Stressful life events and smoking behaviors in Chinese adolescents: a longitudinal analysis

The impacts of latent profiles and transitions of stresses on adolescent mental health: A person-centred analysis

Research has demonstrated robust links between adolescent stress and serious psychological problems. The current study aimed to identify latent stress profiles of 1510 adolescents (59.7% females; Mage  = 16.77 years, SD = 0.86) based on five stresses (parental stresses, family environment stresses, academic stresses, teacher stresses, and peer stresses) at three time points (T1/2/3). Moreover, this study would investigate the transition patterns of these profiles over time and examine the associations between the profiles and adverse psychological symptoms (e.g., anxiety, depression, nonsuicidal self-injury [NSSI], and suicidal ideation). Three latent stress profiles were identified, including High-stress profile, Medium-stress profile, and Low-stress profile. The three profiles were significantly different on the levels of T1/2/3 anxiety, depression, NSSI, and suicidal ideation. The profile memberships remained relatively stable across three time points. Notably, the present study found gender differences, with boys were more likely to be in the High-stress profile and to transition from the Medium- to the High-stress profile, compared to girls. Furthermore, left-behind adolescents were more likely to be in the High-stress profile than non-left-behind adolescents. The findings highlight the importance of adopting 'this-approach-fits-this-profile' interventions for adolescents. Parents and teachers are advised to adopt different strategies for girls and boys.

The relationship between unfair treatment and tobacco use: A national longitudinal Chinese sample

The aim of present study is to contribute to the literature by examining the developmental relationship between unfair treatment and tobacco use in a national longitudinal Chinese sample. Linear mixed model was used to analyze data from a national longitudinal survey, which measured unfair treatment and tobacco use in 33,600 adults in 4 waves from 2010-2016. The results showed that unfair treatment positively predicted tobacco use and the prediction was consistent over time.Our findings imply that reducing unfair treatment may be an effective way to prevent tobacco use, which is one of the leading causes of preventable morbidity and mortality all over the world.

Ethnic variations in the relationship between multiple stress domains and use of several types of tobacco/nicotine products among a diverse sample of adults

Introduction

Financial strain and discrimination are consistent predictors of negative health outcomes and maladaptive coping behaviors, including tobacco use. Although there is considerable information exploring stress and smoking, limited research has examined the relationship between patterns of stress domains and specific tobacco/nicotine product use. Even fewer studies have assessed ethnic variations in these relationships.

Methods

This study investigated the relationship between discrimination and financial strain and current tobacco/nicotine product use and explored the ethnic variation in these relationships among diverse sample of US adults (N = 1068). Separate logistic regression models assessed associations between stress domains and tobacco/nicotine product use, adjusting for covariates (e.g., age, gender, race/ethnicity, and household income). Due to statistically significant differences, the final set of models was stratified by race/ethnicity.

Results

Higher levels of discrimination were associated with higher odds of all three tobacco/nicotine product categories. Financial strain was positively associated with combustible tobacco and combined tobacco/nicotine product use. Financial strain was especially risky for Non-Hispanic Whites (AOR:1.191, 95%CI:1.083-1.309) and Blacks/African Americans (AOR:1.542, 95%CI:1.106-2.148), as compared to other groups, whereas discrimination was most detrimental for Asians/Pacific Islanders (AOR:3.827, 95%CI:1.832-7.997) and Hispanics/Latinas/Latinos (AOR:2.517, 95%CI:1.603-3.952).

Conclusions

Findings suggest discrimination and financial stressors are risk factors for use of multiple tobacco/nicotine products, highlighting the importance of prevention research that accounts for these stressors. Because ethnic groups may respond differently to stress/strain, prevention research needs to identify cultural values, beliefs, and coping strategies that can buffer the negative consequences of discrimination and financial stressors.

