Tobacco use among American Indian adolescents: protective and risk factors

Purpose: To determine the prevalence of, and identify protective and risk factors for, current tobacco use among American Indian adolescents.

Methods: Data from the Voices of Indian Teens Project were used to determine the prevalence of cigarette and smokeless tobacco (ST) use among a sample of 2390 American Indian adolescents, aged 13 to 20 years. Approximately 49% of the sample were female. Data were collected in Fall 1993 among participants from 10 high schools located in five western American Indian communities. The instrument consisted of scales that assessed psychosocial beliefs, attitudes, and behaviors as well as tobacco use. Logistic regression was used to identify protective and risk factors for tobacco use. A replication subsample was used to test the final models.

Results: Approximately 50% of American Indian adolescents in this sample reported some type of cigarette use, and approximately 21% reported using smokeless tobacco. Academic orientation was the only protective factor for cigarette use that replicated in both subsamples. Death/loss and other stressful life events were the risk factors for cigarette and/or ST use that replicated in both subsamples.

Conclusions: The prevalence of tobacco use was high in this sample of American Indian adolescents. Several risk and protective factors were identified, the knowledge of which may inform preventive interventions in this population.     

The density of alcohol outlets and adolescent alcohol consumption: An Australian longitudinal analysis

Higher density of alcohol outlets has been linked to increased levels of adolescent alcohol-related behaviour. Research to date has been cross-sectional. A longitudinal design using two waves of annual survey data from the Australian arm of the International Youth Development Study was used. The sample comprised 2835 individuals with average age at wave 2 of 14 years (SD=1.67; range=11–17 years). GSEM was used to examine how absolute levels of alcohol outlet density was associated with student-reported alcohol use one year later, while controlling for prior alcohol use, risk factors at wave one and changes in density over the 2 years. Adolescents' perception of alcohol availability and friends' alcohol use were tested as potential mediators of the association between alcohol outlet density and adolescent alcohol use. Elasticity modelling identified a 10% increase in overall density at wave one was associated with an approximately 17% increase in odds of adolescent alcohol consumption at wave two. Living in areas with a higher density of outlets was associated with a statistically significant increase in the likelihood of adolescents developing early age alcohol consumption.     

Correlates and predictors of violent behavior among adolescent drinkers

PURPOSE: To examine a wide range of demographic characteristics and psychosocial factors to determine the cross-sectional correlates of violence and longitudinal predictors of violent initiation among adolescent drinkers. METHODS: We conducted secondary analyses of the 1995 (Time 1) and 1996 (Time 2) in-home surveys of the National Longitudinal Study of Adolescent Health (Add Health). This study included a nationally representative school-based sample (N=18,924) of adolescents in grades 7-12. The analyses were restricted to adolescent drinkers (n = 8885). Two logistic regression models were constructed using a backward elimination procedure to identify statistically significant cross-sectional correlates of violence and prospective predictors of violence initiation. RESULTS: Half (49%) of all adolescent drinkers reported violent behavior at Time 1 and 15% of those who were not violent at Time 1 reported initiating violent behavior at Time 2. A total of 14 significant cross-sectional correlates of violence were identified that included measures of alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. Four variables (high-volume drinking, illicit drug use, low grade point average, and having been suspended and/or expelled from school) were significant longitudinal predictors of the initiation of violent behavior. CONCLUSIONS: The factors significantly associated with violence pertain mostly to alcohol use, drug use and selling, exposure to drugs, delinquency, and poor school functioning. However, most of these problems and behaviors tend to occur in closer temporal proximity to violent behavior (i.e., within a year) and do not seem to developmentally precede initiation in violent behavior.     

