Smoking behavior of US youths: a comparison between child welfare system and community populations

Housing status as a social determinant of disparities in adolescent smoking, vaping, and dual use of cigarettes and e-cigarettes

Little is known about how various housing situations among adolescents may be associated with differential patterns of smoking and vaping-information with practical relevance for tobacco prevention and control efforts. We analyzed disparities by housing status in past 30-day smoking, vaping, and dual use of cigarettes and e-cigarettes/vape products among adolescents participating in the population-based California Healthy Kids Survey (N = 931,355; 2017-2019). Generalized linear mixed models for a categorical outcome quantified differences in prevalence and adjusted odds ratios (AORs) of smoking only, vaping only, and dual use among adolescents in various housing situations relative to their peers living in a home with one or more parents/guardians or other relatives. Our findings suggest adolescents living in a friend's home; adolescents living in a hotel, motel, shelter, car, campground, or other transitional or temporary housing; and adolescents living in a foster home, group care, or waiting placement evidenced pronounced disparities in past 30-day smoking only (AORs: 3.16-3.40, ps < 0.0001) and dual use of cigarettes and e-cigarettes/other nicotine vape products (AOR: 3.73-5.83, ps < 0.0001) relative to their peers living in a home with one or more parents/guardians or other relatives. Vaping only disparities, although significant, were relatively smaller (AORs: 1.53-1.88, ps < 0.0001). These findings emphasize housing as a social determinant of smoking, vaping, and dual use disparities among adolescents and have implications for multilevel preventive intervention development.

Using machine learning to determine the shared and unique risk factors for marijuana use among child-welfare versus community adolescents

OBJECTIVE

This study used machine learning (ML) to test an empirically derived set of risk factors for marijuana use. Models were built separately for child welfare (CW) and non-CW adolescents in order to compare the variables selected as important features/risk factors.

METHOD

Data were from a Time 4 (Mage = 18.22) of longitudinal study of the effects of maltreatment on adolescent development (n = 350; CW = 222; non-CW = 128; 56%male). Marijuana use in the past 12 months (none versus any) was obtained from a single item self-report. Risk factors entered into the model included mental health, parent/family social support, peer risk behavior, self-reported risk behavior, self-esteem, and self-reported adversities (e.g., abuse, neglect, witnessing family violence or community violence).

RESULTS

The ML approaches indicated 80% accuracy in predicting marijuana use in the CW group and 85% accuracy in the non-CW group. In addition, the top features differed for the CW and non-CW groups with peer marijuana use emerging as the most important risk factor for CW youth, whereas externalizing behavior was the most important for the non-CW group. The most important common risk factor between group was gender, with males having higher risk.

CONCLUSIONS

This is the first study to examine the shared and unique risk factors for marijuana use for CW and non-CW youth using a machine learning approach. The results support our assertion that there may be similar risk factors for both groups, but there are also risks unique to each population. Therefore, risk factors derived from normative populations may not have the same importance when used for CW youth. These differences should be considered in clinical practice when assessing risk for substance use among adolescents.

Smoking prevalence and desire to quit among employees in Transylvanian foster care homes

OBJECTIVES

Few studies have investigated smoking habits among foster care home children and employees, who are at high risk for smoking. Additionally, there are no published studies on the intention to quit smoking among employees of the Romanian Child Protection system, a gap we address in this manuscript.

METHODS

A repeated cross-sectional survey was conducted among foster care employees in three Transylvanian counties (Mures, Sibiu, Covasna) in January 2014 to February 2015 (baseline) and September-December 2016 (follow-up). A foster home-based smoking prevention and cessation intervention targeting employees and children was conducted between the two waves. Multivariate logistic regression analysis was conducted to determine associations between socio-demographics, reasons for smoking, tobacco use patterns, reasons for quitting, and tobacco policy attitudes on intention to quit (dependent variable), controlling for participation in the smoking prevention intervention.

RESULTS

305 employees participated in the baseline (76.4% of females, 23.6% of males) and 304 employees in the follow-up surveys (68.8% of females, 31.2% of males) after the smoking prevention and cessation intervention. At baseline, 34.8% of respondents reported that no one was smoking within the foster care home, which increased to 59.1% at follow-up (p < 0.001). Being male and a high level of professional satisfaction were the only correlates of intention to quit in the bivariate models at baseline. Professional satisfaction and a belief that smoking is bad for one's health were the only correlates of intention to quit at follow-up. In multivariable models, professional satisfaction was the only consistent predictor of intention to quit at both time points (OR 5.63, 95% CI 1.71-18.56; OR 4.98, 95% CI 1.43-17.30).

CONCLUSIONS

Efforts should be made to promote cessation among foster care employees that includes evidence-based support, along with compliance to policies that prohibit smoking indoors to reinforce cessation efforts.