Relationships Between Stress, Negative Emotions, Resilience, and Smoking: Testing a Moderated Mediation Model

OBJECTIVE

More effective tobacco prevention and cessation programs require in-depth understanding of the mechanism by which multiple factors interact with each other to affect smoking behaviors. Stress has long been recognized as a risk factor for smoking. However, the underlying mediation and moderation mechanisms are far from clear. The purpose of this study was to examine the role of negative emotions in mediating the link between stress and smoking and whether this indirect link was modified by resilience.

METHODS

Survey data were collected using audio computer-assisted self-interview (ACASI) from a large random sample of urban residents (n = 1249, mean age = 35.1, 45.3% male) in Wuhan, China. Perceived stress, negative emotions (anxiety, depression), resilience were measured with reliable instruments also validated in China. Self-reported smoking was validated with exhaled carbon monoxide.

RESULTS

Mediation analysis indicated that two negative emotions fully mediated the link between stress and intensity of smoking (assessed by number of cigarettes smoked per day, effect =.082 for anxiety and.083 for depression) and nicotine dependence (assessed by DSM-IV standard, effect =.134 for anxiety and.207 for depression). Moderated mediation analysis demonstrated that the mediation effects of negative emotions were negatively associated with resilience.

CONCLUSIONS

Results suggest resilience interacts with stress and negative emotions to affect the risk of tobacco use and nicotine dependence among Chinese adults. Further research with longitudinal data is needed to verify the findings of this study and to estimate the effect size of resilience in tobacco intervention and cessation programs.

Predicting Initiation of Smoking Cessation Treatment and Outcome Among Adolescents Using Stressful Life Events and Coping Style

BACKGROUND

Adolescent smoking is a major public health concern, and current treatments are only somewhat effective in promoting abstinence. One way to improve treatments is to identify psychosocial characteristics that impede cessation, allowing development of targeted treatments. This study examined the influence of 2 such characteristics, life event stressors and coping, on initiation of cessation treatment and end-of-treatment abstinence status.

METHODS

One hundred five adolescent smokers were eligible to participate in a validated contingency management (CM) and cognitive-behavioral (CBT) cessation treatment; of those, 72 completed at least 1 treatment session. Data included sociodemographic characteristics, questionnaires assessing past-year life events and coping behavior use, and abstinence status at the end of the 4-week treatment. Logistic regression was used to predict treatment initiation and abstinence status, with life event stressor number, coping, or their interaction as predictors.

RESULTS

Higher levels of cognitive and peer support coping predicted treatment initiation, whereas life events were unrelated. End-of-treatment abstinence was predicted by higher numbers of life events and greater use of avoidant coping. The interaction of helpless coping and life events also predicted abstinence, with greater increases in helpless coping as total life events rose in abstinent but not nonabstinent participants. Finally, greater use of behavioral coping predicted abstinence in participants exposed to only CM treatment, whereas lesser use of behavioral coping predicted abstinence in participants receiving combined CM/CBT treatment.

CONCLUSIONS

Exposure to life event stressors may promote cessation by forcing use of self-control resources prior to the quit attempt, which may strengthen such resources. Techniques that improve self-control resources may improve cessation outcome, and prevention programs may want to emphasize behavioral coping to improve rates of treatment initiation.

Gender difference in interactions between MAOA promoter uVNTR polymorphism and negative familial stressors on body mass index among Chinese adolescents

OBJECTIVES

Monoamine oxidase A (MAOA) modulates metabolism of serotonin and dopamine metabolism, neurotransmitters involved in regulation of appetite and food intake. The gene coding for MAOA contains a 30-bp tandem repeat (uVNTR) polymorphism in its promoter region that has been previously identified to be associated with obesity with mixed findings in the literature. Our goals were to replicate the population effects of this functional polymorphism on obesity risk, and to further explore gender differences and interaction effects with negative stressors.

METHODS

Analyses were conducted with data on genotypes, measured weight and height, and self-reported behavioural characteristics among 1101 Chinese adolescents 11-15 years old living in Wuhan, China.