云南省陇川县男性青年吸毒危险因素分析

目的　探索边境地区男性青年吸毒的危险因素。方法　断面调查基础上建立回顾性队列,观察期为１９９１ 年１ 月１ 日至１９９４ 年８ 月１ 日。被调查对象人口学和行为方面资料采用匿名方法收集。危险因素的确定采用单因素和多因素分析方法。结果　每年新吸毒者发生率在１９９１ ～１９９３ 年间逐年上升。根据多因素分析,吸毒的危险因素包括：未婚、离婚或分居或丧偶（ Ｏ Ｒ＝ ８ ．９） 、被朋友或他人鼓励尝试毒品（ Ｏ Ｒ＝ ８ ．８） ,吸烟（ Ｏ Ｒ＝ ２ ．４） ,属景颇族（ Ｏ Ｒ＝ １ ．８） 以及１９９１ 年家庭成员中有人吸毒（ Ｏ Ｒ＝ １ ．５） 。至少上学７ 年是吸毒的保护因素（ Ｏ Ｒ＝ ０ ．６） 。几个主要危险因素的人群归因危险度分别是：被朋友或他人鼓励尝试吸毒为７０ ．８ ％ ,吸烟５０ ％ ,属景颇族为２４ ％ 。结论　采取社区干预来改变人们对吸烟及吸毒的看法,可能会大幅度降低新吸毒者发生率。为此,建议尽快开展社区干预项目。     

Appetitive traits and body mass index in Chinese adolescents: An 18-month longitudinal study with latent growth curve analyses

A longitudinal approach with Latent Growth Curve Modeling (LGCM) was adopted to explore the trajectories of appetitive traits corresponding to BMI in Chinese adolescents. Within a large sample of adolescents (N = 2566, 45.9% boys) aged from 11 to 17 years (M = 13.80, SD = 1.56) at the baseline survey, our results indicated that appetitive traits of emotional overeating, food fussiness, and hunger increased significantly over time while enjoyment of food decreased over time. Slowness in eating and satiety responsiveness significantly increased in girls, while emotional undereating significantly decreased in boys. Moreover, the growth parameters of emotional undereating and satiety responsiveness were significantly and negatively related to BMI in girls. Our findings evidence that certain appetitive traits could change over time in adolescence and these changes relate to weight status. Gender differences are suggested in the design of future intervention and treatment of overweight/obesity in Chinese adolescents.     

High-risk behaviors associated with early smoking: results from a 5-year follow-up

Purpose: To compare grade 7 nonsmokers, experimenters, and smokers on the basis of prevalence of other problem behaviors at both grade 7 and grade 12.

Methods: Based on longitudinal self-report data from 4327 California and Oregon students, we used logistic regression to develop weighted estimates of the prevalence of academic difficulties, substance use, and delinquent behavior within the three smoking status groups at grades 7 and 12. Huber variance estimates, which adjust for weighting and clustering of observations, were used to assess the statistical significance of differences across groups.

Results: Compared with nonsmokers, early smokers were at least 3 times more likely by grade 12 to regularly use tobacco and marijuana, use hard drugs, sell drugs, have multiple drug problems, drop out of school, and experience early pregnancy and parenthood. These adolescents were also at higher risk for low academic achievement and behavioral problems at school, stealing and other delinquent behaviors, and use of predatory and relational violence. Early experimenters were at significantly greater risk for these problems as well, although to a lesser extent than smokers. Importantly, the higher risk among experimenters and smokers of experiencing many of these problems was evident as early as grade 7.

Conclusions: Early experimenters and smokers are more likely than nonsmokers to experience various problem behaviors by grade 12, with many of these problems evident as early as grade 7. Results suggest that substance use programs that target multiple problems in addition to smoking may be most effective for these high-risk adolescents.     

Protective correlates of stages in adolescent substance use: A swiss national study

Objective: To identify factors potentially protective against involvement with additional illicit drugs among adolescent users of marijuana.

Design and Methods: A cross-sectional, secondary analysis of a national data set of Swiss adolescents was performed. The original survey was conducted in 1992–1993 (N= 9268). Stages of substance use were conceptualized as lifetime use of marijuana of three or more times and as use of marijuana and other illicit drugs (opiates, inhalants, cocaine, hallucinogens, or stimulants) more than twice in the past month. Behavioral characteristics associated with level of drug use were examined. Based on the resilience literature, factors potentially protective against progression of drug use were examined in their bivariate relationships and analyzed in a multiple regression model.

