From adolescence to young adulthood: racial/ethnic disparities in smoking

Evaluating hypothesized explanations for the Black-white depression paradox: A critical review of the extant evidence

The Black-white Depression paradox, the lower prevalence of major depression among non-Hispanic Black (relative to non-Hispanic white) individuals despite their greater exposure to major life stressors, is a phenomenon that remains unexplained. Despite a decade plus of research, there is little clarity as to whether the paradoxical observations are an invalid finding, spuriously produced by selection bias, information bias, or confounding, or are a valid finding, representative of a true racial patterning of depression in the population. Though both artefactual and etiologic mechanisms have been tested, a lack of synthesis of the extant evidence has contributed towards an unclear picture of the validity of the paradox and produced challenges for researchers in determining which proposed mechanisms show promise, which have been debunked, and which require further study. The objective of this critical review is to assess the state of the literature regarding explanations for the Black-white depression paradox by examining some of the more prominent hypothesized explanatory mechanisms that have been proposed and assessing the state of the evidence in support of them. Included mechanisms were selected for their perceived dominance in the literature and the existence of at least one, direct empirical test using DSM major depression as the outcome. This review highlights the very limited evidence in support of any of the extant putative mechanisms, suggesting that investigators should redirect efforts towards identifying novel mechanisms, and/or empirically testing those which show promise but to date have been relatively understudied. We conclude with a discussion of the broader implications of the evidence for well-accepted social theories and raise questions regarding the use of DSM major depression to assess mental health burden in Black communities.

Social class discrimination as a predictor of first cigarette use and transition to nicotine use disorder in Black and White youth

PURPOSE

To characterize the association of social class discrimination with the timing of first cigarette use and progression to DSM-IV nicotine dependence (ND) in Black and White youth, examining variation by race, parent vs. youth experiences of discrimination, socioeconomic status (SES), and stage of smoking.

METHODS

Data were drawn from 1461 youth (55.2% Black, 44.8% White; 50.2% female) and mothers in a high-risk family study of alcohol use disorder and related conditions. Cox proportional hazard regression analyses were conducted, using youth's and mother's social class discrimination to predict first cigarette use and progression to ND, stratifying by race. Interactions between discrimination and SES indicators (parental education and household income) were tested. Adjusted models included psychiatric covariates.

RESULTS

In the adjusted first cigarette use models, neither youth's nor mother's social class discrimination was a significant predictor among Black youth, but mother's discrimination was associated with increased risk [HR = 1.53 (1.18-1.99)] among White youth. In the adjusted ND models, mother's discrimination was associated with reduced ND risk for Black youth in middle-income families [HR = 0.29 (CI 0.13-0.63)], but neither youth's nor mother's discrimination predicted transition to ND among White youth.

CONCLUSIONS

The observed race and smoking stage-specific effects suggest that social class discrimination is more impactful on early stages of smoking for White youth and later stages for Black youth. The robustness of links with mother's discrimination experiences further suggests the importance of considering family-level effects and the need to explore possible mechanisms, such as socialization processes.

Explaining the Black-white depression paradox: Interrogating the Environmental Affordances Model

The Environmental Affordances (EA) model posits that Black Americans' engagement with unhealthy behaviors (i.e. smoking, alcohol use, eating calorie-dense foods) to cope with stressor exposure may simultaneously account for their observed greater risk of chronic physical illness, and their observed equal or lesser prevalence of depression, relative to white Americans - the so-called "Black-white depression paradox." However, the specific mechanisms through which such effects might arise have been theorized and analyzed inconsistently across studies, raising concerns regarding the appropriateness of existing empirical tests of the model as well as the validity of the conclusions. We specify the two mechanisms most consistent with the EA model - 'Mediation-only' and 'Mediation and Modification' - and derive a priori predictions based on each. We systematically test these pathways using a subset of 559 participants of the Child Health and Development Study who were included in an adult follow-up study between 2010 and 2012 and self-identified as Black or white. Results failed to support either of the two mechanisms derived from the EA model, challenging the validity and utility of the model for explaining racial differences in depression; efforts to develop alternative hypotheses to explain the paradox are needed.

Protective Effects of Parental Education Against Youth Cigarette Smoking: Diminished Returns of Blacks and Hispanics

Background

High parental educational attainment is protective against youth health risk behaviors such as tobacco use. According to the Marginalization-related Diminished Returns (MDRs) theory, however, higher parental education is less protective for marginalized groups relative to non-Hispanic Whites.

Objective

To explore race/ethnic differences in the effects of parental educational attainment on cigarette smoking in a national sample of American adolescents.

Methods

In a cross-sectional study, we used baseline data of 10,878 American youth who had participated in the Population Assessment of Tobacco and Health (PATH 2013). The independent variable was parental educational attainment. The dependent variables were lifetime cigarette smoking, current (past 30-day) cigarette moking, and daily cigarette smoking. Youth age, youth gender, and parental marital status were the covariates. Race/ethnicity was the moderating variable. Logistic regression model was used for data analysis.

Results

Overall, a higher parental educational attainment was associated with a lower lifetime cigarette smoking, current (past 30-day) cigarette smoking, and daily cigarette smoking. Parental educational attainment showed significant interaction with race/ethnicity suggesting smaller protective effects of parental educational attainment on youth tobacco outcomes for Black and Hispanic than for non-Hispanic White youth.

Conclusion

For American youth, race/ethnicity limits the health gains that are expected to follow parental educational attainment. While high parental educational attainment is protective against smoking overall, non-Hispanic Whites (the most socially privileged group) gain most and Blacks and Hispanics (the least socially privileged groups) gain least from such resource. In addition to addressing low SES, researchers and policymakers should identify and address mechanisms by which high SES minority youth remain at risk of tobacco use.

Racial differences in alcohol and tobacco use in adolescence and mid-adulthood in a community-based sample

PURPOSE

Smoking and alcohol use have been posited as possible contributors to racial health disparities, despite higher smoking and alcohol use among non-Hispanic White youth and young adults compared to Blacks. To further investigate this claim, we aim to assess variation in alcohol and cigarette use across two distinct points of the life course.

METHOD

Data are from a subset of 559 (279 male, 280 female) self-identified Black and White participants of the Child Health and Development study. Self-report alcohol and cigarette use were collected between age 15-17 and at mean age 50. Logistic regressions were estimated; supplementary analyses adjusted for maternal age, prenatal smoking, household income, childhood SES, and education.

RESULTS

White participants were more likely to drink regularly (Odds ratio (OR) 2.2; 95%CI 1.2, 4.0) and be intoxicated (OR 2.0; 95%CI  1.2, 3.2) in adolescence compared with Blacks. In mid-adulthood, Whites remained more likely to currently drink (OR  2.3; 95%CI 1.6, 3.4) but among drinkers, less likely to binge drink (OR 0.4; 95%CI  0.2, 0.8). White participants were less likely to smoke in mid-adulthood (OR  0.4; 95%CI  0.3, 0.6), but among smokers, were more likely to smoke ≥ ½ a pack per day (OR 3.4; 95%CI  1.5, 7.8).

CONCLUSIONS

Blacks were less likely to engage in drinking across the life course, but, among drinkers, more likely to binge drink in mid-adulthood. Blacks were more likely to smoke in mid-adulthood, but smoked infrequently compared with Whites. These patterns suggest that a reframing of disparities mechanisms to focus on broader structural and social factors may benefit progress in understanding and ameliorating inequities.

Social Determinants of Hookah Smoking in the United States

BACKGROUND

Educational attainment and income are two socioeconomic status indicators with strong protective effects against cigarette smoking. Marginalization-related Diminished Returns, however, refer to less than expected protective effects of socioeconomic status indicators for the members of the racial and ethnic minority groups, particularly Blacks and Hispanics, compared to non-Hispanic Whites.

AIM

Borrowing data from a nationally representative study in the US, this study tested whether racial and ethnic differences exist in the effects of educational attainment and poverty status on cigarette smoking of American adults.

