 0.55-1.30) over adolescent initiators.

CONCLUSIONS

Prior observations that smoking initiation in adulthood is associated with high rates of cessation do not apply to black women. To contribute to the reduction of disparities in women's cessation efforts to prevent initiation should target young adult women, particularly Black young adult women.

Assessment of nicotine dependence among adolescent and young adult smokers: a comparison of measures

INTRODUCTION

Tobacco use often starts in adolescence, yet assessment of dependence among adolescent smokers remains a challenge, particularly given the potential discord between self-reports of smoking behavior and actual use. We could find no prior study, among adolescents, that directly compares the association between objective biomarkers of tobacco exposure (e.g., cotinine) and multiple measures of dependence. This study examined the concurrent validity of two common dependence measures: the Fagerström Test for Nicotine Dependence (FTND) and the Hooked on Nicotine Checklist (HONC). We further examined the FTND by removing the one item on cigarettes smoked per day.

METHODS

Based within a parent clinical trial for adolescent smoking cessation, eligible participants were 12-21years old, smoking >/=5cigarettes per day on average, and with urine cotinine >100ng/ml at baseline. Results are based on participants who completed each measure and who provided a urine cotinine sample at baseline (N=73).

RESULTS

Results showed that the FTND was associated with cotinine (p<0.001; R(2)=0.25), and that this relationship held true for the revised FTND as well (p<0.001; R(2)=0.18). However, the HONC was only marginally associated with cotinine (p=0.06; R(2)=0.09).

DISCUSSION

Our results suggest that the FTND may be better associated with actual smoking behavior in adolescents as compared to the HONC. Pending replication, our data provide caution with regard to assessment of nicotine dependence at least among established adolescent smokers who have more entrenched smoking behavior.

Secondhand smoke avoidance by preteens living with smokers: to leave or stay?

INTRODUCTION

Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior.

PURPOSE

To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.

METHOD

Preteens aged 8-13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multiple Logistic Regression was used to determine predictors of SHS avoidance.

RESULTS

Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.

DISCUSSION

Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.

Gender differences in the association between pre-adolescent smoking initiation and emotional or behavioural problems

BACKGROUND

Emotional and behavioural problems are a risk factor for the initiation of smoking. In this study, we aimed to assess this relationship beyond clinical cut-off values of problem behaviour.

METHODS

Cross-sectional national survey among 9-13 year old children with data on smoking and Childhood Behaviour Checklist (CBCL) (N = 960). Relationships between smoking and tertiles of CBCL-scores were assessed.

RESULTS

Smoking was reported by 5.9% of the children (7.1% boys and 5.0% girls, P > 0.100). Relationships between smoking and problem behaviour were present in girls, but ot in boys. Among girls, smoking was associated with attention problems, thought problems, and delinquent behaviour. For attention problems and delinquent behaviour the associations were limited to the CBCL-scores in the uppermost 16% which agrees with the subclinical cut-off value.

CONCLUSION

Pre-adolescent girls more frequently smoke if having attention problems, delinquent behaviour, or thought problems.

The social determinants of adolescent smoking in Russia in 2004

OBJECTIVES

To determine the prevalence of adolescent smoking in the Russian Federation and examine what factors are associated with it.

METHODS

Data were drawn from Round 13 of the Russia Longitudinal Monitoring Survey (RLMS) carried out in 2004. The sample consists of 815 adolescents (430 boys, 385 girls) aged 14-17 years who answered questions about their health behaviours.

RESULTS

Smoking was more prevalent among boys than girls (26.1 vs. 5.7%). Maternal smoking and adolescent alcohol use were associated with smoking among both sexes. The self-assessment of one's socioeconomic position as unfavourable was associated with girls' smoking, while living in a disrupted family, physical inactivity and having a low level of self-esteem were predictive of boys' smoking.

CONCLUSIONS

The family environment appears to be an important determinant of adolescent smoking in Russia. In particular, boys and girls may be modelling the negative health behaviour lifestyles of their parents, with unhealthy behaviours clustering. Efforts to reduce adolescent smoking in Russia must address the negative effects emanating from the parental home whilst also addressing associated behaviours such as alcohol use.

Evaluation of California's in-school tobacco use prevention education (TUPE) activities using a nested school-longitudinal design, 2003-2004 and 2005-2006

BACKGROUND

Current legislative language requires the California Department of Public Health, California Tobacco Control Program, to evaluate the effectiveness of the school-based Tobacco Use Prevention Education (TUPE) programme in California every 2 years. The objective of the study was to measure change and to identify the impact of school-based tobacco use prevention education activities on youth smoking prevalence and attitudes over time, spanning two school year surveys (2003-2004 and 2005-2006).