Results: Almost one quarter of the surveyed adolescents were classified as past or current marijuana users. One in 20 of these adolescents also used other illicit drugs. Prevalence of risk-related behaviors (e.g., antisocial behavior, accidents, suicide attempts) was elevated for marijuana users compared to nonusers and even more elevated for users of marijuana with other illicit drugs. In a multivariate logistic regression model, communicating well with a parent was significantly associated with not having progressed to use of illicit drugs other than marijuana [for males, odds ratio (OR) = 0.72, confidence interval (CI) = 0.55, 0.92; for females, OR = 0.60, CI = 0.39, 0.93]. Other significant protective correlates for boys were academic achievement (OR = 0.66, CI = 0.47, 0.92), type of education: school versus apprenticeship (OR = 0.42, CI = 0.21, 0.87), confiding in a family member (OR = 0.49, CI = 0.28, 0.85), and regular participation in a sports club (OR = 0.39, CI = 0.22, 0.77).

Conclusion: Within this national sample of Swiss adolescents, a cross-sectional analysis identified the quality of relationships within the family and factors related to school associated with lack of progression of illicit substance use. However, longitudinal studies will be necessary to confirm these associations and to allow for designing interventions targeting the enhancement of protective factors among young people already at risk for serious substance use.     

Does elementary school alcohol, tobacco, and marijuana use increase middle school risk?

Purpose: To assess whether alcohol, tobacco, and other drug (ATOD) use in elementary school may have serious implications for continued ATOD use in middle school and beyond.

Methods: Longitudinal analyses were conducted on questionnaire data from 331 middle school students who had previously provided ATOD-use data during elementary school. Non-school personnel administered questionnaires in three participating school districts in three different states. The sample of students was ethnically and geographically diverse, including students from a range of low socioeconomic status backgrounds living in rural, urban or inner-city environments.

Results: Middle school alcohol use was almost three times as likely to occur if alcohol use had occurred in elementary school (OR = 2.94, p < .001). Elementary school use of tobacco and marijuana also greatly increased the likelihood of middle school use (OR = 5.35, p < .001 and OR = 4.25, p < .05, respectively).

Conclusions: Early use of ATOD is associated with greatly increased odds of later use, which has important implications for the timing of drug prevention programs. Preventive interventions designed for use in pediatric practice settings should commence no later than elementary school, during the middle childhood years.     

A case-control study of psycholotical and psychosocial risk factors for shoulder and neck pain at the workplace

Risk factors associated with work-related shoulder and neck myalgia were investigated in a case-control study with pairs matched for age, gender, and physical exposure. Guided interviews with standardized and self-constructed questionnaires were performed among manual (n = 15 pairs) and office (n = 24 pairs) workers. Perceived general tension was the variable with the strongest association with shoulder and neck pain in both work groups. Otherwise, the results in the two groups were very different, indicating that different risk factors and mechanisms were associated with shoulder and neck pain in the two work groups. The study provides background information for future attempts to establish causal relationships between physical and psychosocial exposure and shoulder and neck pain, which can be more accurately investigated in a longitudinal rather than a cross-sectional experimental design.     

Investigating the early impacts of the COVID-19 pandemic on modifiable risk factors for cancer and chronic disease: a repeated cross-sectional study in Alberta,Canada

