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Brunette MF, Halenar MJ, Edwards KC, Taylor KA, Emond JA, Tanski SE, Woloshin S, Paulin LM, Hyland A, Lauten K, Mahoney M, Blanco C, Borek N, DaSilva LC, Gardner LD, Kimmel HL, Sargent JD. Association between tobacco product use and asthma among US adults from the Population Assessment of Tobacco and Health (PATH) Study waves 2-4. BMJ Open Respir Res 2023; 10:10/1/e001187. [PMID: 36750276 PMCID: PMC9906250 DOI: 10.1136/bmjresp-2021-001187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/08/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Research on cigarettes and adult asthma offers mixed findings, perhaps due to overlap with chronic obstructive pulmonary disease (COPD) and inadequate adjustment for other smoke exposures. Associations between other tobacco products, including e-cigarettes, and asthma are also understudied. RESEARCH QUESTION Using Population Assessment of Tobacco and Health Study waves 2-4 (2014/2015-2016/2017) data, we assessed the relation between tobacco product use and asthma in persons unlikely to have COPD. STUDY DESIGN AND METHODS Prospective study of 10 267 adults aged 18-39 years without COPD diagnoses. Past-month tobacco use at wave 2 was modelled first as combustible versus non-combustible use and second as specific product categories (former, cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco). Outcomes included lifetime asthma prevalence at wave 2, incidence (waves 3 and 4) and Asthma Control Test score (lower=worse). Multivariable regressions adjusted for predictors of asthma, including other smoke exposures: cigarette pack-years, secondhand smoke and marijuana use. Sensitivity analyses examined findings when persons >39 years and those with both COPD and asthma were added, and when smoke exposure adjustments were removed. RESULTS No product, including cigarettes and e-cigarettes, was associated with prevalence or incidence of asthma. Among people with asthma at wave 2, combustible tobacco (beta=-0.86, 95% CI (-1.32 to -0.39)) and cigarettes (beta=-1.14, 95% CI (-1.66 to -0.62)) were associated with worse asthma control. No tobacco product was associated with asthma control over time. In sensitivity analyses, tobacco use became associated with incident asthma as adults >39 years and those with asthma+COPD were added, and as adjustments for other smoke exposures were omitted. INTERPRETATION Although cigarette use was associated with worse asthma control, there were no longitudinal associations between combustible tobacco or e-cigarette use and new onset or worsening asthma in these preliminary analyses. Research on tobacco and asthma should exclude COPD and adjust for smoking history and other smoke exposures.
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Affiliation(s)
- Mary F Brunette
- Research Division, Department of Psychiatry, Dartmouth Health, Lebanon, New Hampshire, USA .,Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA.,The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA.,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Michael J Halenar
- Behavorial Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Kathryn C Edwards
- Behavorial Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Kristie A Taylor
- Behavorial Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Jennifer A Emond
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA,The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA
| | - Susanne E Tanski
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA,The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA
| | - Steven Woloshin
- The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA,The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Laura M Paulin
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA,The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA
| | - Andrew Hyland
- Department of Health and Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Kristen Lauten
- Behavorial Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Martin Mahoney
- Department of Health and Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Carlos Blanco
- Division of Epidemiology, Services and Prevention Research (DESPR), National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, Silver Spring, Maryland, USA
| | | | - Lisa D Gardner
- Office of Science, Center for Tobacco Products, Silver Spring, Maryland, USA
| | - Heather L Kimmel
- Division of Epidemiology, Services and Prevention Research (DESPR), National Institute on Drug Abuse, Bethesda, Maryland, USA
| | - James D Sargent
- Dartmouth College Geisel School of Medicine, Hanover, New Hampshire, USA,The C Everette Koop Institute, Dartmouth College, Lebanon, New Hampshire, USA
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Gabrielli J, Corcoran E, Genis S, McClure AC, Tanski SE. Exposure to Television Alcohol Brand Appearances as Predictor of Adolescent Brand Affiliation and Drinking Behaviors. J Youth Adolesc 2021; 51:100-113. [PMID: 33515372 DOI: 10.1007/s10964-021-01397-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Adolescence and the transition to adulthood is an important developmental stage in the emergence of health risk behaviors, specifically underage alcohol use. Adolescents consume a tremendous amount of screened media (primarily streamed television), and media depictions of behaviors is prospectively linked to youth initiation of behaviors. With the arrival of streamed media technology, alcohol advertising can be nested within television content. This study describes alcohol brand depictions in television and evaluates impact of exposure to such depictions on adolescent drinking outcomes. A national sample of 2012 adolescents (Mage = 17.07; SD = 1.60 years, range 15-20; 50.70% female) reported on television viewership, alcohol brand affiliation, and drinking behavior, with follow-up one year later. Ten series (that remain relevant to youth today) across television ratings from a single television season were content coded for presence/salience of alcohol brand appearances. Adjusting for covariates (e.g., peer/parent drinking, youth sensation seeking, movie alcohol brand exposure), higher exposure to brand appearances in the television shows was associated with youth drinking. Aspirational and usual brand to drink corresponded to television alcohol brand prominence, and television brand exposure was independently associated with drinking initiation and hazardous drinking.
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Affiliation(s)
- Joy Gabrielli
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
| | - Erin Corcoran
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Sam Genis
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Auden C McClure
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Susanne E Tanski
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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McGrath-Morrow SA, Gorzkowski J, Groner JA, Rule AM, Wilson K, Tanski SE, Collaco JM, Klein JD. The Effects of Nicotine on Development. Pediatrics 2020; 145:peds.2019-1346. [PMID: 32047098 PMCID: PMC7049940 DOI: 10.1542/peds.2019-1346] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2019] [Indexed: 01/08/2023] Open
Abstract
Recently, there has been a significant increase in the use of noncombustible nicotine-containing products, including electronic cigarettes (e-cigarettes). Of increasing popularity are e-cigarettes that can deliver high doses of nicotine over short periods of time. These devices have led to a rise in nicotine addiction in adolescent users who were nonsmokers. Use of noncombustible nicotine products by pregnant mothers is also increasing and can expose the developing fetus to nicotine, a known teratogen. In addition, young children are frequently exposed to secondhand and thirdhand nicotine aerosols generated by e-cigarettes, with little understanding of the effects these exposures can have on health. With the advent of these new nicotine-delivery systems, many concerns have arisen regarding the short- and long-term health effects of nicotine on childhood health during all stages of development. Although health studies on nicotine exposure alone are limited, educating policy makers and health care providers on the potential health effects of noncombustible nicotine is needed because public acceptance of these products has become so widespread. Most studies evaluating the effects of nicotine on health have been undertaken in the context of smoke exposure. Nevertheless, in vitro and in vivo preclinical studies strongly indicate that nicotine exposure alone can adversely affect the nervous, respiratory, immune, and cardiovascular systems, particularly when exposure occurs during critical developmental periods. In this review, we have included both preclinical and clinical studies to identify age-related health effects of nicotine exposure alone, examining the mechanisms underlying these effects.
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Affiliation(s)
- Sharon A. McGrath-Morrow
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine and
| | - Julie Gorzkowski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Judith A. Groner
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Ana M. Rule
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Karen Wilson
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children’s Hospital, New York, New York
| | - Susanne E. Tanski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; and
| | - Joseph M. Collaco
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Eudowood Division of Pediatric Respiratory Sciences, Department of Pediatrics, School of Medicine and
| | - Jonathan D. Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois;,Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
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McClure AC, Gabrielli J, Cukier S, Jackson KM, Brennan ZLB, Tanski SE. Internet Alcohol Marketing Recall and Drinking in Underage Adolescents. Acad Pediatr 2020; 20:128-135. [PMID: 31401229 PMCID: PMC7055537 DOI: 10.1016/j.acap.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 07/01/2019] [Accepted: 08/02/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Evidence suggests that adolescents are exposed to alcohol marketing in digital media. We aimed to assess recall of Internet alcohol marketing and its association with underage drinking. METHODS New England adolescents age 12 to 17 years (N = 202) were recruited from a pediatric clinic. Subjects completed an online survey assessing: 1) general simple recall of Internet alcohol marketing and 2) image-prompted recall of specific Internet alcohol marketing channels (display ads, commercials, brand websites, and brand social media pages). Cross-sectional associations between recall (simple and image-prompted) and ever-drinking were each assessed in regression analysis adjusting for age, gender, race, parent education, ever-smoking, media use, sensation-seeking, peer/parent drinking, parent monitoring/responsiveness, and parent Internet monitoring. RESULTS In this sample (Mage = 14.5 years; 55% female; 89% white; high parent education), 20% reported ever-drinking and 87% recalled Internet alcohol marketing. Of the latter, 67% recalled display ads, 67% Internet commercials, 5% websites, and 5% social media pages. In logistic regression, higher simple Internet alcohol advertising recall was independently associated with higher odds of ever-drinking for simple (adjusted odds ratio: 2.66 [1.04,6.83]) but not for image-prompted recall. CONCLUSIONS Despite controlling for potential confounders, simple recall of Internet alcohol marketing was significantly associated with underage drinking whereas image-prompted recall was significant only in bivariate analysis, likely due to small sample and a more limited range of specific channels assessed than those accessed by adolescents. Further longitudinal studies using image-prompted recall and capturing a broader range of internet platforms could be used to better understand adolescent engagement with alcohol marketing and guide policy and prevention efforts.
