Ethnic variation in socioenvironmental factors that influence adolescent smoking

PurposeTo compare black, Hispanic and white adolescent smokers on socioenvironmental factors associated with smoking.MethodsThe study uses a cross-sectional design. A needs assessment of 1305 current, former and never adolescent smokers from four ethnically and geographically diverse sites in the United States was conducted in 1999. Two sites were selected because they represented urban cities in the Northeast and Midwest with a high proportion of black and Hispanic residents. Two additional sites were selected to recruit rural and suburban adolescents. From this larger sample, 181 subjects from three focal ethnic groups (white n = 138; black n = 24; Hispanic n = 19) who had smoked at least 100 cigarettes in their lifetime and were current smokers (smoked in the past 30 days) were included. The three ethnic groups were compared on the following variables of interest: peer and family influences on smoking, situational factors associated with smoking, places that were likely sites for smoking and perceptions of friends and family as potential support persons for quitting smoking. All data were analyzed with Chi-square analysis.ResultsAlmost all (96%) of the black adolescents lived with another smoker compared to 68% of Hispanic and 60% of whites (p = .004). Black teens were more likely to smoke with family members (50%) than Hispanics (5%) or whites (25%) (p = .003). In addition, 50% of black teens compared to 5% of Hispanics and 12% of white teens, reported smoking to fit in (p < .0001). Black teens in this study emphasized the familial and social pressures of smoking. Higher rates of acceptance of smoking by family members, role modeling by household members, more prevalent beliefs that smoking is a way to achieve belonging, and lack of perceived support for quitting by friends appear to influence cigarette smoking more for black than white or Hispanic youth.ConclusionsThese preliminary results indicate that familial and household norms play a critical role in influencing cigarette smoking among black teens.     

Social network influences on adolescent substance use: disentangling structural equivalence from cohesion

This study investigates two contagion mechanisms of peer influence based on direct communication (cohesion) versus comparison through peers who occupy similar network positions (structural equivalence) in the context of adolescents' drinking alcohol and smoking. To date, the two contagion mechanisms have been considered observationally inseparable, but this study attempts to disentangle structural equivalence from cohesion as a contagion mechanism by examining the extent to which the transmission of drinking and smoking behaviors attenuates as a function of social distance (i.e., from immediate friends to indirectly connected peers). Using the U.S. Add Health data consisting of a nationally representative sample of American adolescents (Grades 7-12), this study measured peer risk-taking up to four steps away from the adolescent (friends of friends of friends of friends) using a network exposure model. Peer influence was tested using a logistic regression model of alcohol drinking and cigarette smoking. Results indicate that influence based on structural equivalence tended to be stronger than influence based on cohesion in general, and that the magnitude of the effect decreased up to three steps away from the adolescent (friends of friends of friends). Further analysis indicated that structural equivalence acted as a mechanism of contagion for drinking and cohesion acted as one for smoking. These results indicate that the two transmission mechanisms with differing network proximities can differentially affect drinking and smoking behaviors in American adolescents.     

Systematic review of social network analysis in adolescent cigarette smoking behavior

BACKGROUND: Social networks are important in adolescent smoking behavior. Previous research indicates that peer context is a major causal factor of adolescent smoking behavior. To date, however, little is known about the influence of peer group structure on adolescent smoking behavior. METHODS: Studies that examined adolescent social networks with regard to their cigarette smoking behavior were identified through online and manual literature searches. Ten social network analysis studies involving a total of 28,263 adolescents were included in the final review. RESULTS: Of the 10 reviewed studies, 6 identify clique members, liaisons, and isolates as contributing factors to adolescent cigarette smoking. Significantly higher rates of smoking are noted among isolates than clique members or liaisons in terms of peer network structure. Eight of the reviewed studies indicate that peer selection or influence precedes adolescents' smoking behavior and intent to smoke. Such peer selection or influence accounts for a large portion of similarities among smoking adolescents. CONCLUSION: Adolescents who are identified as isolates are more likely to smoke and engage in risk‐taking behaviors than others in the peer network structure. Given that the vast majority of current adult smokers started their smoking habits during adolescence, adolescent smoking prevention efforts will likely benefit from incorporating social network analytic approaches and focusing the efforts on isolates and other vulnerable adolescents from a peer selection and influence perspective.     

An exploration of the influence of family on cigarette smoking among American Indian adolescents

American Indians have the highest smoking rate of all major racial/ethnic groups in the US, despite significant variation across tribes and regions of the country. Yet, little research has been conducted on smoking initiation among American Indian adolescents. In an effort to identify the mechanisms through which families influence teen smoking, both positively and negatively, 20 focus groups were conducted with 144 non-reservation American Indian teens in Oklahoma. Findings indicated that most of the antismoking messages from family members were given by parents and grandparents, and focused on the long-term health consequences of smoking and addiction. Parental responses to teen smoking varied widely, with some responses sending mixed messages to the teens. Many teens discussed obtaining their first cigarette in a family setting and the teens felt that having smokers in their families influenced them to try smoking. Teens were able to discuss the traditional role of tobacco in their culture and were aware of its presence at Indian events, but felt ceremonial and traditional use was distinct from recreational use. Additional research is necessary to assess whether these results are generalizable to other tribes and regions, and to other racial/ethnic groups.     

