The unique roles of intrapersonal and social factors in adolescent smoking development

Environmental statistics and experience shape risk-taking across adolescence

Adolescents are often portrayed as reckless risk-takers because of their immature brains. Recent research has cast doubt on this portrayal, identifying the environment as a moderator of risk-taking. However, the key features of environments that drive risk-taking behaviors are often underspecified. We call for greater attention to the environment by drawing on research showing that its statistical structure impacts future risk-taking as people learn from outcomes they experience after taking a risk. This opinion shows that adolescents are unlikely to experience harm from many risks because environmental statistics are skewed and favor safe experiences. Environmental statistics and experience suggest entry points for policy interventions by carefully timing risk warnings and leveraging peers' potential to shape the statistics of rewarding experiences.

Interplay of Depression, Smoking Intention, and Smoking Behavior in Chinese Dai Adolescents

ABSTRACT

Tobacco smoking and depression are important contributors to the burden of disease in China, and their onset typically occurs in adolescence. However, there is no consensus on the nature and underlying mechanisms of their interplay, and related studies on Chinese adolescents and ethnic minorities are limited. This study tested the mediation role of depression in the link between smoking intention and behavior in relation to sex. A secondary analysis was conducted on data from a survey of 1,322 Chinese Dai middle school students aged 15-19 years (M = 17.02 years; 773 female students and 542 male students) in Xishuangbanna, China. We found that the mediation role of depression between smoking intention and smoking behavior was nonsignificant, although smoking intention and depression both had significant associations with smoking behavior. Therefore, depression might be better theorized as an underlying predictor of smoking intention or that other volitional factors may link smoking intention and smoking behavior more closely. Nevertheless, depression was a significant independent variable for smoking behavior even when smoking intention was adjusted. Women perceived more depression than men with similar smoking intention levels, yet the relationship between smoking intention and smoking behavior was stronger in men. Although it seems that men were abler to translate their smoking intention into actual smoking, the high level of depression among young women who reported higher levels of smoking intention is noteworthy. Tobacco control for Chinese adolescents could incorporate sex-specific psychological therapies for negative emotions and for the internalization of problems by children.

A cross-national study on adolescent substance use: Intentions, peer substance use, and parent-adolescent communication

This longitudinal two-wave cross-national study investigated whether intentions, friends' substance use, and parent-adolescent substance-use specific communication predict adolescent alcohol and cannabis use 1 year later, while estimating reversed links. The temporal order between these two substances was also examined. We used multi-group cross-lagged panel modeling on data from 2 ethnically and socioeconomically diverse samples: Sint Maarten (N = 350; M_age  = 14.19) and the Netherlands (N = 602; M_age  = 13.50). Results showed that in the Netherlands, cannabis use predicts more subsequent problems (alcohol use, intention to use cannabis, and affiliation with cannabis-using friends). But for Sint Maarten, alcohol use predicts more subsequent problems (cannabis use, intention to use alcohol, and affiliation with alcohol-using friends). These opposing results demonstrate that caution is warranted when generalizing results across countries.

Socioecological Predictors of Change in Adolescent Tobacco Use Across Waves 1-4 of the Population Assessment of Tobacco and Health Study

BACKGROUND

Despite decreases in adolescents' cigarette use over the past decade, overall rates of adolescent tobacco use have increased. Research examining adolescents' changes across a range of tobacco products reflective of the current market, as well as multilevel predictors of use trajectories is needed.

METHODS

Data derive from Waves 1-4 (W1-4; 2013-2018) of the Population Assessment of Tobacco and Health (PATH) study. Participants included 975 adolescents who used ≥1 tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at any wave (W1 Mage = 13.29 [0.86], 54.2% male; 54.5% White, 25.9% Hispanic).

RESULTS

Utilizing latent growth curve modeling (separate models per product), adolescents displayed increases in their past 30-day use of all tobacco products from W1-4. Greater W1 use was predicted by identifying as non-Hispanic (cigarettes); lower parent education (SLT); greater externalizing problems (cigarillos); greater motives (all products except cigarillos); greater youth-reported household smoking rules (cigarillos); and greater isolation (ECIGs). More use across time (i.e., higher slope) was predicted by older age (cigarettes); identifying as male (ECIGs, SLT), Black (vs. White; cigarillos), White (vs. Black, Hispanic; ECIGs, SLT); fewer externalizing problems (SLT); fewer motives (ECIGs); fewer youth-reported rules (cigarillos, SLT); and greater geographic isolation (cigarettes, SLT).