METHODS

This cross-sectional study entered 28,329 adult participants of the Population Assessment of Tobacco and Health (PATH; 2013). Both educational attainment and poverty status were the independent variables. The dependent variable was current hookah smoking. Age, gender, and region were the covariates. Race and ethnicity were the effect modifiers (moderators).

RESULTS

Overall, individuals with higher educational attainment were more likely to smoke a hookah. Individuals who lived out of poverty, however, had lower odds of current hookah smoking. Race and ethnicity both showed statistical interactions with both socioeconomic indicators suggesting that Blacks and Hispanics with high educational attainment and those who live out of poverty have disproportionately high odds of hookah smoking, compared to non-Hispanic Whites with high socioeconomic status.

CONCLUSIONS

In the United States, middle-class racial and ethnic minority people remain at higher risk of smoking hookah. As a result, we should expect a high tobacco burden in middle-class Black and Hispanic adults. We suggest that policymakers should not take an over-simplistic way and reduce the problem of race/ethnic inequalities in tobacco use to gaps in socioeconomic status between groups. Marginalization-related diminished returns generate tobacco disparities in higher socioeconomic status levels. Middle-class racial and ethnic minority people need extra support to stay healthy.

Association of Educational Attainment and Race/Ethnicity With Exposure to Tobacco Advertisement Among US Young Adults

Importance

Associations of educational attainment with improved health outcomes have been found to be weaker among racial/ethnic minority groups compared with those among the racial/ethnic majority group. Recent research has also documented higher than expected prevalence of smoking in highly educated African American and Hispanic adults.

Objective

To compare the association of educational attainment with exposure to tobacco advertisements among racial/ethnic groups of US young adults.

Design, Setting, and Participants

This cross-sectional study included data from 6700 young adults who participated in wave 1 of the Population Assessment of Tobacco and Health Study, a nationally representative survey of US adults in 2013. Educational attainment was classified as less than high school diploma, high school graduate, or college graduate. Analysis was conducted between September 20 and October 4, 2019.

Main Outcomes and Measures

The independent variable was educational attainment (less than high school diploma, high school graduate, and college graduate). The dependent variable was any exposure to tobacco advertisements in the past 12 months. Race/ethnicity, age, sex, poverty status, unemployment, and region were the covariates. Binary logistic and Poisson regression were used to analyze the data.

Results

The study included 6700 participants (3366 [50.2%] men) between ages 18 and 24 years. Most participants were non-Hispanic (5257 participants [78.9%]) and white (5394 participants [80.5%]), while 1443 participants (21.5%) were Hispanic. Educational levels included 1167 participants (17.4%) with less than a high school diploma, 4812 participants (71.8%) who were high school graduates, and 4812 participants (10.8%) who were college graduates. A total of 4728 participants (70.6%) reported exposure to tobacco advertisements in the past 12 months. Exposure to tobacco advertising was reported by 383 participants (53.1%) who were college graduates, 3453 participants (71.8%) who were high school graduates, and 892 participants (76.4%) with less than high school educational attainment. In regression analysis, high school graduation (odds ratio, 0.79; 95% CI, 0.68-0.92) and college graduation (odds ratio, 0.46; 95% CI, 0.39-0.54) were associated with lower odds of exposure to tobacco advertisements compared with young adults with lower educational attainment. Compared with non-Hispanic participants, high school education had a weaker protective association for tobacco advertisement exposure among Hispanic participants (odds ratio, 1.44; 95% CI, 1.03-2.01; P = .03), suggesting that the association of high school graduation with lower exposure to tobacco advertisement is weaker among Hispanic young adults than non-Hispanic young adults.

Conclusions and Relevance

This study found that high school graduation had a weaker inverse association with tobacco advertisement exposure among Hispanic than non-Hispanic young adults. Future research should explore the role of targeted marketing strategies of the tobacco industry that largely advertise tobacco in areas with high concentrations of racial/ethnic minority groups. Future research should also evaluate the efficacy of more restrictive marketing policies on racial/ethnic disparities in tobacco use.

Risk factors for multiple tobacco product use among high school youth

PURPOSE

To examine how youth multiple tobacco product (MTP) users differ relative to non-users and to single-product users on risk factors at multiple levels of influence.

METHODS

We analyzed data on high school students from the North Carolina Youth Tobacco Survey, 2015 (n = 2922). Single- and MTP use were defined as use of one, or two or more tobacco products in the past month, respectively. Multinomial regressions estimated the association between risk factors and MTP use compared to single-product use and non-use of tobacco. Risk factors included intra-personal (e.g., harm perceptions), and interpersonal (e.g., household, peer tobacco use, secondhand smoke or vapor, and advertising) factors.

RESULTS

Of students, 12% and 13% were single product and MTP users, respectively. Many differences emerged between MTP users and non-tobacco users, with MTP users showing lower harm perceptions, higher perceived social benefits of smoking, significantly higher relative risk of having friends who use tobacco (RRR = 4.79, 95% CI 3.42, 6.70), of exposure to secondhand e-cigarette vapor (RRR = 1.35, 95% CI 1.23, 1.48), and of being receptive to tobacco marketing (RRR = 4.01, 95% CI 2.87, 5.61). Fewer differences emerged between MTP and single product users with MTP users having significantly higher relative risk of having friends who use tobacco (RRR = 2.31 95% CI 1.73, 3.07), of exposure to secondhand vapor (RRR = 1.10, 95% CI 1.02, 1.18), and of being receptive to tobacco marketing (RRR = 1.71, 95% CI 1.17, 2.50).

CONCLUSIONS

Efforts that target multiple tobacco product use should increase youth tobacco-related harm perceptions, and protect youth from social, peer, and industry influences.

Second-Hand Smoke Exposure at Home in the United States; Minorities' Diminished Returns

Introduction

Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities' Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults.

Methods

This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator.

Results

Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, P < 0.05) than for Non-Hispanics.

Conclusion

In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.

Education Level and Cigarette Smoking: Diminished Returns of Lesbian, Gay and Bisexual Individuals

Background: Education level is one of the strongest protective factors against high-risk behaviors such as cigarette smoking. Minorities' Diminished Returns (MDRs), however, suggest that the protective effects of education level tend to be weaker for racial and ethnic minority groups relative to non-Hispanic White people. Only two previous studies have shown that MDRs may also apply to lesbian, gay, and bisexual (LGB) individuals; however, these studies have focused on outcomes other than tobacco use. Aims: To compare LGB and non-LGB American adults for the effects of education level on cigarette-smoking status. Methods: Population Assessment of Tobacco and Health (PATH; 2013) entered 31,480 American adults who were either non-LGB (n = 29,303, 93.1%) or LGB (n = 2,177; 6.9%). The independent variable was education level. The dependent variable was current established cigarette smoking. Race, ethnicity, age, gender, poverty status, employment, and region were the covariates. LGB status was the moderator. Results: Overall, individuals with higher education level (odds ratio (OR) = 0.69) had lower odds of current established smoking. We found a significant interaction between LGB status and education level suggesting that the protective effect of education level on smoking status is systemically smaller for LGB people than non-LGB individuals (OR for interaction = 1.19). Conclusions: Similar to the patterns that are shown for racial and ethnic minorities, MDRs can be observed for the effects of education level among sexual minorities. In the United States, highly educated LGB adults remain at high risk of smoking cigarettes, a risk which is disproportionate to their education level. In other terms, high education level better helps non-LGB than LGB individuals to avoid cigarette smoking. The result is a relatively high burden of tobacco use in highly educated LGB individuals.

Unequal Effects of Educational Attainment on Workplace Exposure to Second-Hand Smoke by Race and Ethnicity; Minorities' Diminished Returns in the National Health Interview Survey (NHIS)

BACKGROUND

One of the mechanisms by which high educational attainment promotes populations' health is through reducing exposure to environmental risk factors such as second-hand smoke. Minorities' Diminished Returns theory, however, posits that the protective effect of educational attainment may be smaller for racial and ethnic minority individuals particularly Blacks and Hispanics compared to Whites.

AIMS

To explore racial and ethnic differences in the association between educational attainment and second-hand smoke exposure at work in a national sample of American adults.

