Trajectories of cigarette smoking from adolescence to young adulthood as predictors of obesity in the mid-30s

Sexual Identity Differences in Health Behaviors and Weight Status among Urban High School Students

Although racial/ethnic disparities in childhood obesity are well documented in the United States (U.S.), fewer studies have investigated elevated body mass index (BMI) and related health behaviors among sexual minority youth (SMY; gay/lesbian, bisexual, not sure). We examined pooled data from the 2009-2017 Youth Risk Behavior Surveys, which included high school students from 12 urban U.S. school districts. We used sex-stratified logistic regression models to estimate the association of sexual identity with health behaviors and elevated BMI (reference = heterosexual participants). A total of 133,615 participants were included. Sexual minority boys were more likely to report physical inactivity than heterosexual boys. Gay and not sure boys were also less likely to consume the recommended daily intake of fruit. Bisexual girls were more likely than heterosexual girls to report watching television ≥ 3 hours on a school day and to consume sugar-sweetened beverages (AOR 1.30, 95% CI= 1.18-1.43). All SMY reported higher rates of current tobacco use than their heterosexual peers. Sexual minority girls and bisexual boys had significantly higher rates of obesity than their heterosexual counterparts. These findings can inform tailored health promotion initiatives to reduce obesity risk in SMY.

Antecedents of Exercise Dependence in Ultra-Endurance Sports: Reduced Basic Need Satisfaction and Avoidance-Motivated Self-Control

Initiating and maintaining sports and exercise behavior are usually discussed in terms of strategies for promoting health. In the present study, we analyzed a sample of extreme endurance sport athletes and set out to predict exercise addiction, which is a facet of a sport-related health risk. We therefore draw on self-determination theory (Deci and Ryan, 1985, 2000), according to which low basic psychological need satisfaction can lead to excessive compensatory behavior. We aim to disentangle the effects of need satisfaction in the activity itself (exercising) and outside the activity (work/leisure) on exercise addiction. Furthermore, we propose anxious self-motivation as a mediator and tested whether it links low basic need satisfaction with exercise dependence. A correlational study with 323 multi-triathlon athletes confirmed our hypothesis that need satisfaction in work/leisure (but not in sports) is negatively related to exercise addiction. Furthermore, only need for competence in both domains (sport, work/leisure) is associated with anxious self-motivation. Mediation models showed that low competence satisfaction leads to anxious self-motivation that in turn predicts exercise addiction. The results are discussed critically in terms of their practical and theoretical implications for promoting health through sport and exercise.

Discontinuous Patterns of Cigarette Smoking From Ages 18 to 50 in the United States: A Repeated-Measures Latent Class Analysis

INTRODUCTION

Effective cigarette smoking prevention and intervention programming is enhanced by accurate understanding of developmental smoking pathways across the life span. This study investigated within-person patterns of cigarette smoking from ages 18 to 50 among a US national sample of high school graduates, focusing on identifying ages of particular importance for smoking involvement change.

AIMS AND METHODS

Using data from approximately 15,000 individuals participating in the longitudinal Monitoring the Future study, trichotomous measures of past 30-day smoking obtained at 11 time points were modeled using repeated-measures latent class analyses. Sex differences in latent class structure and membership were examined.

RESULTS

Twelve latent classes were identified: three characterized by consistent smoking patterns across age (no smoking; smoking < pack per day; smoking pack + per day); three showing uptake to a higher category of smoking across age; four reflecting successful quit behavior by age 50; and two defined by discontinuous shifts between smoking categories. The same latent class structure was found for both males and females, but membership probabilities differed between sexes. Although evidence of increases or decreases in smoking behavior was observed at virtually all ages through 35, 21/22 and 29/30 appeared to be particularly key for smoking category change within class.

CONCLUSIONS

This examination of latent classes of cigarette smoking among a national US longitudinal sample of high school graduates from ages 18 to 50 identified unique patterns and critical ages of susceptibility to change in smoking category within class. Such information may be of particular use in developing effective smoking prevention and intervention programming.

IMPLICATIONS

This study examined cigarette smoking among a national longitudinal US sample of high school graduates from ages 18 to 50 and identified distinct latent classes characterized by patterns of movement between no cigarette use, light-to-moderate smoking, and the conventional definition of heavy smoking at 11 time points via repeated-measures latent class analysis. Membership probabilities for each smoking class were estimated, and critical ages of susceptibility to change in smoking behaviors were identified.

Understanding the Relationship of Cigarette Smoking Trajectories Through Adolescence and Weight Status in Young Adulthood in the United States

PURPOSE

Adolescent cigarette smoking has steadily declined since 1999, whereas adolescent obesity rates have quadrupled since the 1980s. Few studies address the longitudinal relationship of smoking and weight in youth and young adulthood. This study examines the relationship of smoking trajectories beginning in adolescence on weight status in young adulthood in a nationally representative longitudinal sample.