DISCUSSION

Although some individual-level factors (i.e., motives, externalizing problems) predicted greater W1 use (i.e., intercept) only, interpersonal- (parent rules) and community-level (geographic isolation) factors were associated with changes in use over time (i.e., slope). Intervention efforts may address such factors to reduce adolescents' escalations in use.

Exploring the mechanistic pathways of how social network influences social norms in adolescent smoking prevention interventions

We know little about how smoking prevention interventions might leverage social network structures to enhance protective social norms. In this study we combined statistical and network science methods to explore how social networks influence social norms related to adolescent smoking in school-specific settings in Northern Ireland and Colombia. Pupils (12-15 years old) participated in two smoking prevention interventions in both countries (n = 1344). A Latent Transition Analysis identified three groups characterized by descriptive and injunctive norms towards smoking. We employed a Separable Temporal Random Graph Model to analyze homophily in social norms and conducted a descriptive analysis of the changes in the students' and their friends' social norms over time to account for social influence. The results showed that students were more likely to be friends with others who had social norms against smoking. However, students with social norms favorable towards smoking had more friends with similar views than the students with perceived norms against smoking, underlining the importance of network thresholds. Our results support the notation that the ASSIST intervention takes advantage of friendship networks to leverage greater change in the students' smoking social norms than the Dead Cool intervention, reiterating that social norms are subject to social influence.

Adolescents' own views on their risk behaviors, and the potential effects of being labeled as risk-takers: A commentary and review

Adolescents are stereotypically viewed as risk-takers ("stereotypical risk-takers") in science, mainstream media, fictional literature and in everyday life. However, increasing research suggests that adolescents do not always engage in "heightened" risk-taking, and adolescents' own perspectives (motives) on risk-taking are largely neglected in research. Hence, this paper is a commentary and review with two aims. First, taking a cross-national perspective, we discuss the definition of adolescence and risk behavior. We argue that much of the research on what drives adolescent risk behavior (e.g., substance use) focuses on the harms that this behavior promotes rather than on the need to explore and grow into adulthood. Thereafter we summarize the dominant approach to studying motives behind substance use, which has mostly considered young adults, and which has typically not focused on adolescents' own self-generated motives. The few empirical studies (including one of our qualitative studies) on adolescents' own motivations for engaging in risk behavior (i.e., cannabis use, alcohol use, and tobacco smoking) show that the most frequently mentioned motives by adolescents were being cool/tough, enjoyment, belonging, having fun and experimenting and coping. Interestingly, the "cool/tough identity" motive is virtually overlooked in research on adolescent risk-taking. The above-mentioned motives, however, generally support newer theories, such as the Developmental Neuro-Ecological Risk-taking Model (DNERM) and the Life-span Wisdom Model that suggest that adolescents' motivations to engage in risk-taking include experimentation, identity development, explorative behavior, and sensation seeking, all of which run counter to the stereotype of adolescents engaging in risk-taking due to "storm and stress." Hence, we also briefly consider additional recent attempts to study positive forms of risk taking. Second, extrapolating from sociological/criminological theories on labeling, we suggest that caution is warranted when (inaccurately) labeling adolescents as the "stereotypical risk-takers," because this can instigate a risk-taking identity in adolescents and/or motivate them to associate with risk-taking peers, which could in turn lead to maladaptive forms of risk-taking. Empirical research testing these hypotheses is needed. To conclude we argue that research on adolescent risk-taking could further benefit from considering adolescent's own motivations, which is also in line with the participatory approach advocated by international children's rights standards.