METHODS

Data came from the National Health Interview Survey (NHIS 2015), a cross-sectional study that included 15,726 employed adults. The independent variable was educational attainment, the dependent variables were any and daily second-hand smoke exposure at workplace, age and gender were covariates, and race and ethnicity were the moderators.

RESULTS

Overall, higher educational attainment was associated with lower odds of any and daily second-hand smoke exposure at work. Race and ethnicity both interacted with educational attainment suggesting that the protective effects of educational attainment on reducing the odds of any and daily second-hand smoke exposure at work are systemically smaller for Blacks and Hispanics than Whites.

CONCLUSIONS

In the United States, race and ethnicity bound the health gains that follow educational attainment. While educational attainment helps individuals avoid environmental risk factors such as second-hand smoke, this is more valid for Whites than Blacks and Hispanics. The result is additional risk of cancer and tobacco related disease in highly educated Blacks and Hispanics. The results are important given racial and ethnic minorities are the largest growing section of the US population. We should not assume that educational attainment is similarly protective across all racial and ethnic groups. In this context, educational attainment may increase, rather than reduce, health disparities.

Protective Effects of Educational Attainment Against Cigarette Smoking; Diminished Returns of American Indians and Alaska Natives in the National Health Interview Survey

BACKGROUND

Although educational attainment is protective against health risk behaviors such as smoking, Minorities' Diminished Returns theory posits that these protective effects are smaller for ethnic minority than the majority groups.

AIMS

compare the effects of educational attainment on smoking status of American Indian Alaska Native (AIAN) and White adults.

METHODS

Data came from the National Health Interview Survey (NHIS - 2015). A total number of 21114 individuals entered our analysis. The independent variable was years of schooling. The dependent variable was current smoking status. Age, gender, region, marital status, and employment were covariates. Ethnicity was the moderator.

RESULTS

Overall, educational attainment was inversely associated with current smoking. Ethnicity showed a significant interaction with educational attainment that was suggestive that the protective effects of educational attainment against smoking is smaller for AIAN than Whites.

CONCLUSIONS

In the United States, while educational attainment helps individuals stay healthy by avoiding high risk behaviors such as smoking, this effect is smaller for AIANs than Whites. The result is additional risk of smoking in highly educated AIANs. To reduce ethnic disparities I tobacco use, it is important to go beyond SES inequalities and investigate why high SES ethnic minorities remain at high risk of tobacco use.

Role of social normative beliefs as a moderating factor in smoking intention among adolescent girls in Korea

In this study, we investigated the relationship between risk-taking tendency and smoking intention as moderated by social normative beliefs among Korean female adolescents. A cross-sectional study was conducted with 274 female adolescents in middle school. Multiple regression and simple slope analyses were employed to test the moderating effects of social normative beliefs regarding smoking on the relationship between risk-taking tendency and smoking intention. Results determined that risk-taking tendency, social normative beliefs regarding smoking, and their interaction were significant factors influencing smoking intention among adolescents. Risk-taking tendency was associated with greater smoking intention among adolescents, with higher than average social normative beliefs regarding smoking. However, risk-taking tendency was not significantly associated with smoking intention for adolescents with lower than average social normative beliefs regarding smoking. In conclusion, social normative beliefs regarding smoking moderated the relationship between risk-taking intention and smoking intention among Korean female adolescents. Unique sociocultural perceptions about smoking behaviors of adolescents need to be reflected in smoking-prevention and -cessation programs.

Trends and Racial Disparities in Mono, Dual, and Poly Use of Tobacco Products Among Youth

Introduction

We examined racial disparities in mono, dual, and poly use of tobacco products including whether racial disparities changed over time.

Methods

We analyzed data on high school students from the North Carolina Youth Tobacco Survey collected in 2011, 2013, and 2015. Dual and poly use included use of two and three or more tobacco products, respectively, in the past month. Multinomial regression models assessed racial differences and changes over time in mono, dual, and poly use. Data include product combinations most commonly used by youth from different racial groups.

Results

In total, 24% (in 2011) and 26% (in 2013 and 2015) of students used tobacco products. No significant changes over time were observed in mono (12%) or dual use (6%). Poly use was 6%, 8%, and 7% in 2011, 2013, and 2015, respectively. Relative to nonuse of tobacco, White students had a higher relative risk than Blacks for mono use. Whites and Hispanics had a higher relative risk than Blacks for dual and poly use. Observed racial differences in tobacco use did not change over time. Types of tobacco products used varied by year and race. In 2015, e-cigarette was the most commonly used product among mono users from all racial groups.

Conclusions

Substantial racial variation persists over time in mono and multiple tobacco product use among North Carolina youth, including racial variation in the types of tobacco products used. Research and policy efforts should examine and eliminate factors that drive multiple tobacco use and racial disparities in use among youth.

Implications

This study reports on racial disparities in mono and multiple tobacco product use among youth. White and Hispanic youth have higher relative risk for dual and poly use of tobacco products than Black youth. In addition, significant racial variation exists in the types of tobacco products used among youth mono, dual, and poly users, with cigarettes, cigars, smokeless tobacco, and e-cigarettes being the most commonly used products. Patterns of multiple tobacco product use vary by race and may warrant tailored prevention efforts. Strengthening tobacco control regulations for other tobacco products than cigarettes is critical to reduce multiple tobacco product use among youth.

Educational Attainment and Smoking Status in a National Sample of American Adults; Evidence for the Blacks' Diminished Return

BACKGROUND

Although higher socioeconomic status (SES) indicators such as educational attainment are linked with health behaviors, the Blacks’ Diminished Return theory posits that the protective effects of SES are systemically smaller for Blacks than Whites.

AIMS

To explore the Black/White differences in the association between education and smoking.

METHODS

This cross-sectional study used the Health Information National Trends Survey (HINTS) 2017 (n = 3217). HINTS is a national survey of American adults. The current analysis included 2277 adults who were either Whites (n = 1868; 82%) or Blacks (n = 409; 18%). The independent variable was educational attainment, and the dependent variables were ever and current (past 30-day) smoking. Demographic factors (age and gender) were covariates. Race was the focal moderator.

RESULTS

In the pooled sample, higher educational attainment was associated with lower odds of ever and current smoking. Race interacted with the effects of higher educational attainment on current smoking, suggesting a stronger protective effect of higher education against current smoking for Whites than Blacks. Race did not interact with the effect of educational attainment on odds of ever smoking.

CONCLUSIONS

In line with previous research in the United States, education is more strongly associated with health and health behaviors in Whites than Blacks. Smaller protective effects of education on health behaviors may be due to the existing racism across institutions such as the education system and labor market.

From childhood adversity to problem behaviors: Role of psychological and structural social integration

BACKGROUND

Childhood adversity (CA) is associated with problem behaviors in adolescence, but the mediators, that is, those factors that help build resilience and prevent some children who experience CA from engaging in problem behaviors, await more exploration, including social integration. The aim of this study was to identify the association between CA and adolescent problem behaviors, and to further examine the mediating role of social integration distinctly as psychological and structural integration.

METHODS

Data used were from the Taiwan Education Panel Survey, a core panel of 4,261 students (age 13) surveyed in 2001 and followed for three more waves until age 18. For psychological integration, an average score was calculated to represent adolescents' feelings about their school. Structural integration was constructed using several items about adolescents' school and extracurricular activities. We used structural equation modeling with the diagonally weighted least squares method to examine the effect of CA on the primary outcome: adolescent problem behaviors via social integration.

RESULTS

The hypothesized structural equation model specifying the path from CA to adolescent problem behavior had good fit. Respondents with one CA were indirectly linked to problem behaviors via psychological but not structural integration (e.g. the level of participation in school and non-school activities). On mediation analysis, psychological integration significantly mediated the paths from one CA to all six problem behaviors (all P < 0.05).

CONCLUSION

The presence of only one CA was indirectly associated with problem behavior via psychological integration; two or more CA were not associated with significant paths to problem behaviors. The contribution of social integration is crucial to an adolescent's development from CA to problem behaviors. To form supportive social relationships to achieve better health, we suggest that those adolescents who have been exposed to CA should be helped to join more teams and take part in more activities, thereby increasing their opportunities for social interaction, and improving their communication skills.