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Affiliation(s)
- Auden C McClure
- Department of Pediatrics (AC McClure and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon, NH; Cancer Control, Norris Cotton Cancer Center (AC McClure and SE Tanski), Lebanon NH; C. Everett Koop Institute (AC McClure, S Cukier, ZLB Brennan, and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon NH.
| | - Joy Gabrielli
- Department of Biomedical Data Science (J Gabrielli and ZLB Brennan), Geisel School of Medicine at Dartmouth, Lebanon NH; Department of Clinical and Health Psychology (J Gabrielli), University of Florida, Gainesville, Fla
| | - Samantha Cukier
- C. Everett Koop Institute (AC McClure, S Cukier, ZLB Brennan, and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon NH; Clinical Epidemiology Program (S Cukier), Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kristina M Jackson
- Center for Alcohol and Addiction Studies, Brown University (KM Jackson), Providence, RI
| | - Zoe L B Brennan
- Department of Biomedical Data Science (J Gabrielli and ZLB Brennan), Geisel School of Medicine at Dartmouth, Lebanon NH; C. Everett Koop Institute (AC McClure, S Cukier, ZLB Brennan, and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon NH
| | - Susanne E Tanski
- Department of Pediatrics (AC McClure and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon, NH; Cancer Control, Norris Cotton Cancer Center (AC McClure and SE Tanski), Lebanon NH; C. Everett Koop Institute (AC McClure, S Cukier, ZLB Brennan, and SE Tanski), Geisel School of Medicine at Dartmouth, Lebanon NH
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Abstract
OBJECTIVE Marketing aims to foster brand allegiance, and alcohol is a heavily marketed commodity. We hypothesize that exposed youth who are able to identify an aspirational alcohol brand will be at higher risk for underage drinking. METHOD U.S. youth ages 15-20 (N = 2,012; 51% female) were surveyed twice in 2011-2013. Aspirational brand was assessed by asking, "If you could drink any brand you want, what is the name of the brand of alcohol you would choose?" Multivariable logistic regression tested associations between having an aspirational brand at baseline and onset of ever, binge (≥6 drinks/occasion), and hazardous drinking (Alcohol Use Disorders Identification Test-Consumption ≥ 4). RESULTS Baseline ever, binge, and hazardous drinking prevalence was 55%, 26%, and 19%, respectively; 47% reported having an aspirational brand, of whom 20% were nondrinkers. Top five reported brands were Budweiser, Smirnoff, Corona, Jack Daniels, and Bacardi, all heavily advertised brands. Older age, male gender, sensation seeking, and peer/parent drinking were associated with having an aspirational brand. After we controlled for these confounders, having an aspirational brand was independently associated cross-sectionally with greater risk of ever, binge, and hazardous drinking (adjusted odds ratio = 4.47, 95% CI [3.33, 6.00], 4.84 [3.41, 6.86], and 5.46 [3.63, 8.23], respectively) and longitudinally with initiation of binge and hazardous drinking (1.80 [1.19, 2.73] and 2.02 [1.33, 3.06], respectively). CONCLUSIONS Having an aspirational alcohol brand is both common and independently associated with subsequent underage alcohol use and misuse. Further studies examining how youth interact with and are affected by branded advertising are critical to guide development of effective education and policy interventions.
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Affiliation(s)
- Auden C McClure
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Cancer Control, Norris Cotton Cancer Center, Lebanon, New Hampshire.,C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Joy Gabrielli
- Cancer Control, Norris Cotton Cancer Center, Lebanon, New Hampshire.,C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - James D Sargent
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Cancer Control, Norris Cotton Cancer Center, Lebanon, New Hampshire.,C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Susanne E Tanski
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Cancer Control, Norris Cotton Cancer Center, Lebanon, New Hampshire.,C. Everett Koop Institute, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Gabrielli J, Brennan ZLB, Stoolmiller M, Jackson KM, Tanski SE, McClure AC. A New Recall of Alcohol Marketing Scale for Youth: Measurement Properties and Associations With Youth Drinking Status. J Stud Alcohol Drugs 2019. [DOI: 10.15288/jsad.2019.80.563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Joy Gabrielli
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Zoe L. B. Brennan
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mike Stoolmiller
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Kristina M. Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Susanne E. Tanski
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Auden C. McClure
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Green VR, Conway KP, Silveira ML, Kasza KA, Cohn A, Cummings KM, Stanton CA, Callahan-Lyon P, Slavit W, Sargent JD, Hilmi N, Niaura RS, Reissig CJ, Lambert E, Zandberg I, Brunette MF, Tanski SE, Borek N, Hyland AJ, Compton WM. Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study. J Am Acad Child Adolesc Psychiatry 2018; 57:944-954.e4. [PMID: 30522740 PMCID: PMC7439766 DOI: 10.1016/j.jaac.2018.06.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/25/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To examine whether mental health problems predict incident use of 12 different tobacco products in a nationally representative sample of youth and young adults. METHOD This study analyzed Wave (W) 1 and W2 data from 10,533 12- to 24-year-old W1 never tobacco users in the Population Assessment of Tobacco and Health (PATH) Study. Self-reported lifetime internalizing and externalizing symptoms were assessed at W1. Past 12-month use of cigarettes, electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, other smokeless tobacco, bidis and kreteks (youth only), and dissolvable tobacco was assessed at W2. RESULTS In multivariable regression analyses, high-severity W1 internalizing (adjusted odds ratio [AOR] = 1.5, 95% CI = 1.3-1.8) and externalizing (AOR = 1.3, 95% CI = 1.1-1.5) problems predicted W2 onset of any tobacco use compared to no/low/moderate severity. High-severity W1 internalizing problems predicted W2 use onset across most tobacco products. High-severity W1 externalizing problems predicted onset of any tobacco (AOR = 1.6, 95% CI = 1.3-1.8), cigarettes (AOR = 1.4, 95% CI = 1.0-2.0), ENDS (AOR = 1.8, 95% CI = 1.5-2.1), and cigarillos (AOR = 1.5, 95% CI = 1.0-2.1) among youth only. CONCLUSION Internalizing and externalizing problems predicted onset of any tobacco use. However, findings differed for internalizing and externalizing problems across tobacco products, and by age, gender, and race/ethnicity. In addition to screening for tobacco product use, health care providers should screen for a range of mental health problems as a predictor of tobacco use. Interventions addressing mental health problems may prevent youth from initiating tobacco use.
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Affiliation(s)
- Victoria R Green
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD; Kelly Government Solutions, Rockville, MD
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Marushka L Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD; Kelly Government Solutions, Rockville, MD.
| | | | - Amy Cohn
- Truth Initiative, Washington, DC
| | | | | | | | - Wendy Slavit
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | | | - Nahla Hilmi
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD; Kelly Government Solutions, Rockville, MD
| | | | - Chad J Reissig
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | - Elizabeth Lambert
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
| | - Izabella Zandberg
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | | | | | - Nicolette Borek
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD
| | | | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD
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Groner JA, Rule AM, McGrath-Morrow SA, Collaco JM, Moss A, Tanski SE, McMillen R, Whitmore RM, Klein JD, Winickoff JP, Wilson K. Assessing pediatric tobacco exposure using parent report: comparison with hair nicotine. J Expo Sci Environ Epidemiol 2018; 28:530-537. [PMID: 30013229 DOI: 10.1038/s41370-018-0051-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/04/2018] [Accepted: 04/22/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION The purpose of this study was to examine the relationships between screening questions for secondhand smoke (SHS) exposure and biomarker results using hair nicotine levels. Our ultimate goal was to develop sensitive and valid screening tools in pediatric clinical settings for SHS exposure. METHODS Investigators developed a core set of questions regarding exposure. Data from two separate ongoing studies of well children and those with bronchopulmonary dysplasia (BPD) were used to assess the concordance between responses and hair nicotine levels. Sensitivity, a positive predictive value, and accuracy were examined. RESULTS There was no single question with similar sensitivity in both populations. The question with the highest positive predictive value (90.8% well-cohort and 84.6% BPD cohort) for both the groups was whether the child had been exposed to in-home smoking in the last 7 days. The question with the highest accuracy for both groups was the number of smokers at home (0 vs ≥ 1), with an accuracy of 72.4% for well children and 79.0% for the BPD cohort. CONCLUSIONS There was a wide variability in the performance of specific questions. These data demonstrate that a "one-size-fits-all" approach to screening for secondhand tobacco smoke exposure may not be appropriate for all pediatric populations.
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Affiliation(s)
- Judith A Groner
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA.
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Ana M Rule
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sharon A McGrath-Morrow
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Collaco
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Angela Moss
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Denver, Aurora, CO, USA
| | - Susanne E Tanski
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Robert McMillen
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Social Science Research Center, Mississippi State University, Starkville, MS, USA
| | - Regina M Whitmore
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Jonathan D Klein
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
| | - Jonathan P Winickoff
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Harvard Medical School, Massachusetts General Hospital Division of General Pediatrics, Boston, MA, USA
| | - Karen Wilson
- AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Silveira ML, Conway KP, Green VR, Kasza KA, Sargent JD, Borek N, Stanton CA, Cohn A, Hilmi N, Cummings KM, Niaura RS, Lambert EY, Brunette MF, Zandberg I, Tanski SE, Reissig CJ, Callahan-Lyon P, Slavit WI, Hyland AJ, Compton WM. Longitudinal associations between youth tobacco and substance use in waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study. Drug Alcohol Depend 2018; 191:25-36. [PMID: 30077053 PMCID: PMC6239207 DOI: 10.1016/j.drugalcdep.2018.06.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 06/12/2018] [Accepted: 06/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND While evidence suggests bidirectional associations between cigarette use and substance (alcohol or drug) use, how these associations are reflected across the range of currently available tobacco products is unknown. This study examined whether ever tobacco use predicted subsequent substance use, and ever substance use predicted subsequent tobacco use among 11,996 U.S. youth (12-17 years) from Waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) Study. METHODS Ever use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, smokeless tobacco excluding snus pouches, dissolvable tobacco, bidis, kreteks, alcohol, marijuana, prescription drugs, and other drugs (cocaine and other stimulants, heroin, inhalants, solvents, and hallucinogens) was assessed at Wave 1 followed by past 12-month use assessments at Wave 2. The analyses included covariates (demographics, mental health, sensation seeking, prior use) to mitigate confounding. RESULTS Ever tobacco use predicted subsequent substance use. The magnitude of the associations was lowest for alcohol, higher for marijuana, and highest for other drugs. Ever substance use also predicted subsequent tobacco use. Specifically, ever alcohol, marijuana, and non-prescribed Ritalin/Adderall use predicted tobacco-product use. Ever e-cigarette and cigarette use exclusively and concurrently predicted subsequent any drug (including and excluding alcohol) use. E-cigarette and cigarette use associations in the opposite direction were also significant; the strongest associations were observed for exclusive cigarette use. CONCLUSION Tobacco and substance use prevention efforts may benefit from comprehensive screening and interventions across tobacco products, alcohol, and drugs, and targeting risk factors shared across substances.