Welfare Participation in Childhood as a Predictor of Cigarette Use in Adulthood in the United States

OBJECTIVE

Smoking is widely acknowledged as a high-risk behavior associated with poor physical health outcomes. We use Add Health Wave I and Wave IV data (N = 15,701) to explore whether childhood welfare participation predicts smoking behaviors in adulthood.

METHOD

We conducted propensity score matching and dosage analysis of welfare participation to explore whether childhood welfare participation had different effects on smoking behaviors in adulthood. We used 3 approaches for dealing with the survey weight and propensity score weights for post-matching regression analyses.

RESULTS

Adults who as children lived in families that participated in welfare programs were more likely to smoke when compared to young adults whose families did not participate in welfare programs. Being from a smoking household, having smoked before adulthood, having peer smokers, and race/ethnicity increased the risk for smoking. Protective factors associated with decreased smoking behaviors included being female, higher parental education, and being older.

CONCLUSIONS

Risk related to cigarette use in adulthood varies based on welfare dosage in childhood. The development and implementation of interventions specific to subpopulations among welfare recipient families may make programs more effective.

Smoking Behaviors Among Adolescents in Foster Care: A Gender-Based Analysis

BACKGROUND AND OBJECTIVES

Adolescents in foster care are at high risk for cigarette smoking. However, it is not clear how their smoking behaviors vary by gender. The present study examined lifetime and current smoking among males and females, and explored gender-specific risk factors for engagement in smoking behaviors.

METHOD

Data from the Multi Site Evaluation of Foster Youth Programs was used to evaluate patterns of smoking among adolescents aged 12-18 years (N = 1121; 489 males, 632 females).

RESULTS

Males and females did not differ significantly in rates of lifetime and current smoking, or in the age of smoking initiation and number of cigarettes smoked on a typical day. Gender-based analyses revealed that older age and placement in group homes or residential treatment facilities were associated with heightened risk of smoking among males. In contrast, sexual minority status (i.e., nonheterosexual orientation) and increased childhood victimization were associated with heightened risk of smoking among females. A history of running away was linked to smoking in both genders.

CONCLUSION

Gender should be considered when designing intervention programs to address cigarette smoking among foster youth, as the stressors associated with smoking may differ for males and females.

The influence of childhood welfare participation on adulthood substance use: evidence from the National Longitudinal Study of Adolescent to Adult Health

BACKGROUND

The associations between early life-socioeconomic status and health, specifically substance use, are well substantiated. The vulnerabilities associated with adversity in childhood, particularly poverty, can have a cumulative effect on an individual's risk and resilience throughout the life course. While several studies substantiate the relationship between substance use and welfare participation, less known is the impact of and prevalence of behavioral health problems later in life among young adults who were welfare recipients before age 18.

OBJECTIVE

This article explores whether childhood welfare participation before the age of 18 years influences substance use until young adulthood (24-34 years).

METHODS

This study used Add Health data with sample sizes ranging from 12,042 to 12,324 respondents, and propensity score matching methods to balance the samples and account for selection bias. Matched data were then used to run a series of regression models.

RESULTS

Those who participated in welfare before the age of 18 years had a significant lower probability of remaining substance-free until young adulthood (marijuana-free by 30%, p < 0.001; and other illicit substances-free by 16%, p < 0.05). However, no significant between-group differences were found on any of the alcohol-related variables.

CONCLUSIONS

Findings highlight long-term behavioral health risks, especially substance use, faced by young adults who participated in welfare before the age of 18 years. Acknowledging the vulnerabilities associated with welfare participation and living in poverty could help increase the effectiveness of program and treatment efforts. The prevention of long-term behavioral health disorders hinges on early diagnosis and intervention.

Tobacco use among children in Romanian foster care homes

BACKGROUND

Children living in facilities under the supervision of child protection authorities are vulnerable to early smoking experimentation. This is the first study to report the prevalence and correlates of smoking behaviour among foster care home residents in Romania.

METHODS

We conducted an in-person, cross-sectional survey of 914 resident children in 148 foster care homes of four Transylvanian counties. We included children <18 and those with complete tobacco use information in the analytical sample (n = 791). Sociodemographic, peer and foster family characteristics were evaluated for their influence on tobacco experimentation and past 30-day use.

RESULTS

Respondents included 50.7% girls of average age 13.6 years (range 8-17). Almost half reported ever experimenting with tobacco (44.6%) and approximately one in four reported past 30-day use (25.9%). Factors significantly associated with an increased odds of smoking experimentation and past 30-day use in the multivariable model included being 13-17 years old (vs. <12 years), having friends who are current smokers, and having a sibling who smokes. Living in a home with a foster mother or foster father who smokes was associated with increased odds of experimentation and past-30 day use, respectively. The longer time living in foster care was associated with decreased odds of experimentation and past 30-day use controlling for all covariates.