Ethno-specific preferences of cigarette smoking and smoking initiation among Canadian immigrants - a multi-level analysis

BACKGROUND

Cigarette smoking is the leading cause of preventable morbidity and mortality worldwide. Over the last decade, increased immigration has significantly shifted Canada's demographic profile. According to a 2011 National Household Survey, approximately 20.6% of the Canadian population was immigrants, the highest among the G8 countries. It is estimated that by 2031, one-in-three Canadian's will be an immigrant. This study examined the ethno-specific preference of cigarette smoking and smoking initiation among Canadian immigrants.

METHODS

This study used data from the 2013 to 2014 combined cycles of the Canadian Community Health Survey. This was a nationally generalizable, telephone-based survey that included a total of 130,000 respondents, aged 12 years or older. Ethnic differences in the preference of cigarette use among Canadian immigrant groups were determined. A three-level mixed effects logistic regression model was used to estimate the effect of ethnicity on the likelihood of smoking initiation after migration to Canada.

RESULTS

In our study, 82% of respondents were native-born Canadians (one group), while the rest were immigrants (six groups=18%). Results of the logistic regression analysis revealed statistically significant differences in the number of cigarettes smoked daily (P=0.0001), age of smoking onset (P=0.0001), and smoking initiation (P=0.0001) between Canadian-born and immigrant participants. Immigrant smokers in Canada were significantly more likely to be younger, single, Caucasian, females with high income and post-secondary education (P=0.0001).

CONCLUSION

The results of our study suggest that Caucasian female immigrants in Canada initiated smoking at a younger age and smoked more cigarettes than any other immigrant group or native-born Canadians. This is a particularly interesting finding as Caucasian female immigrants may not be considered a vulnerable or at-risk population. To be effective, tobacco strategies specifically tailored for this overlooked population would require increased awareness, culturally appropriate initiatives, and gender-specific interventions.

Examination of the Involvement of Cholinergic-Associated Genes in Nicotine Behaviors in European and African Americans

Introduction

Cigarette smoking is a physiologically harmful habit. Nicotinic acetylcholine receptors (nAChRs) are bound by nicotine and upregulated in response to chronic exposure to nicotine. It is known that upregulation of these receptors is not due to a change in mRNA of these genes, however, more precise details on the process are still uncertain, with several plausible hypotheses describing how nAChRs are upregulated. We have manually curated a set of genes believed to play a role in nicotine-induced nAChR upregulation. Here, we test the hypothesis that these genes are associated with and contribute risk for nicotine dependence (ND) and the number of cigarettes smoked per day (CPD).

Methods

Studies with genotypic data on European and African Americans (EAs and AAs, respectively) were collected and a gene-based test was run to test for an association between each gene and ND and CPD.

Results

Although several novel genes were associated with CPD and ND at P < 0.05 in EAs and AAs, these associations did not survive correction for multiple testing. Previous associations between CHRNA3, CHRNA5, CHRNB4 and CPD in EAs were replicated.

Conclusions

Our hypothesis-driven approach avoided many of the limitations inherent in pathway analyses and provided nominal evidence for association between cholinergic-related genes and nicotine behaviors.

Implications

We evaluated the evidence for association between a manually curated set of genes and nicotine behaviors in European and African Americans. Although no genes were associated after multiple testing correction, this study has several strengths: by manually curating a set of genes we circumvented the limitations inherent in many pathway analyses and tested several genes that had not yet been examined in a human genetic study; gene-based tests are a useful way to test for association with a set of genes; and these genes were collected based on literature review and conversations with experts, highlighting the importance of scientific collaboration.

Emerging Adulthood, Emergent Health Lifestyles: Sociodemographic Determinants of Trajectories of Smoking, Binge Drinking, Obesity, and Sedentary Behavior

During the transition to adulthood, many unhealthy behaviors are developed that in turn shape behaviors, health, and mortality in later life. However, research on unhealthy behaviors and risky transitions has mostly focused on one health problem at a time. In this article, we examine variation in health behavior trajectories, how trajectories cluster together, and how the likelihood of experiencing different behavior trajectories varies by sociodemographic characteristics. We use the National Longitudinal Study of Adolescent Health (Add Health) Waves I to IV to chart the most common health behavior trajectories over the transition to adulthood for cigarette smoking, alcohol consumption, obesity, and sedentary behavior. We find that health behavior trajectories cluster together in seven joint classes and that sociodemographic factors (including gender, parental education, and race-ethnicity) significantly predict membership in these joint trajectories.

Can reflexivity be learned? An experience with tobacco control practitioners in Canada

Summary

To explore an example of a reflexive intervention with health professionals working in tobacco control (TC). This study reports the perceived intervention effects regarding: (i) participants' understanding of reflexivity and personal learning and (ii) conditions needed in order to integrate reflexivity into professional and organizational practices. This is a qualitative study using an interpretative evaluation framework to assess the perceived effects of a reflexive intervention in Montréal, Québec. Semi-structured qualitative interviews (n = 8) gathered data. Data analysis began deductively, guided by the broad categories found in research questions. Sub-categories to populate these broad categories captured the inhibitors and facilitators through an inductive thematic analysis. Our study reveals that, following the intervention, most participants had a generally good understanding of reflexivity and described concrete learning in association with the intervention. Main facilitators and inhibitors to conducting a reflexive workshop pertained to the organizational context as well as to the professional and individual characteristics of the participants. Some participants implemented sustainable changes as a result of the intervention, such as creating a tool, reviewing work plans and developing new mechanisms to integrate the voice of their clientele in the planning process. The need and interest for dialogue among health professionals about how TC intervention activities may inadvertently contribute to social inequalities in smoking is apparent. While there appears to be potential for reflexive practice, the integration of reflexivity into practice is reliant upon the organizational context (financial and time constraints, culture, support, and climate) and the reflexivity concept itself (intangibility, complexity and fuzziness).

Childhood sexual abuse and two stages of cigarette smoking in African-American and European-American young women

OBJECTIVE

The aim of the current study was to determine whether the higher rates of childhood sexual abuse (CSA) but lower rates of cigarette smoking in African-American vs. European-American women can be explained in part by a lower magnitude of association between CSA and smoking in African-American women.

METHODS

Data were drawn from a same-sex female twin study of substance use (n=3521; 14.3% African-American). Cox proportional hazards regression analyses using CSA to predict smoking initiation and progression to regular smoking were conducted separately by race/ethnicity. Co-twin status on the smoking outcome was used to adjust for familial influences on smoking (which may overlap with family-level influences on CSA exposure).

RESULTS

After adjusting for co-twin status, CSA was associated with smoking initiation in European Americans (hazard ratio (HR)=1.43, 95% confidence intervals (CI): 1.26-1.62) and with smoking initiation ≤16 in African Americans (HR=1.70, CI: 1.26-2.29). CSA was associated with regular smoking onset ≤15 in European Americans (HR=1.63, CI: 1.21-2.18), with no change in HR after adjusting for co-twin status. In the African-American subsample, the HR for CSA was reduced to non-significance after adjusting for co-twin status (from HR=3.30, CI: 1.23-8.89 to HR=1.16, CI: 0.71-1.92 for regular smoking ≤15).

CONCLUSIONS

CSA is associated with moderate elevation in risk for initiating smoking among African-American and European-American women. By contrast, CSA is associated with elevated risk for (adolescent onset) regular smoking only in European-American women. Furthermore, there is significant overlap between risk conferred by CSA and familial influences on regular smoking in African-American but not European-American women.

Associations Between Cigarette Print Advertising and Smoking Initiation Among African Americans

OBJECTIVES

The objective of this study was to examine changes in the annual number of cigarette advertisements in magazines with a predominantly African-American audience following the broadcast ban on tobacco, and whether fluctuations in cigarette print advertising targeting African Americans during the late-1970s until the mid-1980s were associated with declines in smoking initiation.