The Effects of Cigarette Advertisement and Peer Influence on Adolescent’s Smoking Intention in Indonesia

BACKGROUND: The occurrence of smoking among adolescents keeps increasing. Based on data from the Regional Health Research 2013, the prevalence of child smokers aged 10–18 years old was 7.2–9.1% in 2018. In fact, it exceeds the government’s target to reduce the number of child smokers in 2019 to 5.4%. Cigarette advertising is one of the reasons children are attracted to smoking, and Indonesia ranks first in ASEAN for youth exposure to tobacco advertisement and promotion. AIM: The aim of the study is to determine the factors that affect the urge to smoke in adolescents, specifically the influence of friends who smoke and exposure to cigarette advertisements in Sleman, Indonesia. METHODOLOGY: A non-experimental study with a correlation study and a cross-sectional approach. The sample was 318 respondents with a total sampling technique on first-grade junior high school students from three schools. The research instruments used were a questionnaire on exposure to cigarette advertisements, smoker friends, and the intention to smoke. The bivariate analysis used was the chi-square correlation test. RESULTS: Most of the respondents were exposed to cigarette advertisements in the medium category (56.6%), most of the respondents had smoking friends (57.2%), 11% of respondents had the desire to smoke shortly, and 15.1% of respondents had a desire to smoke for an extended period. The correlation test results between exposure to cigarette advertisements and smoking friends and the desire to smoke in the near and long term showed a p-value of <0.001. CONCLUSION: There was a significant relationship between exposure to cigarette advertisements and friends who smoke and the intention to smoke in the near and long term among adolescents in Sleman Regency, Indonesia.

Prevalence of Internet Addiction during the COVID-19 Outbreak and Its Risk Factors among Junior High School Students in Taiwan

The coronavirus disease 2019 (COVID-19) outbreak has significantly disrupted normal activities globally. During this epidemic, people around the world were expected to encounter several mental health challenges. In particular, Internet addiction may become a serious issue among teens. Consequently, this study aimed to examine the prevalence of Internet addiction and identify the psychosocial risk factors during the COVID-19 outbreak. This study was constructed using a cross-sectional design with 1060 participants recruited from among junior high school students around Taiwan using stratified and cluster sampling methods. Taiwan's first COVID-19 case was diagnosed on 28 January 2020. New cases exploded rapidly in February, and as a result, participants were surveyed during March 2 through 27 March 2020. The prevalence of Internet addiction was found to be 24.4% during this period. High impulsivity, high virtual social support, older in age, low subjective well-being, low family function, and high alexithymia was all independently predictive in the forward logistic regression analyses. The prevalence rate of Internet addiction was high among junior high school students during the COVID-19 outbreak. Results from this study can be used to help mental health organizations and educational agencies design programs that will help prevent Internet addiction in adolescents during the COVID-19 pandemic.

Impulsivity across substance use categories: Consideration of sex/gender

PURPOSE OF REVIEW

The goal was to review recent (1/2015-2/2020) evidence of impulsivity as a feature of substance use disorders or use of substances (alcohol, cannabis, nicotine, opioids, stimulants) in males compared to females in terms of: a) impulsivity in substance-using groups (or substance-using compared to control groups), and b) relationship between impulsivity and substance use behavior, clinical severity, or treatment outcomes.

RECENT FINDINGS

Of 361 papers identified by the searches, 69 met inclusion criteria, and 39 were highlighted for considering sex/gender in relation to impulsivity in substance-using populations. Taken together, findings supported higher impulsivity in males and females who use substances, relative to controls; and higher impulsivity was linked with more substance use/severity in both sex/genders. There were mixed findings regarding male versus female differences in impulsivity among individuals who use substances, or in the magnitude of the relationship between impulsivity and substance use severity.

SUMMARY

The current body of evidence does not point to a consistent sex/gender difference in the role of impulsivity within and across substance use disorders. Impulsivity is a clinically-relevant construct for male and female individuals who use substances, across a range of substances.

Individual Variables Involved in Perceived Pressure for Adolescent Drinking

Adolescence is a stage when individuals are especially vulnerable to the influence of their peer group, which could lead to the development of problematic behavior, such as drinking alcohol, due to perceived pressure. The objective of this study was to analyze the role of self-esteem, impulsivity, anxiety sensitivity and expectations for use under perceived pressure to drink alcohol among young people.

METHODS

The sample was made up of 1287 high school students aged 14 to 18, with a mean age of 15.11. The Bayes factor and mediation models were estimated to evaluate the data.