METHODS

The study sample was drawn from the National Longitudinal Study of Adolescent to Adult Health Waves I-IV (N = 13,361). Four trajectories were generated through repeated-measures latent class analyses using current cigarette smoking status in Waves I-IV and age of initiation: nonsmokers (44%), early establishers (23%), late establishers (21%), and former smokers (12%). Wave IV weight status included self-reported body mass index (BMI) and measured waist circumference. Bivariate analyses addressed associations between smoking trajectory and BMI at each wave. Multivariate linear regression models tested the relationship of smoking trajectory and weight status at Wave IV.

RESULTS

In bivariate analyses, early and late establishers had a significantly lower BMI at Wave III and all smoking trajectories had a significantly lower BMI at Wave IV versus nonsmokers. All smoking trajectories had a significantly lower BMI than nonsmokers (early establishers: β = -1.27, confidence interval [CI]: -1.56 to -.98]; late establishers: β = -.84, CI: -1.16 to -.52; and former smokers: β = -.63, CI: -.93 to -.34; p < .05) in an adjusted multivariable regression model.

CONCLUSIONS

This study reveals that weight status increased over time for all trajectories; thus smoking does not mitigate obesity risk. These results have implications for both research and interventions to help youth and young adults avoid both smoking and obesity.

Adolescent Academic Adjustment Factors and the Trajectories of Cigarette Smoking from Adolescence to the Mid-thirties

Knowledge of early predictors which differentiate between various longitudinal smoking patterns might facilitate designing more effective interventions. Using data from 806 participants, we examined the association of three adolescent academic adjustment factors, Educational Aspirations and Expectations; Perception of School Achievement; and Trouble at School, to five trajectories of cigarette use covering 23 years from adolescence to adulthood. The five trajectory groups were: heavy/continuous smokers, late starters, quitter/decreasers, occasional smokers, and nonsmokers. Each academic factor predicted smoking trajectory group membership. Each academic factor was significantly associated with being a heavy/continuous smoker rather than a member of other trajectory groups. Behavioral academic factors also differentiated quitter/decreasers from late starters, occasional smokers, and nonsmokers. Adolescents manifesting academic maladjustment risk becoming early, chronic smokers. Prevention and intervention efforts targeting educational maladjustment may decrease cigarette smoking.

Cigarette smoking exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis: the Bogalusa Heart Study

Age and metabolic syndrome are major risk factors for atherosclerosis. However, limited information is available regarding whether cigarette smoking, another major, modifiable risk factor, has synergistic effects with age and metabolic syndrome on subclinical atherosclerosis, particularly in young adults. This aspect was examined in 1,051 adults (747 whites and 304 blacks; aged 24–43 years) from the Bogalusa Heart Study. General linear models were used to examine the effects of cigarette smoking and its interactive effects with age and metabolic syndrome on carotid intima-media thickness (CIMT). After adjusting for age, race, and sex, current smokers had lower BMI (mean±SE: 27.4±0.4, 29.3±0.5, and 29.9±0.3 kg/m² in current, former, and never smokers, respectively; p<0.0001) and lower levels of fasting glucose (82.8±0.9, 89.5±2.3, and 87.1±1.1 mg/dL, respectively; p = 0.001) and insulin (10.6±0.4, 14.2±1.0, 13.6±0. 6 µU/ml, respectively; p<0.0001). Despite being lean and having favorable levels of glucose and insulin, current smokers had greater CIMT (0.850±0.012, 0.808±0.011, and 0.801±0.006 mm, respectively; p = 0.0004). Importantly, cigarette smoking showed significant interactions with age and metabolic syndrome on CIMT: Age-related change in CIMT in current smokers was significantly greater (0.013±0.002 mm/year) than in nonsmokers (former and never smokers combined) (0.008±0.001 mm/year) (p for interaction = 0.005); the difference in CIMT between those with and without metabolic syndrome was significantly greater in current smokers (0.154±0.030 mm, p<0.0001) than in nonsmokers (0.031±0.014 mm, p = 0.03) (p for interaction<0.0001). In conclusion, cigarette smoking significantly exacerbates the adverse effects of age and metabolic syndrome on subclinical atherosclerosis in young adults, which underscores the importance of prevention and cessation of cigarette smoking behavior in the young.

Neural correlates of performance monitoring in daily and intermittent smokers

OBJECTIVES

Despite efforts that have increased smoking regulation, cigarette taxation, and social stigma, cigarette smoking remains the leading cause of preventable death worldwide, and a significant personal and public economic burden. In the U.S., intermittent smokers comprise approximately 22% of all smokers and represent a stable, non-dependent group that may possess protective factors that prevent the transition to dependence. One possibility is that intermittent smokers have intact CNS frontal regulatory and control mechanisms that enable resistance to nicotine-induced changes.