DESIGN

We tabulated the annual number of cigarette advertisements from magazines with large African-American readerships (Ebony, Essence, and Jet) from 1960 to 1990. Advertisements were coded depending on whether they featured African-American models. We calculated the incidence rate of regular smoking initiation from 1975 to 1990 for African-American 14-25 years old using data from the 1992-1993, 1995-1996, 1998-1999, and 2001-2002 Tobacco Use Supplements of the Current Population Survey. We examined whether trends in smoking initiation coincided with trends in cigarette advertising practices among African Americans.

RESULTS

The annual aggregated number of printed cigarette advertisements in Ebony, Essence, and Jet magazines increased at least five-fold starting in 1971, following the broadcast ban on cigarette advertising. A decrease in the percentage of ads by Brown & Williamson that showed African-American models was positively correlated (r = 0.30) with declines in the incidence rate of smoking initiation among African Americans from the late-1970s to the mid-1980s.

CONCLUSION

The tobacco industry adapted quickly following the broadcast ban on cigarettes by increasing print advertising in African-American magazines. However, changes in print advertising practices by were associated with declines in smoking initiation among African Americans from the late-1970s to mid-1980s.

The Association of Low Parental Monitoring With Early Substance Use in European American and African American Adolescent Girls

OBJECTIVE

Research indicates that low parental monitoring increases the risk for early substance use. Because low parental monitoring tends to co-occur with other familial and neighborhood factors, the specificity of the association is challenging to establish. Using logistic regression and propensity score analyses, we examined associations between low parental monitoring and early substance use in European American (EA) and African American (AA) girls, controlling for risk factors associated with low parental monitoring.

METHOD

Participants were 3,133 EA and 523 AA girls from the Missouri Adolescent Female Twin Study with data on parental monitoring assessed via self-report questionnaire, and with ages at first use of alcohol, tobacco, and cannabis queried in at least one of three diagnostic interviews (median ages = 15, 22, and 24 years).

RESULTS

The rate of early alcohol use was greater in EA than AA girls, whereas the proportion of AA girls reporting low parental monitoring was higher than in EA girls. EA girls who experienced low parental monitoring were at elevated risk for early alcohol, tobacco, and cannabis use, findings supported in both logistic regression and propensity score analyses. Evidence regarding associations between low parental monitoring and risk for early substance use was less definitive for AA girls.

CONCLUSIONS

Findings highlight the role of parental monitoring in modifying risk for early substance use in EA girls. However, we know little regarding the unique effects, if any, of low parental monitoring on the timing of first substance use in AA girls.

Sociodemographic correlates of continuing tobacco use - a descriptive report from the Nigerian Survey of Mental Health and Wellbeing

OBJECTIVE

To investigate whether sociodemographic factors were associated with continuing tobacco use in a nationwide Nigerian sample.

METHOD

The World Mental Health Survey Schedule was used to interview 6752 Community dwelling participants 18 years and over, selected in a complex multistage sampling from the six geopolitical zones of Nigeria. Ever and current smokers were identified with their sociodemographic characteristics.

RESULTS

About 17% (1137/6752) of the participants were ever smokers, 24.8% of whom were current smokers. Participants who completed primary school, had some College education, were never married, or students were more likely to continue using smoke once they commenced its use. Being in the older age group or having had graduate college education was associated with much less likelihood of continuing to use tobacco among ever smokers.

CONCLUSION

In general, tobacco smoking rate in Nigeria is lower compared to most developed countries. Younger participants, having some education, those who were never married were more likely to continue tobacco smoking. Determinants of factors associated with continuing tobacco use should be adequately investigated to permit appropriate interventions.

A discrete-time analysis of the effects of more prolonged exposure to neighborhood poverty on the risk of smoking initiation by age 25

Evidence suggests that individuals who initiate smoking at younger ages are at increased risk for future tobacco dependence and continued use as well as for numerous smoking-attributable health problems. Identifying individual, household, and to a far lesser extent, contextual factors that predict early cigarette use has garnered considerable attention over the last several decades. However, the majority of scholarship in this area has been cross-sectional or conducted over relatively short windows of observation. Few studies have investigated the effects of more prolonged exposure to smoking-related risk factors, particularly neighborhood characteristics, from childhood through early adulthood. Using the 1970-2011 waves of the Panel Study of Income Dynamics merged with census data on respondents' neighborhoods, this study estimates a series of race-specific discrete-time marginal structural logit models for the risk of smoking initiation as a function of neighborhood poverty, as well as individual and household characteristics, from ages four through 25. Neighborhood selection bias is addressed using inverse-probability-of-treatment weights. Results indicate that more prolonged exposure to high (>20%) as opposed to low (<10%) poverty neighborhoods is associated with an increased risk of smoking onset by age 25, although consistent with prior literature, this effect is only evident among white and not nonwhite youth and young adults.

Race, Social and Environmental Conditions, and Health Behaviors in Men

Although understanding race differences in health behaviors among men is an important step in reducing disparities in leading causes of death in the United States, progress has been stifled when using national data because of the confounding of race, socioeconomic status, and residential segregation. The purpose of this study is to examine the nature of disparities in health behaviors among African American and white men in the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore, which was conducted in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. After adjusting for age, marital status, insurance, income, educational attainment, poor or fair health, and obesity status, African American men in National Health Interview Survey had greater odds of being physically inactive (odds ratio [OR] = 1.48; 95% confidence interval [CI], 129-1.69), reduced odds of being a current smoker (OR = 0.77; 95% CI, 0.65-0.90), and reduced odds of being a current drinker (OR = 0.58; 95% CI, 0.50-0.67). In the Exploring Health Disparities in Integrated Communities Study-Southwest Baltimore sample, African American and white men had similar odds of being physically inactive (OR = 0.79; 95% CI, 0.50-1.24), being a current smoker (OR = 0.86; 95% CI, 0.60-1.23), or being a current drinker (OR = 1.34; 95% CI, 0.81-2.21). Because race disparities in these health behaviors were ameliorated in the sample where African American and white men were living under similar social, environmental, and socioeconomic status conditions, these findings suggest that social environment may be an important determinant of health behaviors among African American and white men. Public health interventions and health promotion strategies should consider the social environment when seeking to better understand men's health disparities.

A pilot study of what African American maternal caregivers and their adolescent daughters talk about when asked to discuss tobacco together

Parents play a critical role in shaping their children's substance use behaviors, yet few studies have examined the messages that caregivers give their adolescents about tobacco. In this study, we identify tobacco-related messages discussed by African American maternal caregivers and their adolescent daughters. Twenty-five African American maternal caregivers and their adolescent daughters participated in a video-taped discussion about tobacco. Discussions were transcribed and coded thematically. Seven themes emerged, which were grouped into tobacco-messages and communication strategies. Messages included health risks, non-health-related reasons to stop smoking, reasons people smoke, and tobacco products and marijuana. Strategies caregivers used to communicate their tobacco-related messages included sharing personal or their families' experience with smoking, using humor, and role-playing. Finally, embedded within all of the themes, participants expressed their disapproval of tobacco use, whether it was directed at their own use, their adolescents' use, a family members' use, or peers' use. African American maternal caregivers and their daughters openly talk about a variety of tobacco-related topics, and caregivers are open to sharing their own and their families' experience with substance use. Findings also suggest that having caregivers and their adolescents participate in discussions tasks could be potentially beneficial in facilitating discussions and could identify areas in which caregivers could use help in discussing sensitive topics.

Smoking-Related Beliefs and Susceptibility Among United States Youth Nonsmokers

PURPOSE

The purpose of the study was to examine racial/ethnic disparities in smoking beliefs and susceptibility in a nationally representative sample of United States youth nonsmokers (N = 21,931).

METHODS

Weighted regression models were used to examine smoking-related beliefs and susceptibility by race/ethnicity adjusting for demographics, exposure to pro-tobacco advertising and promotions, parental guidance against tobacco use, and peer norms.

RESULTS

Compared with non-Hispanic whites, racial/ethnic minority youth endorsed pro-smoking beliefs and were susceptible to smoking. Non-Hispanic blacks, non-Hispanic Asians, and Hispanics embraced social benefits of smoking (all p < .05). Hispanics had lower perceptions of tobacco-related risks (adjusted odds ratio = .87) and were more susceptible to smoking (adjusted odds ratio = 1.56). Disparities in smoking beliefs and susceptibility persisted between minority and non-Hispanic white youth after adjusting for exposure to pro-tobacco advertising and promotions, parental guidance against tobacco use, and peer norms.