ObjectivesThis study contributes to empirical evidence by examining the impact of the first and second waves of the COVID-19 pandemic on modifiable risk factors (MRF) and whether these patterns differ according to level of material deprivation among people living in Alberta.MethodsUsing data from a repeated cross-sectional provincial health survey (Alberta Community Health Survey (ACHS): 2018–2021), we conducted logistic regression analyses examining the impacts of the COVID-19 pandemic on meeting national guidelines on four MRFs (tobacco use, physical activity, fruit and vegetable consumption, alcohol use) (n=11,249). We compared population-level changes in MRFs from one year before the COVID-19 pandemic (March 2019–February 2020) to one year during the pandemic (March 2020–February 2021) in Alberta. We also assessed whether these trends differed by a measure of material deprivation.ResultsCompared to the pre-COVID-19 period, the fully adjusted odds of meeting recommended guidelines for fruit and vegetable consumption (OR=0.42) decreased during the pandemic. Individuals experiencing high material deprivation had lower odds of meeting recommended guidelines for physical activity (OR=0.65) and higher odds of not being current tobacco users (OR=1.36) during the pandemic versus during the pre-pandemic period.ConclusionAt a population level, analyses from the ACHS showed minimal impacts of the first year of the COVID-19 pandemic on MRFs, besides fruit and vegetable consumption. Yet, stratifying results showed statistically significant differences in pandemic impacts on MRFs by level of material deprivation. Therefore, understanding the influence of material deprivation on MRFs during the pandemic is key to tailoring future public health interventions promoting health and preventing cancer and chronic disease.     

Factors related to the potential risk of trying an illicit drug among high school students in Paris

To identify risk factors of trying an illicit drug among adolescents exposed to an environment strongly using licit drugs, attitude toward illicit drugs, and use of tobacco, alcohol and tranquilizers were explored in a high school in Paris, April 1990. After a semi-directive interview and a pilot test, 233 students of one class chosen at random out of three at each high school level, completed an anonymous questionnaire. Logistic regression was used to detect risk factors of trying an illicit drug. Three kinds of risk factors were identified: (a) licit drugs: alcoholic drunkenness and abstaining from tranquilizers if personal discomfort is present, (b) peer modeling: presence of a fellow using marijuana, and (c) risk notion: weak risk notion on hashish use and belief that hard and soft drug use are not related. One student in 3 appeared at potential risk of trying an illicit drug. The risk factors suggested by this study may be used to set a policy of illicit drug primary prevention among adolescent specified populations. The importance of environmental factors is underlined.     

Early Life Predictors of Adult Depression in a Community Cohort of Urban African Americans

Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic.     

不同性别冠心病患者危险因素及冠状动脉病变特点分析

目的 分析不同性别冠心病(CHD)患者危险因素及其冠状动脉(冠脉)病变的特点.方法 纳入2009年1月至2011年1月在解放军总医院经冠脉造影确诊为CHD患者共3765例(男性2661例,女性1104例),收集患者各类临床资料及冠脉病变数据.根据患者年龄和性别进行分层,应用logistic回归模型分析CHD传统危险因素及冠脉病变的特点.结果 (1)女性发病年龄迟于男性,且合并CHD传统危险因素多;女性随年龄增长,吸烟的比例下降,血脂异常和糖尿病的比例显著升高.男性患者中,吸烟是最常见的危险因素.(2)性别间比较的logistic回归模型提示,糖尿病可显著增加女性罹患CHD的风险(OR=2.05,95％CI:1.49～ 2.81,P＜0.001),而吸烟则可明显增加男性罹患CHD的风险(OR=9.27,95％CI:7.68～11.19,P＜0.001).(3)随着年龄增长,女性患者冠脉病变支数增加,血管狭窄程度加重;而男性冠脉病变程度无随年龄增长而变化的趋势.结论 不同性别的CHD患者在不同年龄段具有不同的危险因素和冠脉病变特点.糖尿病和血脂异常似对女性冠脉病变的影响较大,而吸烟则对男性影响较大.     

Longitudinal Trajectories of Posttraumatic Stress Disorder Symptoms and Binge Drinking Among Adolescent Girls: The Role of Sexual Victimization

Purpose

Many studies have documented associations among sexual victimization (SV), posttraumatic stress disorder (PTSD) symptoms, and alcohol use; however, few have examined these associations longitudinally among adolescents. The present study evaluated the effect of SV on the longitudinal trajectory of PTSD symptoms and binge drinking (BD) among adolescent girls, a population known to have high rates of SV and alcohol use.

Methods

Participants (N = 1,808 at wave 1) completed interviews regarding PTSD symptoms, BD, and SV experiences over approximately 3 years.