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Affiliation(s)
- Marushka L Silveira
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA; Kelly Government Solutions, Rockville, MD, USA.
| | - Kevin P Conway
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA
| | - Victoria R Green
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA; Kelly Government Solutions, Rockville, MD, USA
| | - Karin A Kasza
- Department of Health Behavior, Roswell Park Cancer Institute, 665 Elm St, Buffalo, NY 14203, USA
| | - James D Sargent
- Cancer Control Research Program, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Rubin 8 Lebanon, NH 03756, USA
| | - Nicolette Borek
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | | | - Amy Cohn
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA
| | - Nahla Hilmi
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA; Kelly Government Solutions, Rockville, MD, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC 29425, USA
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, USA
| | - Elizabeth Y Lambert
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA
| | - Mary F Brunette
- Cancer Control Research Program, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Rubin 8 Lebanon, NH 03756, USA
| | - Izabella Zandberg
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Susanne E Tanski
- Cancer Control Research Program, Norris Cotton Cancer Center, and Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Geisel School of Medicine, Rubin 8 Lebanon, NH 03756, USA
| | - Chad J Reissig
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Priscilla Callahan-Lyon
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Wendy I Slavit
- Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD 20993, USA
| | - Andrew J Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, 665 Elm St, Buffalo, NY 14203, USA
| | - Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Blvd., Bethesda, MD 20892, USA
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Pierce JP, Sargent JD, Portnoy DB, White M, Noble M, Kealey S, Borek N, Carusi C, Choi K, Green VR, Kaufman AR, Leas E, Lewis MJ, Margolis KA, Messer K, Shi Y, Silveira ML, Snyder K, Stanton CA, Tanski SE, Bansal-Travers M, Trinidad D, Hyland A. Association Between Receptivity to Tobacco Advertising and Progression to Tobacco Use in Youth and Young Adults in the PATH Study. JAMA Pediatr 2018; 172:444-451. [PMID: 29582078 PMCID: PMC5875336 DOI: 10.1001/jamapediatrics.2017.5756] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Cigarette marketing contributes to initiation of cigarette smoking among young people, which has led to restrictions on use of cigarette advertising. However, little is known about other tobacco advertising and progression to tobacco use in youth and young adults. OBJECTIVE To investigate whether receptivity to tobacco advertising among youth and young adults is associated with progression (being a susceptible never user or ever user) to use of the product advertised, as well as conventional cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS The Population Assessment of Tobacco and Health (PATH) Study at wave 1 (2013-2014) and 1-year follow-up at wave 2 (2014-2015) was conducted in a US population-based sample of never tobacco users aged 12 to 24 years from wave 1 of the PATH Study (N = 10 989). Household interviews using audio computer-assisted self-interviews were conducted. EXPOSURES Advertising for conventional cigarettes, electronic cigarettes (e-cigarettes), cigars, and smokeless tobacco products at wave 1. MAIN OUTCOMES AND MEASURES Progression to susceptibility or ever tobacco use at 1-year follow-up in wave 2. RESULTS Of the 10 989 participants (5410 male [weighted percentage, 48.3%]; 5579 female [weighted percentage, 51.7%]), receptivity to any tobacco advertising at wave 1 was high for those aged 12 to 14 years (44.0%; 95% confidence limit [CL], 42.6%-45.4%) but highest for those aged 18 to 21 years (68.7%; 95% CL, 64.9%-72.2%). e-Cigarette advertising had the highest receptivity among all age groups. For those aged 12 to 17 years, susceptibility to use a product at wave 1 was significantly associated with product use at wave 2 for conventional cigarettes, e-cigarettes, cigars, and smokeless tobacco products. Among committed never users aged 12 to 17 years at wave 1, any receptivity was associated with progression toward use of the product at wave 2 (conventional cigarettes: adjusted odds ratio [AOR], 1.43; 95% CL, 1.23-1.65; e-cigarettes: AOR, 1.62; 95% CL, 1.41-1.85; cigars: AOR, 2.01; 95% CL, 1.62-2.49; and smokeless [males only]: AOR, 1.42; 95% CL, 1.07-1.89) and with use of the product (conventional cigarettes: AOR, 1.54; 95% CL, 1.03-2.32; e-cigarettes: AOR, 1.45; 95% CL, 1.19-1.75; cigars: AOR, 2.07; 95% CL, 1.26-3.40). Compared with those not receptive to any product advertising, receptivity to e-cigarette advertising, but not to cigarette advertising, was independently associated with those aged 12 to 21 years having used a cigarette at wave 2 (AOR, 1.60; 95% CL, 1.08-2.38). CONCLUSIONS AND RELEVANCE Receptivity to tobacco advertising was significantly associated with progression toward use in adolescents. Receptivity was highest for e-cigarette advertising and was associated with trying a cigarette.
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Affiliation(s)
- John P. Pierce
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - James D. Sargent
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - David B. Portnoy
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Martha White
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Madison Noble
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - Sheila Kealey
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California
| | - Nicolette Borek
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | | | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Victoria R. Green
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland,Kelly Government Solutions, Rockville, Maryland
| | - Annette R. Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Eric Leas
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - M. Jane Lewis
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, New Jersey
| | - Katherine A. Margolis
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Karen Messer
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - Yuyan Shi
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - Marushka L. Silveira
- National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland,Kelly Government Solutions, Rockville, Maryland
| | - Kimberly Snyder
- Center for Tobacco Products, US Food and Drug Administration, Silver Spring, Maryland
| | - Cassandra A. Stanton
- Westat, Rockville, Maryland,Department of Oncology, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Susanne E. Tanski
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | | | - Dennis Trinidad
- Cancer Prevention Program, Moores Cancer Center, University of California, San Diego, La Jolla, California,Department of Family Medicine and Public Health, University of California, San Diego
| | - Andrew Hyland
- Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, New York
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Conway KP, Green VR, Kasza KA, Silveira ML, Borek N, Kimmel HL, Sargent JD, Stanton CA, Lambert E, Hilmi N, Reissig CJ, Jackson KJ, Tanski SE, Maklan D, Hyland AJ, Compton WM. Co-occurrence of tobacco product use, substance use, and mental health problems among youth: Findings from wave 1 (2013-2014) of the population assessment of tobacco and health (PATH) study. Addict Behav 2018; 76:208-217. [PMID: 28846942 DOI: 10.1016/j.addbeh.2017.08.009] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 08/04/2017] [Accepted: 08/16/2017] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Cigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use. METHODS The current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12-17years from Wave 1 (2013-2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems. RESULTS In multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR=18.9, 95% CI: 15.3-23.4). Cigarette (AOR=14.7, 95% CI: 11.8-18.2) and cigarillo (AOR=8.1, 95% CI: 6.3-10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR=1.6, 95% CI: 1.4-1.8) and externalizing (AOR=1.4, 95% CI: 1.3-1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR=3.4, 95% CI: 2.7-4.3) and have mental health (AOR=1.2, 95% CI: 1.0-1.5) and substance use (AOR=4.7, 95% CI: 3.4-6.6) problems. CONCLUSIONS Regardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings.
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McClure AC, Tanski SE, Li Z, Jackson K, Morgenstern M, Li Z, Sargent JD. Internet Alcohol Marketing and Underage Alcohol Use. Pediatrics 2016; 137:e20152149. [PMID: 26738886 PMCID: PMC5011761 DOI: 10.1542/peds.2015-2149] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Internet alcohol marketing is not well studied despite its prevalence and potential accessibility and attractiveness to youth. The objective was to examine longitudinal associations between self-reported engagement with Internet alcohol marketing and alcohol use transitions in youth. METHODS A US sample of 2012 youths aged 15 to 20 was surveyed in 2011. An Internet alcohol marketing receptivity score was developed, based on number of positive responses to seeing alcohol advertising on the Internet, visiting alcohol brand Web sites, being an online alcohol brand fan, and cued recall of alcohol brand home page images. We assessed the association between baseline marketing receptivity and both ever drinking and binge drinking (≥6 drinks per occasion) at 1-year follow-up with multiple logistic regression, controlling for baseline drinking status, Internet use, sociodemographics, personality characteristics, and peer or parent drinking. RESULTS At baseline, ever-drinking and binge-drinking prevalence was 55% and 27%, respectively. Many (59%) reported seeing Internet alcohol advertising, but few reported going to an alcohol Web site (6%) or being an online fan (3%). Higher Internet use, sensation seeking, having family or peers who drank, and past alcohol use were associated with Internet alcohol marketing receptivity, and a score of 1 or 2 was independently associated with greater adjusted odds of initiating binge drinking (odds ratio 1.77; 95% confidence interval, 1.13-2.78 and odds ratio 2.15; 95% confidence interval, 1.06-4.37 respectively) but not with initiation of ever drinking. CONCLUSIONS Although high levels of engagement with Internet alcohol marketing were uncommon, most underage youths reported seeing it, and we found a prospective association between receptivity to this type of alcohol marketing and future problem drinking, making additional research and ongoing surveillance important.
