Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States

OBJECTIVES: We describe the epidemiology of smoking behaviors in a national young adult sample and identify common and unique demographic, social, and psychological correlates of daily smoking and lifetime and current nicotine dependence by race/ethnicity. METHODS: Data are from the National Longitudinal Survey of Adolescent Health, wave III. Dependence was measured by the Revised Fagerstr?m Test for Nicotine Dependence. Logistic regressions were estimated. RESULTS: Hispanic ethnicity, low education, parental and peer smoking, novelty seeking, early age of smoking onset, and pleasurable initial smoking experiences are significantly correlated with daily smoking and lifetime nicotine dependence. Depressive symptoms are uniquely associated with lifetime and current dependence. Few factors are highly associated with current dependence. Initial sensitivity to smoking has a significantly greater impact on daily smoking than on dependence. Correlates of smoking behaviors are mostly common across racial/ethnic groups, although parental and peer smoking are significant for Whites and Hispanics but not for African Americans. CONCLUSIONS: There are more common than unique correlates of each smoking stage and across racial/ethnic groups. Primary prevention and interventions addressing the factors tested could be uniform for most chronic smokers irrespective of dependence status and race/ethnicity.     

County characteristics and racial and ethnic disparities in the use of preventive services

BACKGROUND: Studies examining predictors of preventive service utilization generally focus on individual characteristics and ignore the role of contextual variables. To help address this gap in the literature, the present study investigates whether county-level characteristics, such as racial and ethnic composition, are associated with the use of preventive services. METHODS: Data from the Medical Expenditure Panel Survey and the Area Resource Files (1996-1998) are used to identify the individual- and county-level predictors of five types of preventive services (n = 49,063). RESULTS: County racial or ethnic composition is associated with the utilization of certain preventive services, net of individual-level characteristics. Specifically, individuals in high percent Hispanic counties are more likely to report cholesterol screenings, while those in counties with more blacks are more likely to have regular mammograms. Moreover, county racial or ethnic composition modifies the relationship between individual race or ethnicity and preventive use. In particular, Hispanic individuals who reside in high percent black counties report higher levels of utilization for most preventive services compared to Hispanics living in other counties. CONCLUSIONS: Physical and social environments are key determinants of health behaviors and outcomes. Future studies should take into account the racial or ethnic composition of an area and how this interacts with individual race or ethnicity when investigating predictors of preventive care use.     

Racial/ethnic differences in perceived smoking prevalence: evidence from a national survey of teens

Prior studies show that perceived smoking prevalence is a significant predictor of smoking initiation. In this study, we examine racial/ethnic differences in perceived smoking prevalence and racial/ethnic differences in exposure to contextual factors associated with perceived smoking prevalence. We used cross-sectional time series data from the Legacy Media Tracking Surveys (LMTS), a national sample of 35,000 12- to 17-year-olds in the United States. Perceived smoking prevalence was the primary outcome variable, measured using an LMTS question: "Out of every 10 people your age, how many do you think smoke?" Multivariable models were estimated to assess the association between perceived smoking prevalence; race/ethnicity; and exposure to social contextual factors. Findings indicate that African American, Hispanic, and American Indian youth exhibit the highest rates of perceived smoking prevalence, while white and Asian youth exhibit the lowest. Minority youth are also disproportionately exposed to social contextual factors that are correlated with high perceived smoking prevalence. These findings suggest that disproportionate exposure to social contextual factors may partially explain why minority youth exhibit such high levels of perceived smoking prevalence.     

Cigarette smoking for weight loss or control among adolescents: gender and racial/ethnic differences.