RESULTS

The results showed the existence of a positive relationship of impulsivity, anxiety sensitivity and expectations for use with perceived pressure. However, this relationship was negative with self-esteem and perception of pressure to drink alcohol. Furthermore, the model results showed that self-esteem mediates the relationship between physical, cognitive and social anxiety sensitivity and positive expectations with perceived pressure to drink alcohol in adolescence.

CONCLUSIONS

Given the strong need for affiliation during youth, it is hard to control grouping and peer influence on drinking behavior. However, knowledge of the role of individual variables, such as those described here, in perceived pressure could improve the prevention and intervention of such behaviors.

Parents modelling, peer influence and peer selection impact on adolescent smoking behavior: A longitudinal study in two age cohorts

Understanding the key factors that influence smoking behavior, especially during adolescence, has a meaningful impact on public health. This study examined the impact of parent modelling, peer influence and peer selection on adolescent smoking behavior in two Portuguese cohorts followed for three years. A questionnaire was delivered in classes and schools randomly selected, three times, one per year (cohort1: time1-7th, time2-8th, time3-9th; cohort2: time1-10th, time2-11th, time3-12th graders). The sample included a total of 656 students (402 younger [time1 Mage = 13.17, SD = 0.53, 63.7% girls;] and 254 older [time 1 Mage = 16.20, SD = 0.53, 65% girls]). Longitudinal data were examined through an autoregressive cross-lagged model (ARCL). The model explained 35% of the variance in smoking behavior at T3 for the global sample (4% for the younger and 58% for the older). Over time, in both cohorts, the percentage of never smokers decreased sharply and the percentage of regular smokers increased rapidly. We observed that participants in the older cohort had higher chances of smoking if their parents smoked. Nevertheless, we did not find a parental modelling effect in the longitudinal model. Peer influence and peer selection influenced smoking behavior. However, peer selection influenced the youngest group, both processes influenced the middle age group, and only peer influence influenced the oldest. Best friend and friends had a stronger impact on the younger while friends and same grade students had a stronger impact on the older. Prevention programs should regard these differences of interpersonal influences through adolescent development and specific strategies for different age groups should be considered.

Is the Peer Presence Effect on Heightened Adolescent Risky Decision-Making only Present in Males?

Social neurodevelopmental imbalance models posit that peer presence causes heightened adolescent risk-taking particularly during early adolescence. Evolutionary theory suggests that these effects would be most pronounced in males. However, the small but growing number of experimental studies on peer presence effects in adolescent risky decision-making showed mixed findings, and the vast majority of such studies did not test for the above-described gender and adolescent phase moderation effects. Moreover, most of those studies did not assess the criterion validity of the employed risky decision-making tasks. The current study was designed to investigate the abovementioned hypotheses among a sample of 327 ethnically-diverse Dutch early and mid-adolescents (49.80% female; M_age = 13.61). No main effect of peer presence on the employed risky-decision making task (i.e., the stoplight game) was found. However, the results showed a gender by peer presence moderation effect. Namely, whereas boys and girls engaged in equal levels of risks when they completed the stoplight game alone, boys engaged in more risk-taking than girls when they completed this task together with two same-sex peers. In contrast, adolescent phase did not moderate peer presence effects on risk-taking. Finally, the results showed that performance on the stoplight game predicted self-reported real-world risky traffic behavior, alcohol use and delinquency. Taken together, using a validated task, the present findings demonstrate that individual differences (i.e., gender) can determine whether the social environment (i.e., peer presence) affect risk-taking in early- and mid-adolescents. The finding that performance on a laboratory risky decision-making task can perhaps help identify adolescents that are vulnerable to diverse types of heightened risk behaviors is an important finding for science as well as prevention and intervention efforts.

Associations of Tobacco Advertising Appeal With Intentions to Use Alternative Tobacco Products Among Young Tobacco Users Experiencing Homelessness

PURPOSE

Virtually nothing is known about the potential effects of tobacco advertising on tobacco use among youth experiencing homelessness, a vulnerable population with high tobacco use rates. This study examines associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated any level of lifetime use.

DESIGN

A cross-sectional design was used.

SETTING

Settings were 25 service and street sites in Los Angeles County.