CONCLUSION

Anti-tobacco programmes that incorporate the role family and peers to reduce smoking are needed to address the high rates of use among Romanian foster care children.

Depressive Symptoms Delayed Quit Attempts and Shortened Abstinence in Young Smokers of the Hong Kong Youth Quitline

INTRODUCTION

Young smokers often report depressive symptoms while receiving smoking cessation counseling. This study examines time patterns in the quitting process among young smokers with or without notable depressive symptoms.

METHODS

The quitting trajectories of young smokers aged 12 to 25 (n = 578) who called the Youth Quitline in Hong Kong between March 2006 and May 2011 were recorded and analyzed through multiple telephone sessions over periods of up to 6 months. The time patterns of young smokers who had or did not have notable depressive symptoms were compared using nonparametric Kaplan-Meier methods with log-rank tests.

RESULTS

Among young smokers with low levels of nicotine dependence, those who had notable depressive symptoms were less likely to initiate a quit attempt within 28 days after their baseline telephone intervention (probability = .38 vs. .60; P value = .04). Furthermore, young smokers who had notable depressive symptoms were less likely to remain abstinent from smoking for 2 days after starting a quit attempt (probability = .50 vs. .64; P value = .012). Young adults aged 18 or above were more likely to relapse into smoking (adjusted HR = 1.50, 95% CI = 1.01, 2.22).

CONCLUSIONS

Depressive symptoms may delay young smokers from initiating quit attempts and shorten their abstinence. A baseline screening process is suggested for identifying youths with co-occurring depressive disorder and nicotine dependence. Further studies should examine a collaborative model of smoking cessation that involves both counselors and physicians in preventing young smokers from rapid relapses after they make quit attempts.

Alcohol use among adolescent youth: the role of friendship networks and family factors in multiple school studies

To explore the co-evolution of friendship tie choice and alcohol use behavior among 1,284 adolescents from 12 small schools and 976 adolescents from one big school sampled in the National Longitudinal Study of Adolescent to Adult Health (AddHealth), we apply a Stochastic Actor-Based (SAB) approach implemented in the R-based Simulation Investigation for Empirical Network Analysis (RSiena) package. Our results indicate the salience of both peer selection and peer influence effects for friendship tie choice and adolescent drinking behavior. Concurrently, the main effect models indicate that parental monitoring and the parental home drinking environment affected adolescent alcohol use in the small school sample, and that parental home drinking environment affected adolescent drinking in the large school sample. In the small school sample, we detect an interaction between the parental home drinking environment and choosing friends that drink as they multiplicatively affect friendship tie choice. Our findings suggest that future research should investigate the synergistic effects of both peer and parental influences for adolescent friendship tie choices and drinking behavior. And given the tendency of adolescents to form ties with their friends' friends, and the evidence of local hierarchy in these networks, popular youth who do not drink may be uniquely positioned and uniquely salient as the highest rank of the hierarchy to cause anti-drinking peer influences to diffuse down the social hierarchy to less popular youth. As such, future interventions should harness prosocial peer influences simultaneously with strategies to increase parental support and monitoring among parents to promote affiliation with prosocial peers.

Higher rates of adolescent substance use in child welfare versus community populations in the United States

OBJECTIVE

Youth substance use exacts costly consequences for a variety of important health outcomes. We examined and compared prevalence rates and a common set of psychosocial factors of lifetime and current substance use among child welfare-involved youths and community youths from two nationally representative data sets.

METHOD

Using the National Survey of Child and Adolescent Well-Being and the National Longitudinal Study of Adolescent Health, we compared prevalence rates and conducted logistic regression models for eight binary outcome measures of substance use: lifetime and current use of alcohol, inhalant, marijuana, and other illicit drugs to examine predictors of substance involvement in the two samples.

RESULTS

Substance use prevalence was higher among child welfare-involved youths than community youths for lifetime marijuana use, lifetime and current inhalant use, and lifetime and current other illicit drug use. Among both child welfare-involved and community youths, delinquency was the factor most strongly associated with all lifetime substance use outcomes. Notably, family structure and parental closeness were important protective factors against current substance use among child welfare-involved youths. For community youths, poorer emotional health was the strongest indicator of current substance use.

CONCLUSIONS

Substance use among all adolescents is a critical public health concern. Given the heightened vulnerability of child welfare-involved youths, it is particularly important to focus prevention and early intervention efforts on this population. Further research should explore additional factors associated with substance use among these youths so that child welfare and behavioral health systems may jointly target prevention and intervention efforts.