Results

Multilevel modeling revealed decreases in PTSD symptoms over the course of the study; however, compared with nonvictims, adolescents who were sexually victimized reported greater PTSD symptoms at wave 1 and maintained higher levels of PTSD symptoms over the course of the study after controlling for age. SV reported during the study also predicted an acute increase in PTSD symptoms at that occasion. BD increased significantly over the course of the study; however, SV did not predict initial BD or increases over time. SV reported during the study was associated with acute increases in BD at that occasion, although this effect diminished when participants reporting substance-involved rape were excluded.

Conclusions

SV was associated with immediate and long-lasting elevations in PTSD symptoms, but not with initial or lasting elevations in BD over time, suggesting that adolescent victims have yet to develop problematic patterns of alcohol use to cope with SV. However, SV was associated with acute increases in PTSD symptoms and BD, suggesting a need for BD interventions to reduce alcohol-related SV.     

Attributable risk of psychiatric and socio-economic factors for suicide from individual-level, population-based studies: a systematic review

The overall importance of a risk factor for suicide in a population is determined not only by the relative risk (RR) of suicide but also the prevalence of the risk factor in the population, which can be combined with the RR to calculate the population attributable risk (PAR). This study compares risk factors from two well studied domains of suicide research - socio-economic deprivation (relatively low RR, but high population prevalence) and mental disorders (relatively high RR risk, but low population prevalence). RR and PAR associated with suicide was estimated for high prevalence ICD-10/DSM-IV psychiatric disorders and measures of socio-economic status (SES) from individual-level, population-based studies. A systematic review and meta-analysis was conducted of population-based case-control and cohort studies of suicide where relative risk estimates for males and females could be extracted. RR for any mental disorder was 7.5 (6.2-9.0) for males and 11.7 (9.7-14.1) for females, compared to RR for the lowest SES groups of 2.1 (1.5-2.8) for males and 1.5 (1.2-1.9) for females. PAR in males for low educational achievement (41%, range 19-47%) and low occupational status (33%, range 21-42%) was of a similar magnitude to affective disorders (26%, range 7-45%) and substance use disorders (9%, range 5-24%). Similarly in females the PAR for low educational achievement (20%, range 19-22%) was of a similar magnitude to affective disorders (32%, range 19-67%), substance use disorder (25%, range 5-32%) and anxiety disorder (12%, range 6-22%). The findings of the present study suggest that prevention strategies which focus on lower socio-economic strata (more distal risk factors) have the potential to have similar population-level effects as strategies which target more proximal psychiatric risk factors in the prevention and control of suicide.     

Associations of family environment and individual factors with tobacco, alcohol and illicit drug use in adolescents

Despite abundant literature the respective roles of psychosomatic status, personality, health perception, family environment, and sport activity in tobacco, alcohol and illicit drug use have not been well known. To assess their roles, an epidemiological cross-sectional study was conducted in 3294 middle and high school adolescents, 2396 (73%) of whom agreed to participate. The standardized questionnaire was filled out by the teenagers under the supervision of the teachers. Strong associations were found between tobacco, alcohol, and illicit drug use. The prevalence of alcohol use and illicit drug use were respectively 7 and 10 times higher in smokers than in non-smokers. On the whole, the potential risk factors for tobacco, alcohol, and illicit drug use were age, psychosomatic status and psychotropic drug consumption, boring family atmosphere, not living with both father and mother, and health perception. Mother being a housewife was a protective factor. No marked role was noted for the head of family's socio-occupational category. Personality would be indicators of self-control ability. Indeed, some self-reported personalities (serious, attentive, calm, organized) had protection roles whereas some others (easily irritable, aggressive, worried, clumsy, careless, solitary, etc.) were risk factors (risk-taking or deviant behaviors). Some sports activities were found to be negatively related, but some others related positively with drug use, possibly due to repetitive meetings between the adolescents at risk. Preventive measures may be targeted at these risk factors.     