PURPOSE: To describe gender and racial/ethnic differences in the prevalence of cigarette smoking for weight loss or control in an adolescent population-based sample, and relationships among heavy smoking, weight concerns and smoking to lose or control weight. METHODS: Anonymous questionnaires were administered to 81,247 9th and 12th grade public school students across the state of Minnesota in 1998. Variables of interest included smoking frequency, weight concerns, and smoking for weight loss or control. Logistic regression analyses were used to estimate the odds of smoking to lose or control weight by race/ethnicity and gender, and to evaluate the relationships between smoking to lose or control weight and heavy smoking, perceptions of overweight, and weight concerns by race/ethnicity and gender. RESULTS: With the exception of black females, female smokers of different racial/ethnic groups were as likely as white girls to smoke for weight loss or control. Compared to white male smokers, American Indian and Asian American male smokers were more likely to smoke for weight loss or control, and black, Hispanic, and mixed race male smokers were equally likely to smoke for weight loss or control. Heavy smokers, smokers who perceived themselves as overweight or were weight-concerned were significantly more likely to report smoking as a weight control method. CONCLUSIONS: Smoking for weight control is prevalent across many race/ethnic groups and both genders among adolescents.     

Inclusion of immigrant status in smoking prevalence statistics

OBJECTIVES: Data from the 1995-1996 and 1998-1999 Current Population Survey tobacco use supplements were used to examine smoking prevalence statistics by race/ethnicity and immigrant status. METHODS: Smoking prevalence statistics were calculated, and these data were decomposed by country of birth for Asian immigrants to illustrate the heterogeneity in smoking rates present within racial/ethnic groups. RESULTS: Except in the case of male Asian/Pacific Islanders, immigrants exhibited significantly lower smoking prevalence rates than nonimmigrants. However, rates varied according to country of birth. CONCLUSIONS: This research highlights the need to disaggregate health statistics by race/ethnicity, sex, immigrant status, and, among immigrants, country of birth. Data on immigrants' health behaviors enhance the development of targeted and culturally sensitive public health smoking prevention programs.     

Does a history of trauma contribute to HIV risk for women of color? Implications for prevention and policy

OBJECTIVES: We investigated history of abuse and other HIV-related risk factors in a community sample of 490 HIV-positive and HIV-negative African American, European American, and Latina women. METHODS: Baseline interviews were analyzed, and logistic regressions were used to identify predictors of risk for positive HIV serostatus overall and by racial/ethnic group. RESULTS: Race/ethnicity was not an independent predictor of HIV-related risk, and few racial/ethnic differences in risk factors for HIV were seen. Regardless of race/ethnicity, HIV-positive women had more sexual partners, more sexually transmitted diseases, and more severe histories of abuse than did HIV-negative women. Trauma history was a general risk factor for women, irrespective of race/ethnicity. CONCLUSIONS: Limited material resources, exposure to violence, and high-risk sexual behaviors were the best predictors of HIV risk.     

Neighborhood context and youth cardiovascular health behaviors

OBJECTIVES: This study sought to determine the relationships between race/ethnicity, socioeconomic status (SES), and cardiovascular health behaviors among youths and whether neighborhood characteristics are associated with such behaviors independently of individual characteristics. METHODS: Linear models determined the effects of individual and neighborhood characteristics (SES, social disorganization, racial/ethnic minority concentration, urbanization) on dietary habits, physical activity, and smoking among 8165 youths aged 12 to 21 years. RESULTS: Low SES was associated with poorer dietary habits, less physical activity, and higher odds of smoking. After adjustment for SES, Black race was associated with poorer dietary habits and lower odds of smoking. Hispanic ethnicity was associated with healthier dietary habits, lower levels of physical activity, and lower odds of smoking than non-Hispanic ethnicity. Low neighborhood SES and high neighborhood social disorganization were independently associated with poorer dietary habits, while high neighborhood Hispanic concentration and urbanicity were associated with healthier dietary habits. Neighborhood characteristics were not associated with physical activity or smoking. CONCLUSIONS: Changes in neighborhood social structures and policies that reduce social inequalities may enhance cardiovascular health behaviors.     