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Affiliation(s)
- Auden C. McClure
- Departments of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire,Address correspondence to Auden C. McClure, MD, MPH, Department of Pediatrics, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756. E-mail:
| | - Susanne E. Tanski
- Departments of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Zhigang Li
- Cancer Epidemiology, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Kristina Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island; and
| | | | - Zhongze Li
- Biostatistics Shared Resources, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - James D. Sargent
- Departments of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire,Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire
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Abstract
IMPORTANCE Alcohol is the most common drug among youth and a major contributor to morbidity and mortality worldwide. Billions of dollars are spent annually marketing alcohol. OBJECTIVE To examine the reach of television alcohol advertising and its effect on drinking among underage youth. DESIGN, SETTING, AND PARTICIPANTS Longitudinal telephone- and web-based surveys conducted in 2011 and 2013 involving 2541 US adolescents 15 to 23 years of age at baseline, with 1596 of these adolescents completing the follow-up survey. Cued recall of television advertising images for top beer and distilled spirits brands that aired nationally in 2010-2011 (n = 351). Images were digitally edited to remove branding, and the respondents were queried about 20 randomly selected images. An alcohol advertising receptivity score was derived (1 point each for having seen the ad and for liking it, and 2 points for correct brand identification). Fast-food ads that aired nationally in 2010-2011 (n = 535) were similarly queried to evaluate message specificity. MAIN OUTCOMES AND MEASURES Among the underage youth at baseline, we determined (1) the onset of drinking among those who never drank, (2) the onset of binge drinking among those who were never binge drinkers, and (3) the onset of hazardous drinking among those with an Alcohol Use Disorders Identification Test consumption subscore of less than 4. Multivariate regressions were used to predict each outcome, controlling for covariates (demographics, drinking among friends and parents, and sensation seeking), weighting to the US population, and using multiple imputation to address loss to follow-up. RESULTS Underage participants were only slightly less likely than participants of legal drinking age to have seen alcohol ads (the mean percentage of ads seen were 23.4%, 22.7%, and 25.6%, respectively, for youth 15-17, 18-20, and 21-23 years of age; P < .005). The transition to binge and hazardous drinking occurred for 29% and 18% of youth 15 to 17 years of age and for 29% and 19% of youth 18 to 20 years years of age, respectively. Among underage participants, the alcohol advertising receptivity score independently predicted the onset of drinking (adjusted odds ratio [AOR], 1.69 [95% CI, 1.17-2.44]), the onset of binge drinking (AOR, 1.38 [95% CI, 1.08-1.77]), and the onset of hazardous drinking (AOR, 1.49 [95% CI, 1.19-1.86]). Fast-food advertising receptivity was not associated with any drinking outcome. CONCLUSIONS AND RELEVANCE Receptivity to television alcohol advertising predicted the transition to multiple drinking outcomes. The findings are consistent with the idea that marketing self-regulation has failed to keep television alcohol advertising from reaching large numbers of underage persons and affecting their drinking patterns.
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Affiliation(s)
- Susanne E. Tanski
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire2Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Auden C. McClure
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire2Norris Cotton Cancer Center, Lebanon, New Hampshire3The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Zhigang Li
- Norris Cotton Cancer Center, Lebanon, New Hampshire4Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kristina Jackson
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Matthis Morgenstern
- Norris Cotton Cancer Center, Lebanon, New Hampshire6Institute for Therapy and Health Research, Kiel, Germany
| | - Zhongze Li
- Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - James D. Sargent
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire2Norris Cotton Cancer Center, Lebanon, New Hampshire3The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire4Section of Biostatistics a
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15
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Soneji S, Sargent JD, Tanski SE, Primack BA. Associations between initial water pipe tobacco smoking and snus use and subsequent cigarette smoking: results from a longitudinal study of US adolescents and young adults. JAMA Pediatr 2015; 169:129-36. [PMID: 25485959 PMCID: PMC4388043 DOI: 10.1001/jamapediatrics.2014.2697] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Many adolescents and young adults use alternative tobacco products, such as water pipes and snus, instead of cigarettes. OBJECTIVE To assess whether prior water pipe tobacco smoking and snus use among never smokers are risk factors for subsequent cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS We conducted a 2-wave national longitudinal study in the United States among 2541 individuals aged 15 to 23 years old. At baseline (October 25, 2010, through June 11, 2011), we ascertained whether respondents had smoked cigarettes, smoked water pipe tobacco, or used snus. At the 2-year follow-up (October 27, 2012, through March 31, 2013), we determined whether baseline non-cigarette smokers had subsequently tried cigarette smoking, were current (past 30 days) cigarette smokers, or were high-intensity cigarette smokers. We fit multivariable logistic regression models among baseline non-cigarette smokers to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with subsequent cigarette smoking initiation and current cigarette smoking, accounting for established sociodemographic and behavioral risk factors. We fit similarly specified multivariable ordinal logistic regression models to assess whether baseline water pipe tobacco smoking and baseline snus use were associated with high-intensity cigarette smoking at follow-up. EXPOSURES Water pipe tobacco smoking and the use of snus at baseline. MAIN OUTCOMES AND MEASURES Among baseline non-cigarette smokers, cigarette smoking initiation, current (past 30 days) cigarette smoking at follow-up, and the intensity of cigarette smoking at follow-up. RESULTS Among 1596 respondents, 1048 had never smoked cigarettes at baseline, of whom 71 had smoked water pipe tobacco and 20 had used snus at baseline. At follow-up, accounting for behavioral and sociodemographic risk factors, baseline water pipe tobacco smoking and snus use were independently associated with cigarette smoking initiation (adjusted odds ratios: 2.56; 95% CI, 1.46-4.47 and 3.73; 95% CI, 1.43-9.76, respectively), current cigarette smoking (adjusted odds ratios: 2.48; 95% CI, 1.01-6.06 and 6.19; 95% CI, 1.86-20.56, respectively), and higher intensity of cigarette smoking (adjusted proportional odds ratios: 2.55; 95% CI, 1.48-4.38 and 4.45; 95% CI, 1.75-11.27, respectively). CONCLUSIONS AND RELEVANCE Water pipe tobacco smoking and the use of snus independently predicted the onset of cigarette smoking and current cigarette smoking at follow-up. Comprehensive Food and Drug Administration regulation of these tobacco products may limit their appeal to youth and curb the onset of cigarette smoking.
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Affiliation(s)
- Samir Soneji
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire2Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - James D. Sargent
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire2Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Susanne E. Tanski
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Brian A. Primack
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Emond JA, Gilbert-Diamond D, Tanski SE, Sargent JD. Energy drink consumption and the risk of alcohol use disorder among a national sample of adolescents and young adults. J Pediatr 2014; 165:1194-200. [PMID: 25294603 PMCID: PMC4252708 DOI: 10.1016/j.jpeds.2014.08.050] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/06/2014] [Accepted: 08/26/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To assess the association between energy drink use and hazardous alcohol use among a national sample of adolescents and young adults. STUDY DESIGN Cross-sectional analysis of 3342 youth aged 15-23 years recruited for a national survey about media and alcohol use. Energy drink use was defined as recent use or ever mixed-use with alcohol. Outcomes were ever alcohol use and 3 hazardous alcohol use outcomes measured with the Alcohol Use Disorders Identification Test (AUDIT): ever consuming 6 or more drinks at once (6+ binge drinking) and clinical criteria for hazardous alcohol use as defined for adults (8+AUDIT) and for adolescents (4+AUDIT). RESULTS Among 15-17 year olds (n = 1508), 13.3% recently consumed an energy drink, 9.7% ever consumed an energy drink mixed with alcohol, and 47.1% ever drank alcohol. Recent energy drink use predicted ever alcohol use among 15-17-year-olds only (OR 2.58; 95% CI 1.77-3.77). Of these 15-17-year-olds, 17% met the 6+ binge drinking criteria, 7.2% met the 8+AUDIT criteria, and 16.0% met the 4+AUDIT criteria. Rates of energy drink use and all alcohol use outcomes increased with age. Ever mixed-use with alcohol predicted 6+ binge drinking (OR 4.69; 95% CI 3.70-5.94), 8+AUDIT (OR 3.25; 95% CI 2.51-4.21), and 4+AUDIT (OR 4.15; 95% CI 3.27-5.25) criteria in adjusted models among all participants, with no evidence of modification by age. CONCLUSIONS Positive associations between energy drink use and hazardous alcohol use behaviors are not limited to youth in college settings.
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Affiliation(s)
- Jennifer A. Emond
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Diane Gilbert-Diamond
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH,Section of Biostatistics and Epidemiology, Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Susanne E. Tanski
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH,Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - James D. Sargent
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH,Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH
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McClure AC, Tanski SE, Gilbert-Diamond D, Adachi-Mejia AM, Li Z, Li Z, Sargent JD. Receptivity to television fast-food restaurant marketing and obesity among U.S. youth. Am J Prev Med 2013; 45:560-8. [PMID: 24139768 PMCID: PMC3934414 DOI: 10.1016/j.amepre.2013.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/25/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Advertisement of fast food on TV may contribute to youth obesity. PURPOSE The goal of the study was to use cued recall to determine whether TV fast-food advertising is associated with youth obesity. METHODS A national sample of 2541 U.S. youth, aged 15-23 years, were surveyed in 2010-2011; data were analyzed in 2012. Respondents viewed a random subset of 20 advertisement frames (with brand names removed) selected from national TV fast-food restaurant advertisements (n=535) aired in the previous year. Respondents were asked if they had seen the advertisement, if they liked it, and if they could name the brand. A TV fast-food advertising receptivity score (a measure of exposure and response) was assigned; a 1-point increase was equivalent to affirmative responses to all three queries for two separate advertisements. Adjusted odds of obesity (based on self-reported height and weight), given higher TV fast-food advertising receptivity, are reported. RESULTS The prevalence of overweight and obesity, weighted to the U.S. population, was 20% and 16%, respectively. Obesity, sugar-sweetened beverage consumption, fast-food restaurant visit frequency, weekday TV time, and TV alcohol advertising receptivity were associated with higher TV fast-food advertising receptivity (median=3.3 [interquartile range: 2.2-4.2]). Only household income, TV time, and TV fast-food advertising receptivity retained multivariate associations with obesity. For every 1-point increase in TV fast-food advertising receptivity score, the odds of obesity increased by 19% (OR=1.19, 95% CI=1.01, 1.40). There was no association between receptivity to televised alcohol advertisements or fast-food restaurant visit frequency and obesity. CONCLUSIONS Using a cued-recall assessment, TV fast-food advertising receptivity was found to be associated with youth obesity.
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Affiliation(s)
- Auden C McClure
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Lebanon, New Hampshire.