糖尿病发病的社会心理风险因素流行病学研究进展

糖尿病的患病率和疾病负担不断增加,成为全球重大公共卫生问题。随着生物-心理-社会医学模式的提出,社会心理因素对糖尿病的影响逐渐引起重视。本文对影响糖尿病发病的社会心理因素流行病学研究进行综述,国外研究显示心理因素与糖尿病的发病密切相关,关于社会因素的研究较少且结论不一致。国内相关研究相对较少且多为小样本横断面研究,仍需更多纵向研究来证实社会心理因素对糖尿病发病的作用。     

DSM-IV alcohol dependence and drinking in the U.S. population: A risk analysis

PURPOSE: This paper examines the relationship between alcohol dependence according to the criteria found in the 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association and drinking in the U.S. general population.

METHODS: The data set under analysis is the 1988 National Health Interview Survey, which interviewed a probability sample of 22,102 adult drinkers in the U.S. household population. The response rate was 86%.

RESULTS: Results indicate that there is a linear relationship between DSM-IV dependence and the mean number of drinks consumed per day, or the number of days drinking five or more glasses of alcohol in the past 12 months. Respondents who reported consuming five or more drinks in a day have about six times more chances of being dependent than respondents who did not report such pattern of drinking. Older drinkers are less at risk than younger drinkers.

CONCLUSIONS: There is a risk of alcohol dependence at relatively low volumes of consumption. The risk increases gradually with the volume of consumption. An added and higher risk exists when drinkers engage in a pattern of consumption involving the ingestion of five or more drinks per day.     

吸烟饮酒作为低发区鼻咽癌致病因素的分析

目的研究我国鼻咽癌低发地区吸烟、饮酒与鼻咽癌致病的关系。方法使用标准化的调查表收集2005年1月～2008年10月湖北省内的245例鼻咽癌及245名与之性别、年龄（±5岁）配对的健康人群的相关信息,并比较他们的吸烟及饮酒习惯。结果本研究发现吸烟可增加鼻咽癌的致病危险性（OR调整=2.22;95%CI：1.42～3.49）。吸烟累积量与鼻咽癌致病危险性有剂量效应关系。吸烟累积量（每天吸烟的支数×烟龄）为300～600支的人患病的危险性是300支以下的人的7.19倍（OR调整=7.19;95%CI：3.02～17.11）,而当吸烟累积量达600支以上,患病危险性则提高到11.89倍（OR调整=11.89;95%CI：4.14～34.13）。重度饮酒能够导致鼻咽癌致病危险性提高,且结果有统计学意义。结论吸烟是鼻咽癌致病的危险因素,吸烟的累积量与鼻咽癌致病风险有剂量效应关系;重度饮酒可导致鼻咽癌发病危险性提高。     

Enduring consequences of parenting for risk behaviors from adolescence into early adulthood

Few studies examine the long-term consequences of family socialization experienced during early adolescence for the health and well being of young adults. This study investigates how two salient dimensions of family socialization--family closeness and parental behavioral control--are associated with three distinct risk-taking behaviors in early adulthood: problem drinking, early school dropout and multiple sex partners. Data from the US National Longitudinal Study of Adolescent Health are analyzed for a sample of over 1500 youth interviewed at three time points (Time 1: ages 12-14 years; Time 2: ages 13-15 years; Time 3: ages 19-21 years). Structural equation modeling techniques were used to identify direct and indirect effects of family closeness and parental behavioral control on problem behaviors among young adults. Indirect effects of family socialization were hypothesized to operate through a delayed onset of risky behaviors in adolescence. Results for females indicated that greater family closeness in early adolescence was directly and indirectly, through less adolescent truancy, associated with less school dropout in young adulthood. Family closeness was also directly associated with less early onset of sex and with fewer sex partners among females. Among males, greater parental behavioral control was directly associated with less problem drinking in young adulthood. Additionally, parental control and family closeness were each associated with males having fewer sex partners in early adulthood. Overall, findings support the strategy of family-focused interventions that stress the importance close relationships for females and of instrumental control for males.