METHODS

The present study measured inhibitory control using a flanker task and a go-nogo continuous performance tasks in daily dependent smokers, intermittent non-dependent smokers, and nonsmokers. Event-related potential (ERP) measures of were concurrently recorded to measure performance monitoring via Event-Related Negativity (ERN) and error positivity (Pe) components during error trials for each task.

RESULTS

In both tasks, behavioral and ERN measures did not differ between groups; however, amplitude of the Pe component was largest among intermittent smokers.

CONCLUSIONS

Thus, intermittent smokers differed from both daily smokers and nonsmokers on error processing, potentially revealing neuroprotective cognitive processes in nicotine dependence.

SIGNIFICANCE

A better understanding of factors that mediate behavioral regulation may provide novel treatment approaches that help individuals achieve controlled smoking or cessation.

Longitudinal predictors of stopping smoking in young adulthood

PURPOSE

This study aims to describe the longitudinal individual and environmental predictors of stopping smoking among a group of young adult smokers.

METHODS

From a longitudinal population-based cohort of Midwestern youth, we analyzed semi-annual surveys when study participants were between the ages of 18 and 21 years. Using data from 2001-2008, we restricted analyses to individuals who, at age 18 years, reported smoking between 1 and 30 days in the previous month (n = 1,022). We used generalized linear mixed modeling to analyze demographic, attitudinal, and social-environmental predictors of stopping smoking over time.

RESULTS

After adjusting for smoking frequency at baseline, demographic and attitudinal factors that were associated with stopping smoking over time included increased age and attending college; male gender, smoking frequency and agreeing that cigarettes are calming were significantly associated with continued smoking. Social-environmental factors associated with stopping smoking over time included a household ban on smoking and living in a state with a clean indoor air policy; factors associated with continued smoking included living with a smoker and having close friends who smoke.

CONCLUSIONS

Both individual and social-environmental factors can serve as risk and protective factors for stopping smoking between ages 18 and 21 years. These factors should be used to refine more effective smoking cessation and prevention interventions in young adults.

Smoking trajectories across high school: sensation seeking and Hookah use

INTRODUCTION

This study investigated the associations of trajectories of cigarette smoking over the high school years with the prior development of childhood sensation seeking and the subsequent use of cigarettes and hookah at age 20/21.

METHODS

Participants (N = 963) were members of a cohort-sequential longitudinal study, the Oregon Youth Substance Use Project. Sensation seeking was assessed across 4th-8th grades and cigarette smoking was assessed across 9th-12th grades. Cigarette and hookah use was assessed at age 20/21 for 684 of the 963 participants.

RESULTS

Four trajectory classes were identified: Stable High Smokers (6%), Rapid Escalators (8%), Experimenters (15%), and Stable Nonsmokers or very occasional smokers (71%). Membership in any smoker class versus nonsmokers was predicted by initial level and growth of sensation seeking. At age 20/21, there was a positive association between smoking and hookah use for Nonsmokers and Experimenters in high school, whereas this association was not significant for Stable High Smokers or Rapid Escalators.

CONCLUSIONS

Level and rate of growth of sensation seeking are risk factors for adolescent smoking during high school (Stable High Smokers, Rapid Escalators, and Experimenters), suggesting the need for interventions to reduce the rate of increase in childhood sensation seeking. For those who were not already established smokers by the end of high school, hookah use may have served as a gateway to smoking.

Sex specific trajectories in cigarette smoking behaviors among students participating in the unplugged school-based randomized control trial for substance use prevention

OBJECTIVES

Understanding the developmental pathways and sex differences in cigarette smoking behaviors in adolescents has the potential to positively impact substance abuse prevention and to reduce smoking-related health problems. Using data from the Unplugged school-based prevention trial, we investigated different patterns of smoking behavior development among secondary school students in the Czech Republic.

METHODS

Growth mixture modeling was used to examine different trajectories in cigarette smoking behaviors among male and female students (N=1874 6th graders; 50.4% male, mean age 11.8 years at baseline) participating in the Unplugged school-based randomized control trial for substance use prevention.

RESULTS

A two-class model characterized cigarette use as a function of sex and Unplugged intervention status. More rapid cigarette use increases were observed in females (OR=1.17, p=0.01 in both rapid/moderate and slow smoking escalator classes) as compared to males. Further, in both classes, more rapid increases in smoking were observed for the control group as compared to the intervention group (OR=1.22, p<0.01 slow escalators; OR=1.54, p=0.08 rapid/moderate escalators). There was no difference in sex distribution when comparing the two classes (OR=1.02, p=0.98).

CONCLUSIONS

This study adds to a growing literature on developmental and sex differences in cigarette use among adolescents. This research supports additional multi-year prevention strategies aimed at adolescent females and early treatment programs for adolescent smokers to prevent increasing cigarette use with age.