RESULTS

Girls with the high-activity allele had significantly lower body mass index (BMI; β = -0.25 ± 0.98, P = 0.011) compared to those with the low activity allele. Experience of negative familial stressors (e.g., death or illness of family members, hit or scolded by parents and increased quarrelling with parents, parents argued frequently) significantly weakened this protective genetic effect on BMI (P for interaction = 0.043). Stratified analyses showed a significant protective genetic effect on BMI only within the stratum of low stress level (β = -0.44 ± 0.14, P = 0.002). No similar effect was observed among boys.

CONCLUSIONS

Our findings confirm the genetic effects of MAOA uVNTR polymorphism on BMI in a Chinese adolescent population and suggest potential genetic interactions with negative familial stressors.

Prevalence of depressive symptoms and associated socio-demographic factors among recruits during military training

BACKGROUND

Military training is a stressful and unusual event. It may predispose individuals towards mental health problems. The stress of military training has been shown to result in depressive symptoms that can potentially influence the combat ability of a soldier. This study aimed to determine the prevalence of depressive symptoms among recruits during military training in Northern Pakistan and analyse the associated socio-demographic factors.

SUBJECTS AND METHOD

The study was carried out at the Mujahid Force Center, Bhimber, in Azad Jammu and Kashmir (AJK) in the North of Pakistan. This is one of the training institutes of the Pakistan Army. The sample population comprised of 313 adult men undergoing military training at Bhimber AJK. General Health Questionnaire 12 (GHQ-12) was used to screen for any psychiatric illness, and those with a score>4 were administered the Beck Depression Inventory (BDI) to record the presence and severity of depressive symptoms. Age, service type (general duty soldier, cook or clerk), education, level of family income, marital status, tobacco smoking, use of naswar (tobacco based substance), worrying about future and social support status were correlated with depressive symptoms to evaluate the association of these factors with depression in the study population.

RESULTS

Out of 313 recruits screened with GHQ-12, 232 were found to have a score of 4 or more as an indicator of the presence of psychiatric morbidity, and had the BDI administered. Of these 232 recruits, 31.5% had no depressive symptoms, 41.4% had mild, 17.7% had moderate and 9.5% had severe depressive symptoms. With logistic regression, we found significant correlation among depressive symptoms and level of family income, worrying about future and lack of social support.

CONCLUSIONS

Prevalence of depressive symptoms was high among recruits. Special attention should be paid to recruits from low socioeconomic background and those who lack social support and who worry about the future.

Effects of stressors on the reinforcing efficacy of nicotine in adolescent and adult rats

RATIONALE AND OBJECTIVES

Stress increases drug intake. This depends on the stressor, drug, and aspect of drug seeking assessed. The objectives of these experiments done in adolescent and adult male rats were to (1) examine social defeat effects on acquisition of nicotine self-administration (SA) and the reinforcing efficacy of nicotine and (2) determine the effects of acute exposure to intermittent footshock (FS) or yohimbine on the reinforcing efficacy of nicotine.

METHODS

In experiment 1, rats received four defeat exposures prior to nicotine SA acquisition and progressive ratio (PR) SA sessions (30 μg/kg nicotine/infusion). Exposure to an olfactory cue previously paired with defeat was also tested on responding maintained by nicotine on the PR schedule. In experiments 2 and 3, the effects of FS (5 and 10 min) or yohimbine (0.625 and 1.25 mg/kg, i.p.) on PR responding for nicotine (15, 30, or 60 μg/kg/infusion) were assessed. Adolescents were aged PD34-36 and adults PD81-85 at the beginning of nicotine SA training.

RESULTS

Defeat did not affect nicotine SA acquisition. Prior exposure to defeat or a defeat-paired olfactory cue did not affect PR responding for nicotine. FS modestly decreased PR responding in adolescents at the middle nicotine infusion dose. Yohimbine increased PR responding independent of nicotine infusion dose and age.