PARTICIPANTS

A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited.

MEASURES

Assessments included product-specific tobacco advertising appeal and future intentions to use the product again, as well as a range of covariate controls (eg, demographics, homelessness severity, current tobacco use, general advertising exposure).

ANALYSIS

Linear regression tested for associations between the appeal of advertising for a specific tobacco product and intentions to use that product again in the future, controlling for myriad covariates.

RESULTS

Advertising appeal was positively associated with future intentions to use again for electronic cigarettes (P = .006) and hookah (P = .001), but not cigars (P = .486), cigarillos (P = .126), or smokeless tobacco (P = .109).

CONCLUSION

Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.

Prevalence of internet addiction and its risk and protective factors in a representative sample of senior high school students in Taiwan

The aim of this study investigated the prevalence of Internet addiction (IA) in a large representative sample of secondary school students and identified the risk and protective factors. Using a crosssectional design, 2170 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling. The prevalence of IA was 17.4% (95% confidence interval, 15.8%-19.0%). High impulsivity, low refusal self-efficacy of Internet use, high positive outcome expectancy of Internet use, high disapproving attitude of Internet use by others, depressive symptoms, low subjective well-being, high frequency of others' invitation to Internet use, and high virtual social support was all independently predictive in the logistic regression analysis. The prevalence of IA among secondary school students in Taiwan was high. Results from this study can be used to help educational agencies and mental health organizations create policies and design programs that will help in the prevention of IA in adolescents.

The Relative Roles of Peer and Parent Predictors in Minor Adolescent Delinquency: Exploring Gender and Adolescent Phase Differences

Social learning theories assume that delinquent peer norms and/or peer pressure are the components of delinquent peer socialization that lead to subsequent adolescent delinquency. However, these specific peer influences are rarely investigated. Moreover, social learning theories such as coercion theory posit that parenting behaviors also play an important role in the development or prevention of delinquency. However, surprisingly, little research has investigated whether parent behaviors could moderate the link between the above-described peer influences and adolescent delinquency. Hence, using structural equation modeling, the current 1-year longitudinal study investigated these questions among ethnically-diverse Dutch adolescents (N = 602; M_age = 13.50; 46.42% female at baseline), who were mostly between12 and 15 years old. Additionally, using multi-group models, and a stringent p-value of p < 0.01, we explored whether gender and adolescent phase (i.e., early versus middle adolescence) further moderated these links. The majority of the analyses, resulted in non-significant findings. Specifically, in our non-multi group model, we found no significant peer, and family effects for the entire sample. However, for our multi-group models, we found that higher levels of negative mother-adolescent relationship quality exacerbated the link between peer pressure and subsequent early adolescent boys' delinquency 1 year later, while low levels of mother-adolescent negative relationship quality reversed the association. That is, low levels of mother-adolescent negative relationship quality attenuated the link from higher levels of peer pressure to higher levels of delinquency, but only in early adolescent boys. These findings existed above and beyond significant links from prior adolescent delinquency (T1) to future adolescent delinquency (T2). To conclude, although this was not the case for most adolescents, for early adolescent boys fewer negative interactions between mother and adolescents at an earlier time point (in advance) could potentially curtail the negative effects that delinquent peer pressure has on delinquency in the future. Implications for theory and practice are discussed.

Positive outcome expectancy mediates the relationship between social influence and Internet addiction among senior high-school students

Background and aims Based on the foundations of Bandura's social cognitive theory and theory of triadic influence (TTI) theoretical framework, this study was designed to examine the mediating role of positive outcome expectancy of Internet use in the relationship between social influence and Internet addiction (IA) in a large representative sample of senior high-school students in Taiwan. Methods Using a cross-sectional design, 1,922 participants were recruited from senior high schools throughout Taiwan using both stratified and cluster sampling, and a comprehensive survey was administered. Results Structural equation modeling and bootstrap analyses results showed that IA severity was significantly and positively predicted by social influence, and fully mediated through positive outcome expectancy of Internet use. Discussion and conclusions The results not only support Bandura's social cognitive theory and TTI framework, but can also serve as a reference to help educational agencies and mental health organizations design programs and create policies that will help in the prevention of IA among adolescents.