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Liu Y, Antwi-Boampong S, BelBruno JJ, Crane MA, Tanski SE. Detection of secondhand cigarette smoke via nicotine using conductive polymer films. Nicotine Tob Res 2013; 15:1511-8. [PMID: 23482719 PMCID: PMC3842131 DOI: 10.1093/ntr/ntt007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 01/08/2013] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The 2006 U.S. Surgeon General's Report found that there is no safe level of exposure to secondhand smoke (SHS). Many smokers attempt to protect others from exposure to SHS; however, it is difficult to assess effectiveness of these behavior changes. There is a need for personal monitoring devices that provide real-time SHS exposure data; at present, there is no device that measures ambient nicotine levels in real time. The development of such a sensor is the objective of this research. METHODS A nicotine sensing film comprising the conductive polymer polyaniline was linked with a reporting layer, recording changes in chemiresistance due to adsorption of nicotine. Experiments were carried out in a microprocessor-controlled smoking chamber using sidestream smoke from standard reference cigarettes; up to 10 cigarettes were smoked simultaneously. The exposure chamber was calibrated for total suspended particle, carbon monoxide, and nicotine concentrations. RESULTS We found significant real-time increases in the resistance of films upon exposure to SHS. The sensors were shown to be sensitive to the number of cigarettes consumed and ambient nicotine and demonstrated reasonable recovery between measurements. The sensors have sufficient sensitivity to detect off-gassing of nicotine or "thirdhand smoke." CONCLUSIONS A sensing element has been developed that can reliably detect secondhand and thirdhand tobacco smoke in real time through the adsorption of ambient nicotine vapor. The device was calibrated to the number of smoked cigarettes and to nicotine concentration. Development of integrated personal sensors to record exposure to SHS using this technology is currently underway.
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Affiliation(s)
- Yuan Liu
- Department of Chemistry, Dartmouth College, Hanover, NH
| | | | | | - Mardi A. Crane
- Department of Microbiology and Immunology at Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Susanne E. Tanski
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon NH
- Cancer Control Research Program, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
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McClure AC, Stoolmiller M, Tanski SE, Engels RCME, Sargent JD. Alcohol marketing receptivity, marketing-specific cognitions, and underage binge drinking. Alcohol Clin Exp Res 2012; 37 Suppl 1:E404-13. [PMID: 23256927 DOI: 10.1111/j.1530-0277.2012.01932.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/25/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure to alcohol marketing is prevalent and is associated with both initiation and progression of alcohol use in underage youth. The mechanism of influence is not well understood, however. This study tests a model that proposes alcohol-specific cognitions as mediators of the relation between alcohol marketing and problematic drinking among experimental underage drinkers. METHODS This study describes a cross-sectional analysis of 1,734 U.S. 15- to 20-year-old underage drinkers, recruited for a national study of media and substance use. Subjects were queried about a number of alcohol marketing variables including TV time, Internet time, favorite alcohol ad, ownership of alcohol-branded merchandise (ABM), and exposure to alcohol brands in movies. The relation between these exposures and current (30-day) binge drinking was assessed, as were proposed mediators of this relation, including marketing-specific cognitions (drinker identity and favorite brand to drink), favorable alcohol expectancies, and alcohol norms. Paths were tested in a structural equation model that controlled for sociodemographics, personality, and peer drinking. RESULTS Almost one-third of this sample of ever drinkers had engaged in 30-day binge drinking. Correlations between mediators were all statistically significant (range 0.16 to 0.47), and all were significantly associated with binge drinking. Statistically significant mediation was found for the association between ABM ownership and binge drinking through both drinker identity and having a favorite brand to drink, which also mediated the path between movie brand exposure and binge drinking. Peer drinking and sensation seeking were associated with binge drinking in paths through all mediators. CONCLUSIONS Associations between alcohol marketing and binge drinking were mediated through marketing-specific cognitions that assess drinker identity and brand allegiance, cognitions that marketers aim to cultivate in the consumer.
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Affiliation(s)
- Auden C McClure
- Department of Pediatrics, Geisel School of Medicine, Hanover, New Hampshire, USA.
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Abstract
OBJECTIVE To compare media/marketing exposures and family factors in predicting adolescent alcohol use. DESIGN Cohort study. SETTING Confidential telephone survey of adolescents in their homes. PARTICIPANTS Representative sample of 6522 US adolescents, aged 10-14 years at baseline and surveyed four times over 2 years. PRIMARY OUTCOME MEASURE Time to alcohol onset and progression to binge drinking were assessed with two survival models. Predictors were movie alcohol exposure (MAE), ownership of alcohol-branded merchandise and characteristics of the family (parental alcohol use, home availability of alcohol and parenting). Covariates included sociodemographics, peer drinking and personality factors. RESULTS Over the study period, the prevalence of adolescent ever use and binge drinking increased from 11% to 25% and from 4% to 13%, respectively. At baseline, the median estimated MAE from a population of 532 movies was 4.5 h and 11% owned alcohol-branded merchandise at time 2. Parental alcohol use (greater than or equal to weekly) was reported by 23% and 29% of adolescents could obtain alcohol from home. Peer drinking, MAE, alcohol-branded merchandise, age and rebelliousness were associated with both alcohol onset and progression to binge drinking. The adjusted hazard ratios for alcohol onset and binge drinking transition for high versus low MAE exposure were 2.13 (95% CI 1.76 to 2.57) and 1.63 (1.20 to 2.21), respectively, and MAE accounted for 28% and 20% of these transitions, respectively. Characteristics of the family were associated with alcohol onset but not with progression. CONCLUSION The results suggest that family focused interventions would have a larger impact on alcohol onset while limiting media and marketing exposure could help prevent both onset and progression.
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Affiliation(s)
- Susanne E. Tanski
- AAP Tobacco Consortium and AAP Julius B. Richmond Center of Excellence, Elk Grove Village, Illinois
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and
| | - Karen M. Wilson
- AAP Tobacco Consortium and AAP Julius B. Richmond Center of Excellence, Elk Grove Village, Illinois
- Department of Pediatrics, University of Rochester, Rochester, New York
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Adachi-Mejia AM, Carlos HA, Berke EM, Tanski SE, Sargent JD. A comparison of individual versus community influences on youth smoking behaviours: a cross-sectional observational study. BMJ Open 2012; 2:bmjopen-2011-000767. [PMID: 22942229 PMCID: PMC3437428 DOI: 10.1136/bmjopen-2011-000767] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To compare individual with community risk factors for adolescent smoking. DESIGN A cross-sectional observational study with multivariate analysis. SETTING National telephone survey. PARTICIPANTS 3646 US adolescents aged 13-18 years in 2007 recruited through a random digit-dial survey. OUTCOME MEASURES Ever tried smoking and, among experimental smokers, smoking intensity (based on smoking in past 30 days). RESULTS One-third of participants (35.6%, N=1297) had tried smoking. After controlling for individual risk factors, neither tobacco outlet density nor proximity were associated with tried smoking or smoking intensity. Associations with trying smoking included age (adjusted OR (AOR)=1.23, 95% CI 1.16 to 1.31), lower socioeconomic status (AOR=0.82, 95% CI 0.74 to 0.91), sibling smoking (AOR=2.13, 95% CI 1.75 to 2.59), friend smoking (AOR=2.60, 95% CI 2.19 to 3.10 for some and AOR=7.01, 95% CI 5.05 to 9.74 for most), movie smoking exposure (AOR=2.66, 95% CI 1.95 to 3.63), team sports participation (AOR=0.69, 95% CI 0.54 to 0.89) and sensation seeking (AOR=7.72, 95% CI 5.26 to 11.34). Among experimental smokers, age (AOR=1.32, 95% CI 1.21 to 1.44), minority status (AOR=0.48, 95% CI 0.30 to 0.79 for Black; AOR=0.46, 95% CI 0.31 to 0.69 for Hispanic; AOR=0.53, 95% CI 0.43 to 0.85 for mixed race/other), friend smoking (AOR=3.37, 95% CI 2.37 to 4.81 for some; AOR=20.27, 95% CI 13.22 to 31.08 for most), team sports participation (AOR=0.38, 95% CI 0.26 to 0.55) and sensation seeking (AOR=6.57, 95% CI 3.71 to 11.64) were associated with smoking intensity. CONCLUSIONS The study suggests that interventions and policies to prevent and reduce youth smoking should focus on individual risk factors for smoking, including supporting participation in team sports, minimising exposure to movie smoking, addressing the social influence of friend smoking and addressing experience seeking among high sensation-seekers.
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Affiliation(s)
- Anna M Adachi-Mejia
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Heather A Carlos
- Dartmouth-Hitchcock Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Ethan M Berke
- Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
- Community & Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Susanne E Tanski
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - James D Sargent
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
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Waylen AE, Leary SD, Ness AR, Tanski SE, Sargent JD. Cross-sectional association between smoking depictions in films and adolescent tobacco use nested in a British cohort study. Thorax 2011; 66:856-61. [PMID: 21933947 DOI: 10.1136/thoraxjnl-2011-200053] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess associations between exposure to smoking depictions in films and adolescent tobacco use in a British population cohort. METHODS Data on exposure to smoking in films and smoking behaviour were collected from 5166 15-year-old adolescents in the UK. Main outcome measures were smoking initiation (ever tried a cigarette) and current smoking status. Social, family and behavioural factors were adjusted for, together with alcohol use and peer smoking as potential mediators. Data from all existing cross-sectional studies examining the effects of exposure to smoking in films were summarised in a meta-analysis. RESULTS Higher exposure to smoking in films was associated with a dose-response increase in the risk of smoking initiation even after adjusting for confounders. Adolescents in the highest exposure quartile were 1.73 (95% CI 1.55 to 1.93) times (RR) more likely to initiate smoking than those in the lowest quartile. They were more likely to report current smoking after adjusting for social and familial factors (RR 1.47 (95% CI 1.07 to 2.02)), but the association attenuated after including behavioural factors (RR 1.34 (95% CI 0.95 to 1.87)). The meta-analysis shows that, after aggregation of all relevant data, viewing smoking in films increases the risk of smoking onset by over 100% (combined RR 2.13 (95% CI 1.76 to 2.57)) and the risk of current or established smoking behaviour by 68% (combined RR 1.68 (95% CI 0.40 to 2.01)). CONCLUSIONS This study provides evidence that adolescents in the UK and elsewhere who are exposed to smoking depictions in films are more likely to initiate smoking. Given the association between smoking and poor health outcomes, these data justify a review of film ratings.
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Affiliation(s)
- Andrea E Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol BS1 2LY, UK.