CONCLUSIONS

Together with previous work with other drugs, our data indicate that the effects of stress on the reinforcing efficacy of nicotine are stressor- and drug-dependent. This suggests that there is heterogeneity among stressors on how they affect neuronal systems underlying drug intake.

Structural model of factors influencing smoking behavior among Korean-Chinese adolescent boys

AIM

The aim of this study is to develop and test structural equation model to explore factors influencing smoking behavior among Korean-Chinese adolescent boys.

METHODS

Participants were recruited from six middle schools in China (N=768). Self-administered questionnaire included: (1) demographic information, (2) smoking behavior, and (3) individual factor (i.e., life satisfaction, future orientedness, stress), familial factor (i.e., relationship with parents, family life, socioeconomic status), environmental factor (i.e., father's smoking, friends' smoking, anti-smoking environment), and Intention Refusal Self-efficacy. AMOS analyses were used to evaluate the proposed model.

RESULTS

The model was a good fit for the data. Intention Refusal Self-efficacy significantly influenced smoking behavior. The model explained 52% of the variance in smoking behavior.

CONCLUSIONS

Smoking behavior is significantly related with factors of intention to smoke, refusal skill, self-efficacy, friends' and father's smoking, and anti-smoking environment. Targeting these issues might be useful when developing strategies for smoking prevention programs.

Tobacco smoking in adolescence predicts maladaptive coping styles in adulthood

INTRODUCTION

To examine the extent to which cigarette smoking in adolescence is associated with maladaptive versus adaptive coping behaviors in adulthood.

METHOD

The data came from a longitudinal study of New Zealand adolescents followed into adulthood at age 32 years. Using structural equation modeling (SEM), we examined the predictive association between daily smoking of cigarettes and symptoms of tobacco dependence from 18 to 26 years of age and later coping at age 32 years. We included pathways from childhood family disadvantage in addition to both adolescent stress-worry and adult coping in the model.

RESULTS

SEM revealed that cigarette smoking had a small but direct inverse effect on later adaptive coping (-.14) and a direct effect on maladaptive coping (.23) independent of the relationships between adolescent coping and stress-worry and later adult coping.

CONCLUSIONS

The findings are consistent with the hypothesis that tobacco smoking may inhibit the development of self-efficacy or one's ability to act with appropriate coping behaviors in any given situation.

Developmental trajectories of cigarette use and associations with multilayered risk factors among Chinese adolescents

INTRODUCTION

We aimed to identify developmental trajectories of cigarette use and risk factors associated with the distinct developmental courses of smoking in Chinese early adolescents from age 12 to 16 years.

METHODS

Analysis was conducted with secondary data from a longitudinal, prospective cohort of 3,521 Chinese adolescents randomly selected from 4 rural and 7 urban middle schools in Wuhan, China. A group-based growth mixture modeling approach was adopted to identify developmental trajectories of cigarette use. Multilayered intrapersonal (e.g., attitudes toward smoking) and interpersonal (e.g., parental smoking and perceived parental disapproval of smoking) risk factors selected from an ecological perspective were prospectively linked to the identified patterns of smoking trajectory.

RESULTS

Three trajectory patterns were identified from the whole cohort: nonsmokers (48.7%), stable light/occasional smokers (48.6%), and accelerating smokers (2.7%). After adjustments for gender, urban residence, and family socioeconomic status, adolescents with higher levels of problems in parent-child relationships and family disharmony, higher perceived norms of peer smoking, higher proportion of good friend smoking, having more troubles with teachers, poorer academic performance, and reporting more frequent depressive symptoms were significantly more likely to be in the trajectory group of either stable light/occasional smokers or accelerating smokers than in the group of nonsmokers. The probability of being in the accelerating smoking trajectory group was positively and significantly related to parental smoking and lack of school bonding.

CONCLUSIONS

Study findings help to advance knowledge of the distinct developmental courses of smoking behavior and their associations with multilayered risk factors among Chinese early adolescents.