Perceived smoking environment and smoking initiation among multi-ethnic urban girls

PurposeTo examine associations between the perceived smoking environment and smoking initiation among urban multi-ethnic adolescent girls in New York City.MethodsSelf-report surveys completed in grades 7, 8, and 9 assessed girls’ (n = 858) smoking initiation, and perceived smoking environment (family smoking, friends’ smoking, smoking norms, and cigarette availability). Carbon monoxide breath samples were collected from girls using a variation of the bogus pipeline procedure.ResultsDifferences were found in smoking prevalence with white girls reporting the highest prevalence of smoking at baseline and greatest increase in smoking prevalence from seventh to eighth grade. Black girls reported an initial increase in smoking prevalence from seventh to eighth grade followed by a decrease from eighth to ninth grade. Family smoking, friends’ smoking, smoking norms, and cigarette availability were all associated with smoking initiation at eighth grade but only friends’ smoking was associated with smoking initiation at ninth grade. Few ethnic differences were found in risk factors at baseline and racial/ethnic group did not modify associations between risk and smoking initiation.ConclusionsUrban adolescent girls of different racial/ethnic backgrounds had similar perceptions of the smoking environment. Despite the similarity of risk factors across racial/ethnic groups, urban white girls are at increased risk to initiate smoking. Preventive interventions that target girls’ perceived smoking environment during early adolescence should be effective across ethnic groups.     

Ethnic and gender differences in smoking and smoking cessation in a population of young adult air force recruits

PURPOSE: To examine gender and ethnic differences in smoking and smoking cessation in a population of young adult military recruits. DESIGN: A self-administered survey of demographics, tobacco use, and other health risk behaviors was administered at the start of basic military training. SETTING: The study was conducted at Lackland Air Force Base, San Antonio, Texas, where all U.S. Air Force recruits complete basic military training. SUBJECTS: All recruits who entered the U.S. Air Force between September 1995 and September 1996 participated in this study (n = 32,144; 100% participation rate). MEASURES: Recruits completed a written 53-item behavioral risk questionnaire. Measures examined in the present study included smoking status (ever having smoked a cigarette, current daily smoking, and quitting); demographics (ethnicity, gender, education, family income, and age); smoking history; and nicotine dependence. RESULTS: Rates of ever smoking, current daily smoking, and quitting were examined in multiple logistic regression analyses as a function of gender and ethnicity, controlling for age, education, and family income. Overall, 54% of recruits had ever smoked a cigarette and 24.9% smoked daily at the time of entry into basic military training. Smoking rates were highest among white and Native American recruits. Among whites, women were more likely to be a current daily smoker (31.6% vs. 29.4%; odds ratio [OR] = 1.18, 99% confidence intervals [CI] = 1.08-1.29). The opposite pattern was observed among African-Americans (5.6% vs. 9.8%, respectively; OR = .57; CI = .41-.79). Current smokers had low levels of nicotine dependence compared with the general population of U.S. smokers, but whites tended to be more dependent than other ethnic groups. Cessation rates were similar for men and women but differed according to ethnicity, ranging from 15% among whites to 23% among Hispanics. CONCLUSIONS: These findings document important gender and ethnic differences in cigarette smoking among military recruits. Whites and Native Americans were more likely to smoke, less likely to quit, and more nicotine-dependent than other ethnic groups. Across gender/ethnicity groups, smoking rates were especially high among white women, with nearly one-third smoking daily until entry into basic training. Gender differences were not observed in cessation rates, but Hispanics were more likely than other ethnic groups to have quit smoking. The results highlight the need to develop effective cessation interventions for this population.     

An exploration of family influences on smoking among ethnically diverse adolescents.

In an attempt to better understand mechanisms through which families might influence adolescent smoking, focus group data collected as part of a larger study of ethnic and gender differences in teen smoking were analyzed for family-related themes. Across six sites, 132 focus groups were conducted with African American, American Indian, Hispanic, Asian/Pacific Islander, and White youth. Similarities across race/ethnicity were evident in the content of antismoking messages and the feeling among youth that they would get in trouble with their parents if caught smoking. African American and Asian/Pacific Islander youth appeared more concerned about their parents thinking less of them if they smoked than were youth from other racial/ethnic groups. White and American Indian youth were more likely to discuss that their parents felt it was their own decision as to whether or not to smoke than were the other groups.