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Gibbons FX, Pomery EA, Gerrard M, Sargent JD, Weng CY, Wills TA, Kingsbury J, Dal Cin S, Worth KA, Stoolmiller M, Tanski SE, Yeh HC. Media as social influence: racial differences in the effects of peers and media on adolescent alcohol cognitions and consumption. Psychol Addict Behav 2011; 24:649-59. [PMID: 21198226 DOI: 10.1037/a0020768] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Racial differences in the effects of peer and media influence on adolescents' alcohol cognitions and consumption were examined in a large-scale panel study. With regard to peer influence, results from cross-lagged panel analyses indicated that the relation between perceived peer drinking and own drinking was significant for both Black and White adolescents, but it was stronger for the White adolescents. With regard to media influence, structural modeling analyses indicated that exposure to drinking in movies was associated with more alcohol consumption 8 months and 16 months later. These effects were mediated by increases in the favorability of the adolescents' drinker prototypes, their willingness to drink, and their tendency to affiliate with friends who were drinking. Multiple group analyses indicated that, once again, the effects (both direct and indirect) were much stronger for White adolescents than for Black adolescents. The results suggest media influence works in a similar manner to social influence and that Whites may be more susceptible to both types of influence.
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Affiliation(s)
- Frederick X Gibbons
- Department of Psychological and Brain Sciences, Dartmouth College, NH 03755, USA .
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Winickoff JP, McMillen RC, Vallone DM, Pearson JL, Tanski SE, Dempsey JH, Cheryl Healton, Klein JD, David Abrams. US attitudes about banning menthol in cigarettes: results from a nationally representative survey. Am J Public Health 2011; 101:1234-6. [PMID: 21566038 DOI: 10.2105/ajph.2011.300146] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Menthol is a cigarette flavoring that makes smoking more appealing to smokers. The US Food and Drug Administration (FDA) has regulatory authority to ban mentholated cigarettes to reduce youth uptake and encourage adult cessation. Survey findings indicate that more than half of all Americans (56.1%) and of Blacks alone (68.0% in one sample and 75.8% in another) support banning menthol. Endorsement of a ban-especially by Blacks, who have the highest rates of menthol cigarette use-would support FDA action to ban menthol to protect the public's health.
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Winickoff JP, Tanski SE, McMillen RC, Ross KM, Lipstein EA, Hipple BJ, Friebely J, Klein JD. Acceptability of testing children for tobacco-smoke exposure: a national parent survey. Pediatrics 2011; 127:628-34. [PMID: 21422089 PMCID: PMC3387887 DOI: 10.1542/peds.2010-2462] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Tests are available to measure children's exposure to tobacco smoke. One potential barrier to testing children for tobacco-smoke exposure is the belief that parents who smoke would not want their child tested. No previous surveys have assessed whether testing children for exposure to tobacco smoke in the context of their child's primary care visit is acceptable to parents. OBJECTIVE To assess whether testing children for tobacco-smoke exposure is acceptable to parents. DESIGN AND METHODS We conducted a national random-digit-dial telephone survey of households from September to November 2006. The sample was weighted by race and gender, based on the 2005 US Census, to be representative of the US population. RESULTS Of 2070 eligible respondents contacted, 1803 (87.1%) completed the surveys. Among 477 parents in the sample, 60.1% thought that children should be tested for tobacco-smoke exposure at their child's doctor visit. Among the parental smokers sampled, 62.0% thought that children should be tested for tobacco-smoke exposure at the child's doctor visit. In bivariate analysis, lower parental education level, allowing smoking in the home, nonwhite race, and female gender were each associated (P < .05) with wanting the child tested for tobacco-smoke exposure. CONCLUSIONS The majority of nonsmoking and smoking parents want their children tested for tobacco-smoke exposure during the child's health care visit.
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Affiliation(s)
- Jonathan P. Winickoff
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; ,American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois
| | - Susanne E. Tanski
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Robert C. McMillen
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Social Science Research Center, Mississippi State University, Starkville, Mississippi
| | - Kaile M. Ross
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Ellen A. Lipstein
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts; ,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Bethany J. Hipple
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Joan Friebely
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, Massachusetts
| | - Jonathan D. Klein
- American Academy of Pediatrics Tobacco Consortium and Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; ,Department of Pediatrics, University of Rochester, Rochester, New York
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de Leeuw RNH, Sargent JD, Stoolmiller M, Scholte RHJ, Engels RCME, Tanski SE. Association of smoking onset with R-rated movie restrictions and adolescent sensation seeking. Pediatrics 2011; 127:e96-e105. [PMID: 21135004 PMCID: PMC3375469 DOI: 10.1542/peds.2009-3443] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES In this study, we examined how often US youths reported having complete parental restrictions on watching R-rated movies. In addition, we assessed the relationship between parental R-rated movie restrictions and adolescents' sensation seeking and how this interplay is related to smoking onset. METHODS Data from a 4-wave longitudinal study of 6522 adolescents (10-14 years of age) who were recruited through a random-digit-dial telephone survey were used. At baseline, subjects were nationally representative of the US population. Subjects were monitored for 2 years and queried about their smoking status, their sensation-seeking propensity, and how often they were allowed to watch R-rated movies. A cross-lagged model combined with survival analysis was used to assess the relationships between parental R-rated movie restrictions, sensation-seeking propensity, and risk for smoking onset. RESULTS Findings demonstrated that 32% of the US adolescents reported being completely restricted from watching R-rated movies by their parents. Model findings revealed that adolescents' sensation seeking was related to greater risk for smoking onset not only directly but also indirectly through their parents becoming more permissive of R-rated movie viewing. Parental R-rated movie restrictions were found to decrease the risk of smoking onset directly and indirectly by changing children's sensation seeking. CONCLUSIONS These findings imply that, beyond direct influences, the relationship between adolescents' sensation seeking and parental R-rated movie restrictions in explaining smoking onset is bidirectional in nature. Finally, these findings highlight the relevance of motivating and supporting parents in limiting access to R-rated movies.
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Affiliation(s)
| | - James D. Sargent
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire; ,Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire; and
| | - Mike Stoolmiller
- Center on Teaching and Learning, College of Education, University of Oregon, Eugene, Oregon
| | - Ron H. J. Scholte
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, Netherlands
| | | | - Susanne E. Tanski
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire; ,Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, New Hampshire; and
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Berke EM, Tanski SE, Demidenko E, Alford-Teaster J, Shi X, Sargent JD. Alcohol retail density and demographic predictors of health disparities: a geographic analysis. Am J Public Health 2010; 100:1967-71. [PMID: 20724696 DOI: 10.2105/ajph.2009.170464] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether the geographic density of alcohol retailers was greater in geographic areas with higher levels of demographic characteristics that predict health disparities. METHODS We obtained the locations of all alcohol retailers in the continental United States and created a map depicting alcohol retail outlet density at the US Census tract level. US Census data provided tract-level measures of poverty, education, crowding, and race/ethnicity. We used multiple linear regression to assess relationships between these variables and retail alcohol density. RESULTS In urban areas, retail alcohol density had significant nonlinear relationships with Black race, Latino ethnicity, poverty, and education, with slopes increasing substantially throughout the highest quartile for each predictor. In high-proportion Latino communities, retail alcohol density was twice as high as the median density. Retail alcohol density had little or no relationship with the demographic factors of interest in suburban, large town, or rural census tracts. CONCLUSIONS Greater density of alcohol retailers was associated with higher levels of poverty and with higher proportions of Blacks and Latinos in urban census tracts. These disparities could contribute to higher morbidity in these geographic areas.
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Affiliation(s)
- Ethan M Berke
- Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH 03766, USA.
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Halterman JS, Conn KM, Hernandez T, Tanski SE. Parent knowledge, attitudes, and household practices regarding SHS exposure: a case-control study of urban children with and without asthma. Clin Pediatr (Phila) 2010; 49:782-9. [PMID: 20522612 DOI: 10.1177/0009922810368290] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Impoverished children suffer disproportionately from asthma and are more likely than other children to be exposed to secondhand smoke (SHS). We conducted a case-control study to describe and compare knowledge, attitudes, and household practices regarding SHS exposure among parents of young urban children with and without asthma (response rate, 76%). Overall, 39% of children lived with > or =1 smoker (cases, 36%; controls, 43%). The majority of parents (78%) felt that cigarette smoking is very dangerous and agreed that smoke harms the health of children (97%). Cases were more likely than controls to report that smoking in a car affects children's health (54% vs 42%) and that smoking in front of children is never allowed in their home (88% vs 79%). Additionally, more cases reported a home smoking ban (81% vs 70%). Our findings suggest that parents of children with asthma have somewhat better knowledge, attitudes, and practices regarding SHS; however, gaps remain, and many urban children continue to be exposed.
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Affiliation(s)
- Jill S Halterman
- University of Rochester School of Medicine, Golisano Children's Hospital at Strong Memorial Hospital, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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Abstract
OBJECTIVE The aim of this study was to determine if parental restriction regarding Restricted-rated movies (R movies) predicts lower rates of early-onset alcohol use. METHOD Students from 15 northern New England middle schools were surveyed in 1999, and never-drinkers were resurveyed 13-26 months later to determine alcohol use. Drinking was determined by the question, "Have you ever had beer, wine, or other drink with alcohol that your parents didn't know about?" R-movie restriction was assessed by the question, "How often do your parents allow you to watch movies that are rated R?" RESULTS The sample included 2,406 baseline never-drinkers who were surveyed at follow-up, of whom 14.8% had initiated alcohol use. At baseline, 20% reported never being allowed to watch R movies, and 21% reported being allowed all the time. Adolescents allowed to watch R-rated movies had higher rates of alcohol initiation (2.9% initiation among never allowed, 12.5% once in a while, 18.8% sometimes, and 24.4% all the time). Controlling for sociodemographics, personality characteristics, and authoritative parenting style, the adjusted odds ratios for initiating alcohol use were 3.0 (95% CI [1.7, 5.1]) for those once in a while allowed, 3.3 [1.9, 5.6] for those sometimes allowed, and 3.5 [2.0, 6.0] for those always allowed to watch R-rated movies. Alcohol initiation was more likely if R-rated movie restriction relaxed over time; tightening of restriction had a protective effect (p < .001). A structural model was developed that modeled two latent parenting constructs: (a) authoritative parenting and (b) media parenting. Both constructs had direct inverse paths to trying alcohol and indirect paths through lower exposure to R-rated movies. CONCLUSIONS After accounting for differences in authoritative parenting style, adolescents reporting lesser restrictions for R movies have higher odds of future alcohol use. The structural model suggests that media parenting operates independently from authoritative parenting and should be incorporated explicitly into parenting prevention programs.