Earlier joint trajectories of cigarette smoking and low perceived self-control as predictors of later poor health for women in their mid-60s

INTRODUCTION

The current study was designed to assess the prospective relationship between the earlier joint trajectories of cigarette smoking and low perceived self-control (X age = 40-48) and later health problems (X age = 65.2) within a community sample of understudied females.

METHODS

The participants were given self-administered questionnaires.

RESULTS

The results of the growth mixture model suggested 5 joint trajectories of cigarette smoking and perceived self-control, which consisted of 1 at-risk group (chronic smoking and low perceived self-control), 1 low-risk group (infrequent or nonsmoking and high perceived self-control), and 3 intermediate groups (i.e., high on one factor and low on the other). The results from logistic regression analyses supported a model by which (a) women in the at-risk group, in comparison with the low-risk group, were more likely to report 5 or more diseases (adjusted odds ratio [AOR] = 4.81; p < .001) and poor or very poor general health (AOR = 5.98; p < .001); (b) women in the at-risk group as compared with women in the intermediate groups were also more likely to report 5 or more diseases (AOR = 2.36; p < .05) and poor or very poor general health (AOR = 2.86; p < .01); and (c) women in the intermediate group were more likely to report 5 or more diseases (AOR = 2.04; p < .05) and poor or very poor general health (AOR = 2.09; p < .05) than women in the low-risk group.

CONCLUSIONS

The findings highlight the significance of targeting dispositional factors (e.g., perceived self-control) in conjunction with smoking in designing programs for promoting the health of women in midlife.

Dietary, Lifestyle, and Health Correlates of Overweight and Obesity in Adults 19 to 39 Years of Age

Diet and lifestyle factors of young adults and their relationship to health risk factors are understudied. Data from the Bogalusa Heart Study population (n = 1214; 19-39 years; 74.1% white; 60.8% female) were used to study associations of lifestyle, health risk factors, and reported health problems with the National Institutes of Health body mass index (BMI) categories of normal, overweight, and obese. Data from self-reported questionnaires and laboratory measures were evaluated using covariate-adjusted multinomial logistic regression and analysis of covariance, linear trend test, and the Cochran–Armitage trend test. Obese individuals had lower odds of consuming high-fat dairy products (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.62-0.96) and fruit/fruit juice/vegetables (OR = 0.83; CI = 0.75-0.93) and had higher odds of consuming hamburgers/sandwiches (OR = 2.81; CI = 1.52-5.20); processed meats (OR = 6.95; CI = 2.20-21.96); and sweetened (OR = 1.20; CI = 1.01-1.43) or diet beverages (OR = 1.27; CI = 1.02-1.58) than those of normal weight. Obese participants also had higher odds of being physically inactive versus being very active (OR = 2.65; CI = 1.64-4.29). Mean serum total and low-density lipoprotein cholesterol, triglycerides, apolipoprotein-B, and insulin resistance were higher ( P < .05 for all) in the overweight/obese when compared with normal weight individuals. Values were higher in those with higher weight status (linear trend P < .0001 for all). Self-reported health problems also increased with BMI. Interventions to improve diet and physical activity patterns among overweight/obese adults in this age group are needed.

Characterizing patterns of smoking initiation in adolescence: comparison of methods for dealing with missing data

INTRODUCTION

Tobacco use is common and remains one of the leading causes of preventable death in developed countries. Smoking commonly begins in adolescence, and hence, it is important to understand how smoking behavior develops during this period.

METHODS

In a U.K.-based birth cohort, we analyzed repeated measures of smoking frequency in a sample of 7,322 young adolescents. Latent class analysis was used to summarize the data, and the resulting classes of behavior were related to a range of smoking risk factors. Results from a complete case analysis were compared with estimation using full-information maximum likelihood (FIML) and estimation using multiple imputation (MI).

RESULTS

Fifty-three percent of the sample reported having smoked a whole cigarette by age 16 years. The longitudinal data were summarized by 4 distinct patterns of smoking initiation: nonsmokers (79.7%), experimenters (10.3%), late-onset regular smokers (5.5%), and early-onset regular smokers (4.5%). Social disadvantage, other substance use, conduct problems, and female sex were strongly related to being a regular smoker; however, no risk factors studied showed any strong or consistent association with experimentation. In the complete case sample, smoking prevalence was lower, and in addition, the association between different smoking patterns and covariates was often inconsistent with those obtained through FIML/MI.

CONCLUSIONS

Most young people have experimented with tobacco smoking by age 16 years, and regular smoking is established in a substantial minority characterized by social disadvantage, other substance, use and conduct disorder. Prevention strategies should focus on this subgroup as most children who experiment with tobacco do not progress to regular smoking.