METHODS

Evaluation focused on school-based tobacco use prevention activities in 57 schools (student sample size, n=16 833) that participated in the in-school administration of the 2003-2004 and 2005-2006 California Student Tobacco Surveys. Hierarchical linear models were used to predict student tobacco use and precursors to tobacco use.

RESULTS

Overall, student tobacco use, intention to smoke, number of friends smoking and perceived smoking prevalence by peers increased as students moved through grades 9 and 10 to grades 11 and 12. TUPE-related activities showed a suggestive association (p=0.06) with reduced rate in student tobacco use between the two surveys after adjusting for other contextual factors such as each school's socioeconomic characteristics.

CONCLUSIONS

TUPE activities appears to be beneficial in reducing tobacco use in California high school students over time. Other contextual factors were important moderating influences on student tobacco use.

Young adult smoking behavior: a national survey

BACKGROUND

Young adults have the highest smoking rate of any age group in the U.S., and new strategies to decrease young adult smoking are needed. The objective of the current study was to identify psychographic and demographic factors associated with current smoking and quitting behaviors among young adults.

METHODS

Attitudes, social groups, and self-descriptors, including supporting action against the tobacco industry, advertising receptivity, depression, alcohol use, and other factors associated with smoking were tested for associations with smoking behaviors in a 2005 cross-sectional survey of 1528 young adults (aged 18-25 years) from a web-enabled panel. Analyses were conducted in 2007.

RESULTS

Being older was associated with current smoking, whereas having some higher education and being African American or Hispanic were negatively associated with smoking. Supporting action against the tobacco industry was negatively associated with smoking (AOR=0.34 [95% CI=0.22, 0.52]). Perceived usefulness of smoking, exposure to smokers, increased perceived smoking prevalence, receptivity to tobacco advertising, binge drinking, and exposure to tobacco advertising in bars and clubs were associated with smoking. Supporting action against the tobacco industry was associated with intentions to quit smoking (AOR=4.43 [95% CI=2.18, 8.60]).

CONCLUSIONS

Young adults are vulnerable to tobacco-industry advertising. Media campaigns that denormalize the tobacco industry and appeal to young adults appear to be a powerful intervention to decrease young adult smoking.

Adolescent nondaily smokers: favorable views of tobacco yet receptive to cessation

INTRODUCTION

Favorable views of cigarette use may be a potentiating factor that influences the progression of nicotine dependence among adolescents.

METHODS

Using data from the South Carolina Youth Tobacco Survey (2005-2007), a statewide two-stage cluster sample of students in Grades 6-12 (N = 7,385), we examined attitudes toward smoking and quit behaviors among adolescent smokers across a range of smoking frequencies.

RESULTS

Compared with past-30-day nonsmokers, adolescents who smoked 1-2 days in the past month were more likely to believe that (a) smokers have more friends, (b) smoking looks cool, and (c) it is safe to smoke in the short term and then quit, but less likely to think that (d) tobacco is as addictive as other drugs and (e) smoking few cigarettes per day is harmful. Those who smoked 1-2 days in the past month were similar to more frequent smokers, including those who smoked daily. Similar findings were found for lifetime exposure to smoking. Among those who smoked 1-2 days in the previous month, motivation to quit (54%) and incidence of quit attempts (52% in past year) were slightly higher compared with heavier smokers.

DISCUSSION

Even minimal levels of cigarette use are associated with favorable views of smoking, and adolescents with minimal levels of cigarette use resemble chronic smokers in several key ways. Adolescents at very early stages of cigarette use are at significant risk for chronic use. Tobacco control efforts should capitalize on motivation to quit with focused prevention strategies that arrest the progression from nondaily to daily smoking.

A web-based contingency management program with adolescent smokers

The present study evaluated a new 30-day Web-based contingency management program for smoking abstinence with 4 daily-smoking adolescents. Participants made 3 daily video recordings of themselves giving breath carbon monoxide (CO) samples at home that were sent electronically to study personnel. Using a reversal design, participants could earn money for continued abstinence during the treatment phases (CO < or =5 ppm). All participants were compliant with the treatment (submitting 97.2% of samples), and all achieved prolonged abstinence from smoking.