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Affiliation(s)
- Susanne E Tanski
- Department of Pediatrics and Norris Cotton Cancer Center, Dartmouth Medical School, Hanover, New Hampshire 03755-1404, USA
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Abstract
OBJECTIVE To assess the association between smoking onset and exposure to movie smoking according to character type. METHODS A longitudinal, random-digit-dial telephone survey of 6522 US adolescents was performed with movie exposure assessed at 4 time points over 24 months. Adolescents were asked whether they had seen a random subsample of recently released movies, for which we identified smoking by major characters and type of portrayal (divided into negative, positive, and mixed/neutral categories). Multivariate hazard regression analysis was used to assess the independent effects of these exposures on the odds of trying smoking. RESULTS By the 24-month follow-up survey, 15.9% of baseline never-smokers had tried smoking. Within the sample of movies, 3848 major characters were identified, of whom 69% were male. Smokers represented 22.8% of 518 negative characters, 13.7% of 2486 positive characters, and 21.1% of 844 mixed/neutral characters. Analysis of the crude relationship showed that episodes of negative character smoking exposure had the strongest influence on smoking initiation. However, because most characters were portrayed as positive, exposure to this category was greatest. When the full population effect of each exposure was modeled, each type of character smoking independently affected smoking onset. There was an interaction between negative character smoking and sensation-seeking with stronger response for adolescents lower in sensation-seeking. CONCLUSIONS Character smoking predicts adolescent smoking initiation regardless of character type, which demonstrates the importance of limiting exposure to all movie smoking. Negative character portrayals of smoking have stronger impact on low risk-taking adolescents, undercutting the argument that greater exposure is a marker for adolescent risk-taking behavior.
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Affiliation(s)
- Susanne E. Tanski
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire,Cancer Risk Behaviors Group, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Mike Stoolmiller
- Oregon Social Learning Center, University of Oregon, Eugene, Oregon
| | - Sonya Dal Cin
- Department of Communication, University of Michigan, Ann Arbor, Michigan
| | - Keilah Worth
- Cancer Risk Behaviors Group, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Jennifer Gibson
- Cancer Risk Behaviors Group, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - James D. Sargent
- Department of Pediatrics, Dartmouth Medical School, Hanover, New Hampshire,Cancer Risk Behaviors Group, Norris Cotton Cancer Center, Lebanon, New Hampshire
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McClure AC, Stoolmiller M, Tanski SE, Worth KA, Sargent JD. Alcohol-branded merchandise and its association with drinking attitudes and outcomes in US adolescents. ACTA ACUST UNITED AC 2009; 163:211-7. [PMID: 19255387 DOI: 10.1001/archpediatrics.2008.554] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To describe ownership of alcohol-branded merchandise (ABM) and its association with attitudinal susceptibility, initiation of alcohol use, and binge drinking. DESIGN Three-wave longitudinal study. SETTING Confidential telephone survey. PARTICIPANTS Representative US sample of 6522 adolescents aged 10 to 14 years at baseline survey (4309 of whom were never-drinkers at 8 months); subjects were resurveyed at 16 and/or 24 months. Main Exposures Ownership of ABM (first assessed at the 8-month survey) and attitudinal susceptibility to alcohol use. OUTCOME MEASURES Initiation of alcohol use that parents did not know about and binge drinking (> or =5 drinks in a row). RESULTS Prevalence of ABM ownership ranged from 11% of adolescents (at 8 months) to 20% (at 24 months), which extrapolates to 2.1 to 3.1 million US adolescents, respectively. Clothing and headwear comprised 88% of ABM. Beer brands accounted for 75% of items; 45% of items bore the Budweiser label. Merchandise was obtained primarily from friends and/or family (71%) but was also purchased by the adolescents themselves (24%) at stores. Among never-drinkers, ABM ownership and susceptibility were reciprocally related, each significantly predicting the other during an 8-month period. In turn, we found that ABM ownership and susceptibility predicted both initiation of alcohol use and binge drinking, while controlling for a broad range of covariates. CONCLUSIONS Alcohol-branded merchandise is widely distributed among US adolescents, who obtain the items one-quarter of the time through direct purchase at retail outlets. Among never-drinkers, ABM ownership is independently associated with susceptibility to as well as with initiation of drinking and binge drinking.
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Affiliation(s)
- Auden C McClure
- Department of Pediatric and Adolescent Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
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Abstract
OBJECTIVE There is no safe level of exposure to tobacco smoke. Thirdhand smoke is residual tobacco smoke contamination that remains after the cigarette is extinguished. Children are uniquely susceptible to thirdhand smoke exposure. The objective of this study was to assess health beliefs of adults regarding thirdhand smoke exposure of children and whether smokers and nonsmokers differ in those beliefs. We hypothesized that beliefs about thirdhand smoke would be associated with household smoking bans. METHODS Data were collected by a national random-digit-dial telephone survey from September to November 2005. The sample was weighted by race and gender within Census region on the basis of US Census data. The study questions assessed the level of agreement with statements that breathing air in a room today where people smoked yesterday can harm the health of children. RESULTS Of 2000 eligible respondents contacted, 1510 (87%) completed surveys, 1478 (97.9%) answered all questions pertinent to this analysis, and 273 (18.9%) were smokers. Overall, 95.4% of nonsmokers versus 84.1% of smokers agreed that secondhand smoke harms the health of children, and 65.2% of nonsmokers versus 43.3% of smokers agreed that thirdhand smoke harms children. Strict rules prohibiting smoking in the home were more prevalent among nonsmokers: 88.4% vs 26.7%. In multivariate logistic regression, after controlling for certain variables, belief that thirdhand smoke harms the health of children remained independently associated with rules prohibiting smoking in the home. Belief that secondhand smoke harms the health of children was not independently associated with rules prohibiting smoking in the home and car. CONCLUSIONS This study demonstrates that beliefs about the health effects of thirdhand smoke are independently associated with home smoking bans. Emphasizing that thirdhand smoke harms the health of children may be an important element in encouraging home smoking bans.
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Affiliation(s)
- Jonathan P. Winickoff
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, Massachusetts,American Academy of Pediatrics Tobacco Consortium and Julius B. Richmond Center Lebanon, New Hampshire
| | - Joan Friebely
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | - Susanne E. Tanski
- American Academy of Pediatrics Tobacco Consortium and Julius B. Richmond Center Lebanon, New Hampshire,Department of Pediatrics, Dartmouth Medical School, Lebanon, New Hampshire
| | - Cheryl Sherrod
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, Massachusetts
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, California
| | - Melbourne F. Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Robert C. McMillen
- American Academy of Pediatrics Tobacco Consortium and Julius B. Richmond Center Lebanon, New Hampshire,Social Science Research Center and Department of Psychology, Mississippi State University, Starkville, Mississippi
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35
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Abstract
AIMS To determine if adolescents who report that their parents restrict viewing movies based on rating have a lower risk of trying smoking and drinking alcohol in the future. DESIGN Prospective observational study. A cohort of 2110 German adolescents younger than 15 years who had never smoked or drunk alcohol at baseline were surveyed 12-13 months later to determine smoking and binge drinking initiation. Risk of substance use was assessed as a function of parental restriction on viewing FSK-16 movies (movies that only those aged 16 years and over would be allowed to see in theaters). FINDINGS The percentage of students who tried smoking was 16.3%, 10.9% initiated binge drinking and 5.0% used both substances during the follow-up period. There was a significant effect of parental movie restriction on each substance use outcome measure after controlling for covariates. Compared with adolescents whose parents never allowed them to view FSK-16 movies, the adjusted relative risk [(RR) (95% confidence interval (CI)] for use of both substances were 1.64 (1.05-2.58) for adolescents allowed to view them once in a while, 2.30 (1.53-3.45) for sometimes and 2.92 (1.83-4.67) for all the time. FSK-16 restrictions were associated with lower viewership of all classes of movies, but especially FSK-16/18 movies; in addition, FSK-16 restrictions were associated with substantially lower exposure to movie depiction of tobacco and alcohol use, suggesting a mediational mechanism for the association. CONCLUSIONS Among young adolescents, parental restriction from viewing movies rated for older adolescents/adults decreases the risk of substance use in the future.
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Affiliation(s)
| | | | - Susanne E. Tanski
- Dartmouth Medical School, Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, NH, USA
| | - James D. Sargent
- Dartmouth Medical School, Cancer Control Research Program, Norris Cotton Cancer Center, Lebanon, NH, USA
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36
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Abstract
BACKGROUND To assess whether movie alcohol exposure is associated with alcohol use during early adolescence. METHODS We conducted a survey of adolescents (N = 5,581) from 27 schools in Germany. Each was asked if he/she had seen a list of 50 movie titles, randomly selected from a sample of 398 US box office hits released there. Screen alcohol use was timed for each movie, summed for movies each adolescent had seen, and adjusted to reflect exposure to all 398 movies. We assessed the association between this exposure and any alcohol use without parental knowledge (WPK) and binge drinking (>or= 5 drinks). RESULTS Alcohol use was depicted in 88% of the 398 movies. Median exposure to movie alcohol use was 3.44 h (interquartile range = 1.51-6.23 h). Overall 36.6% of subjects used alcohol WPK and 18.1% reported binge drinking. Movie alcohol exposure was directly associated with alcohol use WPK and binge drinking, after controlling for multiple covariates including sociodemographics, personality characteristics and social influences. Compared with quartile one, the adjusted odds of alcohol use WPK were 1.47 [95% confidence interval (CI) 1.19-1.82], 2.12 (1.75-2.57) and 2.95 (2.35-3.70) for quartiles 2, 3 and 4, respectively; similarly, adjusted odds of binge drinking were 1.42 (0.93-2.28), 1.84 (1.27-2.67) and 2.59 (1.70-3.95). CONCLUSION This study demonstrates an association between exposure to alcohol use in US movies and alcohol use without parental knowledge in Germany, and is the first study to link movie exposure with binge drinking. Given international distribution of US movies, depicted behaviours may influence adolescents outside the country of origin.