CONCLUSIONS

Smoking-related beliefs and susceptibility varied by race/ethnicity among youth nonsmokers after accounting for known predictors of youth smoking.

Life course transitions and racial and ethnic differences in smoking prevalence

This study aims to: (1) describe trajectories in the likelihood of smoking by racial or ethnic group across the transition to adulthood, (2) identify the influence of achieved socioeconomic status (SES) and the nature and timing of adult role transitions, and (3) determine the extent to which achieved SES and adult roles mediate the effects of race and ethnicity on smoking. The analyses use U.S. longitudinal data from the National Longitudinal Study of Adolescent Health (Add Health), which follows a representative national sample over four waves and from ages 11-17 in 1994/95 to 26-34 in 2007/08. Growth curve models compare trajectories of smoking likelihood for white, black, Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native individuals. While whites have higher rates of smoking than blacks and Hispanics during their teen years and 20s, blacks and Hispanics lose their advantage relative to whites as they approach and enter their 30s. American Indian/Alaska Natives show high rates of smoking at earlier ages and an increasing likelihood to smoke. Although life course transitions are influential for smoking prevalence in the overall U.S. population, SES and the nature and timing of adult role transitions account for little of the gap between whites and black, Hispanic, and American Indian/Alaska Native individuals. Racial and ethnic disparities in adult smoking are independent of SES and life transitions, pointing to explanations such as culturally specific normative environments or experiences of discrimination.

Physical activity and nicotine dependence among a national sample of young U.S. adults who smoke daily: evaluation of cross-sectional and longitudinal associations to determine which behavior drives this relationship

The association between nicotine dependence and physical activity (PA) is relatively unknown. No study has concurrently examined the cross-sectional and longitudinal associations between PA and nicotine dependence, which was the primary purpose of this study. A secondary purpose was to examine how well nicotine dependence and PA behavior track over a two-year period. Data from the 2003-2005 National Youth Smoking Cessation Survey (NYSCS) were used, with young adults (18-24 yrs; n=1168) being followed over a two-year period. Physical activity was assessed using a questionnaire and nicotine dependence was assessed using the modified Fagerstrom Test for Nicotine Dependence scale. This study identified three notable findings: 1) baseline PA and nicotine dependence demonstrated a bidirectional, cross-sectional association (e.g., β=-0.23; 95% CI: -0.44 to -0.02; p=0.02); 2) when examined longitudinally, nicotine dependence influenced PA (OR=0.90; 95% CI: 0.82-0.99; p=0.04), but there was no evidence of the reverse pathway (i.e., PA influencing 2-year follow-up smoking status [OR=0.95; 95% CI: 0.66-1.39; p=0.82) or nicotine dependence (β=0.05; 95% CI: -0.14 to 0.24, p=0.61]); and 3) both PA (OR=3.52, 95% CI: 2.68-4.69; p<0.001) and nicotine dependence (β=0.52; 95% CI: 0.46-0.58, p<0.001) tracked relatively well over a two-year period during early adulthood. These findings suggest that both behaviors (physical activity and nicotine dependence) track over time, but nicotine dependence appears to be driving the cross-sectional relationship between nicotine dependence and physical activity, as opposed to the reverse pathway.

Racially classified social group differences in cigarette smoking, nicotine dependence, and readiness to quit

The purpose was to determine racially classified social group differences in smoking, nicotine dependence, and readiness to quit between African American and Caucasian smokers. The cross-sectional study included 53 African American and 839 Caucasian smokers participating in a larger population-based cessation intervention study. Data were analyzed from the interview conducted before the intervention; half of the participants were in the treatment group, recruited from those who had joined a cessation contest, whereas control group participants were recruited using random-digit dialing and were not in the contest. African Americans began smoking later, smoked fewer cigarettes daily, reported lower nicotine dependence, and had greater readiness to quit smoking than Caucasians. Of those who had ever used an evidence-based method, African American smokers were more likely to only use evidence-based quit methods, whereas Caucasian smokers were more likely to mix evidence-based with "cold turkey." Controlling for demographics and treatment group, racially classified social group was a predictor of readiness to quit smoking. Later, age of initiation, positive partner support, and using evidence-based quit methods also predicted greater readiness to quit.

Reasons for smoking among tri-ethnic daily and nondaily smokers

INTRODUCTION

Nondaily smokers experience adverse effects from tobacco use, yet they have been understudied compared to daily smokers. Understanding how reasons for smoking (RS) differ by smoking level, gender, and race/ethnicity could inform tailored interventions.

METHODS

A cross-sectional survey was administered through an online panel survey service to 2,376 current smokers who were at least 25 years of age. The sample was stratified to obtain equal numbers of 3 racial/ethnic groups (African American [AA], Latino, and White) across smoking level (native nondaily, converted nondaily, daily light, and daily moderate/heavy).

RESULTS

A 7-factor structure of a 20-item Modified Reasons for Smoking Scale (MRSS) was confirmed (each subscale alpha > 0.80). Each factor of the MRSS varied by smoking level, with nondaily smokers endorsing all RS less frequently than daily smokers (p < .0001). The 4 smoker subgroups incrementally differed from one another (p < .05) with several exceptions between converted nondaily and daily light smokers. Males reported stronger RS on 5 out of 7 reasons (p < .05). Females had higher scores on tension reduction/relaxation (p < .0001). Latinos reported stronger RS than Whites and AAs on all reasons (p < .05) except for tension reduction/relaxation (p > .05). AAs and Whites were comparable on all RS (p > .05).

CONCLUSIONS

The present study highlights considerable variability across smoking level, gender, and race/ethnicity in strength of RS. Addressing subgroup differences in RS may contribute to more sensitive and effective prevention and treatment efforts.

Sexual orientation disparities in adolescent cigarette smoking: intersections with race/ethnicity, gender, and age

OBJECTIVES

We examined sexual orientation differences in adolescent smoking and intersections with race/ethnicity, gender, and age.

METHODS

We pooled Youth Risk Behavior Survey data collected in 2005 and 2007 from 14 jurisdictions; the analytic sample comprised observations from 13 of those jurisdictions (n = 64,397). We compared smoking behaviors of sexual minorities and heterosexuals on 2 dimensions of sexual orientation: identity (heterosexual, gay-lesbian, bisexual, unsure) and gender of lifetime sexual partners (only opposite sex, only same sex, or both sexes). Multivariable regressions examined whether race/ethnicity, gender, and age modified sexual orientation differences in smoking.

RESULTS

Sexual minorities smoked more than heterosexuals. Disparities varied by sexual orientation dimension: they were larger when we compared adolescents by identity rather than gender of sexual partners. In some instances race/ethnicity, gender, and age modified smoking disparities: Black lesbians-gays, Asian American and Pacific Islander lesbians-gays and bisexuals, younger bisexuals, and bisexual girls had greater risk.

CONCLUSIONS

Sexual orientation, race/ethnicity, gender, and age should be considered in research and practice to better understand and reduce disparities in adolescent smoking.

Siblings, friends, course-mates, club-mates: how adolescent health behavior homophily varies by race, class, gender, and health status

Many unhealthy behaviors develop during adolescence, and these behaviors can have fundamental consequences for health and mortality in adulthood. Social network structure and the degree of homophily in a network affect how health behaviors and innovations are spread. However, the degree of health behavior homophily across different social ties and within subpopulations is unknown. This paper addresses this gap in the literature by using a novel regression model to document the degree of homophily across various relationship types and subpopulations for behaviors of interest that are related to health outcomes. These patterns in health behavior homophily have implications for which behaviors and ties should be the subjects of future research and for predicting how homophily may shape health programs focused on specific subpopulations (gender, race, class, health status) or a specific social context (families, peer groups, classrooms, or school activities).