Genetic and environmental influences on the association between depressive symptom dimensions and smoking initiation among Chinese adolescent twins

INTRODUCTION

Extant twin research on the depression-smoking association in adolescents has been conducted in U.S. and European samples and considered depression as a unitary phenotype. This study explored genetic and environmental influences on covariation between smoking initiation and 4 depressive symptom dimensions (positive affect [PA], negative affect [NA], somatic features [SF], and interpersonal problems [IP]) in adolescent Chinese twins.

METHODS

Questionnaires measuring current depressive symptoms and lifetime smoking initiation were administered to 602 twin pairs (M [SD] age = 12.2 (1.93) years, range 9-16 years). Cholesky bivariate decomposition models examined influences on each depressive symptom dimension, smoking initiation, and their covariation using age- and sex-adjusted threshold variables.

RESULTS

Within-twin correlations between smoking initiation and each depressive symptom dimension were significant (|r|s = .29-.61). Bivariate twin modeling showed significant genetic effects on overall depressive symptoms (55% variance), shared environment effects on NA (36%) and PA (53%), and shared environment effects on smoking initiation (46%) unique from PA. No other familial influences on the individual phenotypes (apart from those accounting for smoking-depression covariance) were significant. Relations of smoking initiation to overall depressive symptoms and IP were influenced by familial (shared environment and/or genetic) factors and nonshared environmental factors. The SF-smoking initiation relation was influenced mostly by familial factors. Only shared environment significantly influenced the association of lower PA and higher NA to smoking initiation.

CONCLUSIONS

Relations between each symptom dimension and smoking initiation are of sizeable magnitude in Chinese adolescents. Genetic and environmental factors underlying depression-smoking comorbidity may vary across different depressive symptom dimensions.

Perceived racial/ethnic discrimination, smoking and alcohol consumption in the Multi-Ethnic Study of Atherosclerosis (MESA)

OBJECTIVE

To examine the association of perceived racial/ethnic discrimination with smoking and alcohol consumption in adults participating in the Multi-Ethnic Study of Atherosclerosis.

METHODS

Data on 6680 black, Chinese, Hispanic and white adults aged 45 to 84 years of age recruited from Illinois, New York, Maryland, North Carolina, Minnesota and California during 2000 and 2002 were used for this analysis. Logistic regression was used to estimate the association of perceived racial/ethnic discrimination with smoking status and alcohol consumption for each racial/ethnic group separately.

RESULTS

Blacks were more likely to experience racial/ethnic discrimination (43%) than Hispanics (19%), Chinese participants (10%) or whites (4%, P<0.0001). In the fully-adjusted model, blacks reporting racial/ethnic discrimination had 34% and 51% greater odds of reporting smoking and drinking, respectively, than blacks who did not report racial/ethnic discrimination. Hispanics reporting racial/ethnic discrimination had 62% greater odds of heavy drinking. Whites reporting racial/ethnic discrimination had 88% greater odds of reporting being current smokers than whites who did not report racial/ethnic discrimination.

CONCLUSIONS

Our findings suggest that the experience of discrimination is associated with greater prevalence of unhealthy behaviors. Specifically, the use of smoking and alcohol may be patterned by experience of discrimination.

Family and personal protective factors moderate the effects of adversity and negative disposition on smoking among Chinese adolescents

Tobacco use among Chinese adolescents is increasing at approximately 80,000 new smokers per day. Assessing the causes for initiating tobacco use in China will be important in developing effective interventions and policies to stem rising prevalence rates. This study tested predictors of Resilience Theory in a sample of 602 Chinese adolescents. Results revealed that prior adversity, measured through school and family-related events, was significantly associated with increased smoking in females. Family factors (i.e., family cohesion, family adaptability, parental monitoring) and one personal factor (i.e., academic score) were associated with lower odds for smoking due to prior adversity and negative disposition.