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Affiliation(s)
- Reiner Hanewinkel
- Institute for Therapy and Health Research, Düsternbrooker Weg 2, 24105 Kiel, Germany.
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37
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Abstract
BACKGROUND Several studies have linked seeing smoking in movies with adolescent smoking, but none have determined how much movie smoking adolescents see. OBJECTIVE Our aim was to determine exposure to movie smoking in a representative sample of young US adolescents. METHODS. We surveyed 6522 nationally representative US adolescents aged 10-14 years. We content analyzed 534 contemporary box-office hits for movie smoking. Each movie was assigned to a random subsample of adolescents (mean: 613) who were asked whether they had seen the movie. Using survey weights, we estimated the total number of US adolescents who had seen each movie and then multiplied by the number of smoking depictions in each movie to obtain gross smoking impressions seen by adolescents. RESULTS The 534 movies were mainly rated PG-13 (41%) and R (40%), and 74% contained smoking (3830 total smoking occurrences). On average, each movie was seen by 25% of the adolescents surveyed. Viewership was higher with increased age and lower for R-rated movies. Overall, these movies delivered 13.9 billion gross smoking impressions, an average of 665 to each US adolescent aged 10-14 years. Although this sample's R-rated movies contained 60% of smoking occurrences, they delivered only 39% of smoking impressions because of lower adolescent viewership. Thirty popular movies each delivered > or =100 million gross smoking impressions. Thirty actors each delivered >50 million smoking impressions, such that just 1.5% of actors delivered one quarter of all character smoking to the adolescent sample. CONCLUSIONS Popular movies deliver billions of smoking images and character smoking depictions to young US adolescents. Removing smoking from youth-rated films would substantially reduce exposure from new box-office hits. Furthermore, the popular actors who frequently smoke in movies could have a major impact on adolescent movie smoking exposure by choosing not to portray characters who smoke.
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Affiliation(s)
- James D Sargent
- Norris Cotton Cancer Center, Dartmouth Medical School, Lebanon, New Hampshire, USA.
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38
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Abstract
OBJECTIVE Provision of telephone smoking cessation counseling can increase the rate of quitting smoking. The US Public Health Service recently helped to establish a free national quitline enrollment service. No previous surveys have assessed the acceptability to parents of enrollment in quitline counseling in the context of their child's health care visits. Therefore, the objective of this study was to assess acceptability to parents of enrollment in quitline counseling and to compare that with the reported rate of actually being enrolled in any smoking cessation counseling outside the office in the context of the child's health care visit. METHODS Data were collected by a national random-digit-dial telephone survey of households from September to November 2004. The sample is weighted by race and gender on the basis of the current US Census to be representative of the US population. RESULTS Of 3615 eligible respondents contacted, 3011 (83.3%) completed surveys; 958 (31.8%) who completed the survey were parents with children under the age of 18 years. Of these parents, 187 (19.7%) were self-identified smokers. Of the parents who smoked, 113 (64.2%) said that they would accept enrollment in a telephone cessation program if the child's doctor offered it to them. In contrast, of the 122 smoking parents who accompanied their child to the doctor in the past year, only 11 (9%) had any counseling recommended to them, and only 1 (0.8%) was actually enrolled. These results did not vary by parent age, gender, race, or child age. CONCLUSIONS When interacting with parents who smoke, child health care providers have low rates of referring and enrolling parents in any services related to smoking. Enrollment in quitlines would be acceptable to the majority of parents in the context of their child's health care visit. Tobacco control efforts in the child health care setting should include implementation of office systems that can facilitate enrollment of parental smokers in telephone quitlines.
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39
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Winickoff JP, Tanski SE, McMillen RC, Klein JD, Rigotti NA, Weitzman M. Child health care clinicians' use of medications to help parents quit smoking: a national parent survey. Pediatrics 2005; 115:1013-7. [PMID: 15805379 DOI: 10.1542/peds.2004-1372] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Smokers who use cessation medications when they attempt to quit double their likelihood of success. No prior survey has assessed the acceptability to parents of receiving smoking cessation medication prescriptions in the context of their child's primary care visits. OBJECTIVE To assess acceptability to parents of receiving smoking cessation medication prescriptions and to compare that with the reported rate of actually receiving smoking cessation medication prescriptions in the context of the child's health care visit. METHODS Data were collected through a national random-digit dial telephone survey of households from July to September 2003. The sample was weighted according to race and gender, on the basis of the 2002 US Census, to be representative of the US population. RESULTS Of 3990 eligible respondents contacted, 3010 (75%) completed surveys; 1027 (34%) of those were parents. Of those parents, 211 (21%) were self-identified smokers. One half would consider using a smoking cessation medication and, of those, 85% said that it would be acceptable if the child's doctor prescribed or recommended it to them. In contrast, of the 143 smoking parents who accompanied their child to the doctor, only 15% had pharmacotherapy recommended and only 8% received a prescription for a smoking cessation medication. These results did not vary according to parent age, gender, race, or child age. CONCLUSIONS Child health care clinicians have low rates of recommending and prescribing cessation therapies that have proved effective in other settings. The recommendation or provision of cessation medications would be acceptable to the majority of parents in the context of their child's health care visit.
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Affiliation(s)
- Jonathan P Winickoff
- Massachusetts General Hospital Center for Child and Adolescent Health Policy, Boston, Massachusetts 02114, USA.
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40
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Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thomson C, Lando HA, Curry S, Muramoto M, Prokhorov AV, Best D, Weitzman M, Pbert L. State-of-the-art interventions for office-based parental tobacco control. Pediatrics 2005; 115:750-60. [PMID: 15741382 DOI: 10.1542/peds.2004-1055] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.
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Affiliation(s)
- Jonathan P Winickoff
- General Pediatrics Division, MGH Center for Child and Adolescent Health Policy, MassGeneral Hospital for Children, and Tobacco Research and Treatment Center, 50 Staniford St, Suite 901, Boston, Massachusetts 02114, USA.
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41
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Tanski SE, Prokhorov AV, Klein JD. Youth and tobacco. Minerva Pediatr 2004; 56:553-65. [PMID: 15765019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Youth around the world take up smoking and use tobacco products at high rates. Young people may not grasp the long-term consequences of tobacco use, although tobacco consumption and exposure has been shown to have significant negative health effects. Youth use a variety of tobacco products that are smoked, chewed, or sniffed, including machine-manufactured cigarettes, cigars, bidis, kreteks, sticks, and snuff. Prevention efforts have focused on countering those aspects that are believed to contribute to smoking uptake, such as tobacco industry advertising and promotion, and access to tobacco. There are many aspects of tobacco promotion through the media that have been more difficult to control, however, such as product placement within popular cinema movies. Once a youth has taken up tobacco, he or she is more likely than an adult to become addicted and should be offered treatment for tobacco cessation. Although there is not yet sufficient evidence to prove efficacy, the same treatments are suggested for youth as are recommended for adults, including nicotine replacement products. Given the severity of the tobacco epidemic worldwide and the devastating health effects on an individual and population basis, there are currently many efforts to curtail the tobacco problem, including the World Health Organization (WHO) sponsored Framework Convention on Tobacco Control. It is through comprehensive and collaborative efforts such as this that the global hazard of tobacco is most likely to be overcome.
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Affiliation(s)
- S E Tanski
- Center for Child Health Research, University of Rochester, Rochester, NY 14620, USA.
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Winickoff JP, McMillen RC, Carroll BC, Klein JD, Rigotti NA, Tanski SE, Weitzman M. Addressing parental smoking in pediatrics and family practice: a national survey of parents. Pediatrics 2003; 112:1146-51. [PMID: 14595060 DOI: 10.1542/peds.112.5.1146] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child's visit to primary care. OBJECTIVE To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking. Design/Methods. Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based on 1999 US Census estimates to be representative of the US population. RESULTS Of 3566 eligible respondents contacted, 3002 (84%) completed surveys; 902 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner reported that they had been asked about household member smoking status (52% vs 48%). More parents who visited pediatricians had been asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs 29%). Of 190 (21%) parents who were smokers, fewer than half reported being counseled by either specialty about dangers of second-hand smoke (41% vs 33%) or risks of modeling smoking behavior (31% vs 28%). Similarly, fewer than half of parental smokers received advice to quit (36% vs 45%). CONCLUSION Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in primary care settings that serve children.
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Affiliation(s)
- Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Policy, Harvard Pediatric Health Services Research Program, Boston, Massachusetts 02114, USA.
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43
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Abstract
OBJECTIVE To assess the frequency of clinician-reported delivery of counseling for avoidance of child environmental tobacco smoke (ETS) exposure and tobacco use at periodic well-child visits and at illness visits for asthma and otitis media (OM). METHODS Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from 1997 to 1999 were analyzed. The frequency of pediatric visits (<or=18 years) that included clinician-reported counseling for tobacco use/exposure prevention was assessed. Diagnosis-specific visits were determined by using International Classification of Diseases, Ninth Revision codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed. RESULTS Of 33 823 ambulatory care visits by children, 1.5% were reported to include delivery of tobacco counseling. Only 4.1% of well-child visits, 4.4% of illness visits for asthma, and 0.3% of illness visits for OM included tobacco counseling. With the use of logistic regression models, adolescent patient visits (13-18 years) were more likely to include delivery of tobacco counseling than younger child visits [OR = 15.8, 95% CI (7.5-33.5)]. Visits by children with Medicaid and those seen by a nurse practitioner or a physician's assistant were also more likely to include tobacco counseling (odds ratio: 1.6; 95% confidence interval: 1.002-2.50; and odds ratio: 3.0; 95% confidence interval: 1.5-6.0, respectively). There were no significant differences in counseling delivery by race, ethnicity, or clinician specialty. CONCLUSIONS Rates of tobacco counseling at well-child visits and at illness visits for diagnoses directly affected by tobacco use and ETS are extremely low. Significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care.
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Affiliation(s)
- Susanne E Tanski
- Strong Children's Research Center, University of Rochester, Rochester, New York 14620-3917, USA.
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