Parent and child cigarette use: a longitudinal, multigenerational study

OBJECTIVES

Using longitudinal data from the multigenerational Youth Development Study (YDS), this article documents how parents' long-term smoking trajectories are associated with adolescent children's likelihood of smoking. Prospective data from the parents (from age 14-38 years) enable unique comparisons of the parents' and children's smoking behavior, as well as that of siblings.

METHODS

Smoking trajectories are constructed using latent class analysis for the original YDS cohort (n = 1010). Multigenerational longitudinal data from 214 parents and 314 offspring ages 11 years and older are then analyzed by using logistic regression with cluster-corrected SEs.

RESULTS

Four latent smoking trajectories emerged among the original cohort: stable nonsmokers (54%), early-onset light smokers who quit/reduce (16%), late-onset persistent smokers (14%), and early-onset persistent heavy smokers (16%). Although 8% of children of stable nonsmokers smoked in the last year, the other groups' children had much higher percentages, ranging from 23% to 29%. Multivariate logistic regression models confirm that these significant differences were robust to the inclusion of myriad child- and parent-level measures (for which child age and grade point average [GPA] are significant predictors). Older sibling smoking, however, mediated the link between parental heavy smoking and child smoking.

CONCLUSIONS

Even in an era of declining rates of teenage cigarette use in the United States, children of current and former smokers face an elevated risk of smoking. Prevention efforts to weaken intergenerational associations should consider parents' long-term cigarette use, as well as the smoking behavior of older siblings in the household.

The dynamic role of parental influences in preventing adolescent smoking initiation

BACKGROUND

As adolescents grow, protective parental influences become less important and peer influences take precedence in adolescent's initiation of smoking. It is unknown how and when this occurs. We sought to: prospectively estimate incidence rates of smoking initiation from late childhood through mid-adolescence, identify important risk and protective parental influences on smoking initiation, and examine their dynamic nature in order to identify key ages.

METHODS

Longitudinal data from the National Survey of Parents and Youth of 8 nationally representative age cohorts (9-16 years) of never smokers in the U.S. were used (N=5705 dyads at baseline). Analysis involved a series of lagged logistic regression models using a cohort-sequential design.

RESULTS

The mean sample cumulative incidence rates of tobacco use increased from 1.8% to 22.5% between the 9 and 16 years old age cohorts. Among risk factors, peer smoking was the most important across all ages; 11-15 year-olds who spent time with peers who smoked had 2 to 6.5 times higher odds of initiating smoking. Parent-youth connectedness significantly decreased the odds of smoking initiation by 14-37% in 11-14 year-olds; parental monitoring and punishment for smoking decreased the odds of smoking initiation risk by 36-59% in 10-15 year-olds, and by 15-28% in 12-14 year-olds, respectively.

CONCLUSIONS

Parental influences are important in protecting against smoking initiation across adolescence. At the same time, association with peers who smoke is a very strong risk factor. Our findings provide empirical evidence to suggest that in order to prevent youth from initiating smoking, parents should be actively involved in their adolescents' lives and guard them against association with peers who smoke.

Racial/Ethnic and Nativity Patterns of U.S. Adolescent and Young Adult Smoking

We document racial/ethnic and nativity differences in U.S. smoking patterns among adolescents and young adults using the 2006 Tobacco Use Supplement to the Current Population Survey (n=44,202). Stratifying the sample by nativity status within five racial/ethnic groups (Asian American, Mexican American, other Hispanic, non-Hispanic black, and non-Hispanic white), and further by sex and age, we compare self-reports of lifetime smoking across groups. U.S.-born non-Hispanic whites, particularly men, report smoking more than individuals in other racial/ethnic/nativity groups. Some groups of young women (e.g., foreign-born and U.S.-born Asian Americans, foreign-born and U.S.-born Mexican Americans, and foreign-born blacks) report extremely low levels of smoking. Foreign-born females in all of the 25-34 year old racial/ethnic groups exhibit greater proportions of never smoking than their U.S.-born counterparts. Heavy/moderate and light/intermittent smoking is generally higher in the older age group among U.S.-born males and females whereas smoking among the foreign-born of both sexes is low at younger ages and remains low at older ages. Taken together, these findings highlight the importance of considering both race/ethnicity and nativity in assessments of smoking patterns and in strategies to reduce overall U.S. smoking prevalence and smoking-attributable health disparities.

Indoor air pollution and risk of lung cancer among Chinese female non-smokers

PURPOSE

To investigate indoor particulate matter (PM) level and various indoor air pollution exposure, and to examine their relationships with risk of lung cancer in an urban Chinese population, with a focus on non-smoking women.

METHODS

We conducted a case-control study in Taiyuan, China, consisting of 399 lung cancer cases and 466 controls, of which 164 cases and 218 controls were female non-smokers. Indoor PM concentrations, including PM(1), PM(2.5), PM(7), PM(10), and TSP, were measured using a particle mass monitor. Unconditional logistic regression models were used to calculate odds ratios (ORs) and 95 % confidence intervals after adjusting for age, education, annual income, and smoking.

RESULTS

Among non-smoking women, lung cancer was strongly associated with multiple sources of indoor air pollution 10 years ago, including heavy exposure to environmental tobacco smoke at work (aOR = 3.65), high frequency of cooking (aOR = 3.30), and solid fuel usage for cooking (aOR = 4.08) and heating (aOR(coal stove) = 2.00). Housing characteristics related to poor ventilation, including single-story, less window area, no separate kitchen, no ventilator, and rarely having windows open, are associated with lung cancer. Indoor medium PM(2.5) concentration was 68 μg/m(3), and PM(10) was 230 μg/m(3). PM levels in winter are strongly correlated with solid fuel usage for cooking, heating, and ventilators. PM(1) levels in cases are more than 3 times higher than that in controls. Every 10 μg/m(3) increase in PM(1) is associated with 45 % increased risk of lung cancer.

CONCLUSIONS

Indoor air pollution plays an important role in the development of lung cancer among non-smoking Chinese women.

Socioeconomic, demographic and smoking-related correlates of the use of potentially reduced exposure to tobacco products in a national sample

BACKGROUND AND AIM

In recent years, new non-traditional, potentially reduced exposure products (PREPs), claiming to contain fewer harmful chemicals than the traditional products, have been introduced in the market. Little is known about socioeconomic, demographic and smoking-related determinants of the likelihood of using these products among smokers. The aim of this study was to examine these determinants.

METHODS

Data from the 2006-2007 Tobacco Use Supplement to the Current Population Survey was used. We limited the analysis to current smokers (n=40724). Multivariate logistic regression analyses were conducted to estimate the association between covariates and the probability of the use of PREPs.

RESULTS

We found that younger age, lower education, higher nicotine addiction and having an intention to quit are associated with higher likelihood of the use of PREPs. The likelihood of using these products was found to be higher among respondents who are unemployed or have a service, production, sales or farming occupation than those with a professional occupation. Smokers living in the midwest, south or west, were found to have a greater likelihood of the use of PREPs than those living in the northeast.

CONCLUSIONS

Because there is little evidence to suggest that PREPs are less harmful that other tobacco products, their marketing as harm-minimising products should be regulated. Smokers, in particular those who are younger, have a lower socioeconomic status, and are more nicotine-dependent, should be the target of educational programmes that reveal the actual harm of PREPs.

State tobacco control plans: who falls outside the plans?

PURPOSE

To review published state tobacco control plans (STCPs) to determine the extent to which the needs of the states' populations are being addressed.

DESIGN

A qualitative cross-sectional comparison of states' strategic plans for tobacco control as of March 2010.

SETTING

Online searches.

PARTICIPANTS

The 50 states and the District of Columbia.

METHOD

Internet-based searches were completed using tobacco and other keywords (control, prevention, strategies, comprehensive/strategic plan) to obtain all publicly available STCPs; telephone follow-up was conducted to ensure that all publicly available plans were captured. Each plan was coded by two researchers using a standardized protocol to assess provisions made for addressing disparate populations as defined by the states.

RESULTS

A total of 43 states addressed disparate populations. Thirty-six states addressed these populations within published STCPs, six states had separate stand-alone tobacco disparities plans, and one addressed it within their cancer plan. Specific populations addressed included racial and ethnic minorities, blue-collar employees, pregnant women, children under the age of 18, and college students. There were also several STCPs that cited the general goal of eliminating tobacco use disparities.

CONCLUSION

More work is needed to address tobacco disparities, including additional planning efforts in some states and effective implementation and evaluation among states with plans. States can look to the experiences of other states to help guide tobacco control planning for their own populations.

Healthy Behavior Trajectories between Adolescence and Young Adulthood

Healthy behaviors including adequate exercise and sleep, eating breakfast, maintaining a healthy weight, and not smoking or binge drinking inhibit chronic disease. However, little is known about how these behaviors change across life course stages, or the social factors that shape healthy behaviors over time. I use multilevel growth models and waves I-III of the National Longitudinal Study of Adolescent Health (N=10,775) to evaluate relationships between adolescents' psychosocial resources, social support, and family of origin characteristics during adolescence and healthy behavior trajectories through young adulthood (ages 13-24). I find that healthy behaviors decline dramatically during the transition to young adulthood. Social support resources, such as school connectedness and support from parents, as well as living with non-smoking parents, are associated with higher levels of healthy behaviors across adolescence and adulthood. Social support from friends is associated with lower engagement in these behaviors, as is living in a single parent family or with a smoking parent during adolescence. Findings indicate that psychosocial, social support, and family of origin resources during adolescence exert a persistent, though generally not cumulative, influence on healthy behavior trajectories through young adulthood.

A review of culturally targeted/tailored tobacco prevention and cessation interventions for minority adolescents

AIM

Emerging racial/ethnic disparities in tobacco use behaviors and resulting long-term health outcomes highlight the importance of developing culturally tailored/targeted tobacco prevention and cessation interventions. This manuscript describes the efficacy and the components of prevention and cessation interventions developed for minority adolescents.

METHODS

Thirteen studies focused on culturally tailoring and targeting tobacco prevention/cessation interventions were selected and information on intervention design (type, number of sessions), setting (school or community), theoretical constructs, culture-specific components (surface/deep structures), and treatment outcomes were extracted.

RESULTS

Of the 13 studies, 5 focused on prevention, 4 on cessation, and 4 combined prevention and cessation, and most of the studies were primarily school-based, while a few used community locations. Although diverse minority groups were targeted, a majority of the studies (n = 6) worked with Hispanic adolescents. The most common theoretical construct examined was the Social Influence Model (n = 5). The overall findings indicated that culturally tailoring cessation interventions did not appear to improve tobacco quit rates among minority adolescents, but culturally tailored prevention interventions appeared to produce lower tobacco initiation rates among minority adolescents than control conditions.

CONCLUSIONS

The results of review suggest that there is a critical need to develop better interventions to reduce tobacco use among minority adolescents and that developing a better understanding of cultural issues related to both cessation and initiation of tobacco use among minority populations is a key component of this endeavor.

Continued importance of family factors in youth smoking behavior

INTRODUCTION

Although it is known that levels of family factors (FF) such as parental monitoring and parent-adolescent connectedness vary during adolescence, it is unknown which factors remain protective, preventing smoking initiation, in youth of differing racial/ethnic groups. Using a longitudinal, nationally representative sample, we examined which FF protect against smoking initiation in White, Black, and Hispanic youth.

METHODS

A total of 3,473 parent-nonsmoking youth dyads from Round 1 (T1) of the National Survey of Parents and Youth were followed to Round 3 (T2). Youth smoking status at T2 was assessed as the primary outcome. We examined changes in FF (T2 - T1) and the protection afforded by these factors at T1 and T2 for smoking initiation, both by race/ethnicity and overall.

RESULTS

There were statistically significant decreases in levels of protective FF from T1 to T2 across all racial/ethnic groups; however, FF levels were higher in never-smokers compared with smoking initiators at both T1 and T2 (p < .05). Separate models by race/ethnicity showed the protective effect of increased perceived punishment in all racial/ethnic groups and protection against initiation by increased parental monitoring in Black and Hispanic youth. Overall, higher parental monitoring at T1 was associated with decreased odds of smoking initiation (33%); decreased parental monitoring and perceived punishment from T1 to T2 were associated with increased odds of smoking initiation (55% and 17%, respectively).

CONCLUSIONS

Smoking prevention interventions should encourage parents to both enforce consistent consequences of smoking behavior, and continue monitoring, especially in minority groups.

Tobacco use by college students: a comparison of daily and nondaily smokers

OBJECTIVES

To explore demographics, contextual factors, and health risk behaviors associated with nondaily smoking by college students.

METHODS

In fall 2005, a random sample of 4100 students completed an online survey.

RESULTS

Of those surveyed, 29% reported current smoking; of that 29%, 70% were nondaily smokers. Compared to daily smokers, nondaily smokers were younger, African American (compared to white), had mothers with higher education, belonged to Greek organizations, and attended private (vs public) schools. Nondaily smokers were less likely to have used illicit drugs.

CONCLUSIONS

Nondaily and daily smokers differed on several demographic and contextual factors, but reported mostly similar health risk behaviors.

The role of family influences on adolescent smoking in different racial/ethnic groups

INTRODUCTION

Although differing levels of family influences may explain some of the varying racial/ethnic trends in adolescent smoking behavior, clarification of which influences are protective against smoking may aid in the development of future ethnic-specific smoking prevention interventions. We sought to identify and compare the association of family influences on adolescent smoking among Black, Hispanic, and White adolescents in a cross-sectional national sample.

METHODS

Data from 6,426 parent-child dyads from Round 1 of the National Survey of Parents and Youth were analyzed. The association of family influences with ever-smokers and recent smokers was evaluated. Multinomial logistic regression using SUDAAN software was used.

RESULTS

While all measures of family influences except for parent-adolescent activities and intention to monitor were significantly protective against recent smoking and ever smoking among Whites, ethnic-specific family influence predictors of smoking were found in Blacks and Hispanics. Higher parental monitoring, higher intention to monitor, and higher connectedness were protective among Hispanics, while higher parental punishment and favorable attitude toward monitoring were protective against smoking among Blacks. For family influences significantly associated with protection against smoking, consistently greater protection was afforded against recent smoking than against ever smoking.

CONCLUSIONS

Higher levels of family influences are protective against smoking among all racial/ethnic groups. There are consistencies in family influences on youth smoking; however, there may be specific family influences that should be differentially emphasized within racial/ethnic groups in order to protect against smoking behavior. Our results offer insight for designing strategies for preventing smoking in youth of different racial/ethnic backgrounds.

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

OBJECTIVES

We compared rates of smoking for 2 groups of youths aged 12 to 14 years: those involved in the child welfare system (CW) and their counterparts in the community population. We then investigated factors associated with smoking for each group.

METHODS

We drew data from 2 national-level US sources: the National Survey of Child and Adolescent Well-Being and the National Longitudinal Study of Adolescent Health. We estimated logistic regression models for 3 binary outcome measures of smoking behavior: lifetime, current, and regular smoking.

RESULTS

CW-involved youths had significantly higher rates of lifetime smoking (43% vs 32%) and current smoking (23% vs 18%) than did youths in the community population. For CW-involved youths, delinquency and smoking were strongly linked. Among youths in the community population, multiple factors, including youth demographics and emotional and behavioral health, affected smoking behavior.

CONCLUSIONS

Smoking prevalence was notably higher among CW-involved youths than among the community population. In light of the persistent public health impact of smoking, more attention should be focused on identification of risk factors for prevention and early intervention efforts among the CW-involved population.

Causes of the decline in cigarette smoking among African American youths from the 1970s to the 1990s

Adult cigarette smoking prevalence trends among African Americans (AAs) and Whites are similar. However, during the decline in youth smoking that occurred between the mid-1970s and the early 1990s, the drop in smoking rates among AA adolescents was more than double that among Whites. We examined the evidence for potential explanations for this phenomenon. On the basis of our findings, we propose that racial differences in parental attitudes, religious ties, negative perceptions and experiences of the health effects of smoking, worsening poverty, increased use of food stamps, and price sensitivity were major factors contributing to the more rapid decrease in and continued lower rates of smoking among AA youths.