Prospective Analysis of Peer and Parent Influences on Smoking Initiation Among Early Adolescents

The nature and relative importance of psychosocial influences on smoking initiation among early adolescents are topics of substantial research interest. Students (N = 1081) from four middle schools were surveyed at the beginning and end of the sixth grade. Baseline predictors were regressed on smoking initiation at end of sixth grade. In bivariate, logistic regression analyses association with problem behaving peers, perceived prevalence, and depression were positively associated and adjustment to school, perceived social competence, parent expectations, parental monitoring, and parental involvement were negatively associated with smoking initiation. In multivariate logistic regression analyses controlling for sex, race, and school, peer affiliation and perceived prevalence were positively associated, whereas social competence and parental monitoring were negatively associated with smoking initiation. A significant interaction between parental involvement and peer affiliation indicated that among teens with problem behaving friends only those with parents who were relatively uninvolved were are at increased risk for smoking initiation. This finding held for boys, girls, Whites, Blacks, and teens living in single parent families. These findings provide evidence that antecedent parenting behaviors may protect early adolescents against smoking even in the context of negative peer affiliation.     

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.     

Receptivity to protobacco media and its impact on cigarette smoking among ethnic minority youth in California

Adolescents from different ethnic groups show different cigarette smoking prevalence rates, suggesting potential differences in receptivity to and influences from protobacco media. Understanding these differences will be helpful in tailoring smoking prevention and cessation programs for diverse adolescent populations in the United States. Data from cross-sectional surveys of 20,332 randomly sampled California boys and girls, 12-17 years of age, were analyzed. Results indicate that receptivity to protobacco media was lower among African Americans, Asian Americans, and Hispanics than among White youth. There was a consistent dose-response relationship between receptivity to protobacco media and 30-day cigarette smoking across ethnic groups. Having a cigarette brand preference was associated with the highest risk for cigarette smoking, having a favorite tobacco ad showed the lowest risk, while having received or being willing to use tobacco promotional items was associated with a moderate risk. After controlling for 13 covariates, the odds ratio for receptivity to protobacco media and 30-day cigarette smoking was significant for Whites (RR = 1.38, p < 0.01) and Hispanics (RR = 1.46, p < 0.01), but not for African American (RR = 1.05, p > 0.05) and Asian American (RR = 1.17, p > 0.05) youth. African American, Asian American, and Hispanic adolescents have a lower level of receptivity to protobacco media than do Whites. The association between media receptivity and 30-day cigarette smoking exists for all four ethnic groups without controlling for other smoking predictor variables, but only for Hispanics and Whites when other variables are controlled. Protecting adolescents from protobacco advertising influences is an important element in tobacco control among ethnic minority youth.     

Receptivity to Protobacco Media and Its Impact on Cigarette Smoking Among Ethnic Minority Youth in California

Adolescents from different ethnic groups show different cigarette smoking prevalence rates, suggesting potential differences in receptivity to and influences from protobacco media. Understanding these differences will be helpful in tailoring smoking prevention and cessation programs for diverse adolescent populations in the United States. Data from cross-sectional surveys of 20,332 randomly sampled California boys and girls, 12-17 years of age, were analyzed. Results indicate that receptivity to protobacco media was lower among African Americans, Asian Americans, and Hispanics than among White youth. There was a consistent dose-response relationship between receptivity to protobacco media and 30-day cigarette smoking across ethnic groups. Having a cigarette brand preference was associated with the highest risk for cigarette smoking, having a favorite tobacco ad showed the lowest risk, while having received or being willing to use tobacco promotional items was associated with a moderate risk. After controlling for 13 covariates, the odds ratio for receptivity to protobacco media and 30-day cigarette smoking was significant for Whites (RR = 1.38, p < 0.01) and Hispanics (RR = 1.46, p < 0.01), but not for African American (RR = 1.05, p > 0.05) and Asian American (RR = 1.17, p > 0.05) youth. African American, Asian American, and Hispanic adolescents have a lower level of receptivity to protobacco media than do Whites. The association between media receptivity and 30-day cigarette smoking exists for all four ethnic groups without controlling for other smoking predictor variables, but only for Hispanics and Whites when other variables are controlled. Protecting adolescents from protobacco advertising influences is an important element in tobacco control among ethnic minority youth.     

Behavioral health in multiracial adolescents: the role of Hispanic/Latino ethnicity

OBJECTIVES: The purpose of the present study was twofold: (1) to determine whether adolescents who self-identify as multiracial have more adverse health behaviors than their monoracial counterparts, and (2) to examine whether the health behaviors of adolescents who are multiracial and Hispanic are more similar to those who identify as monoracial Hispanic or those who are multiracial and non-Hispanic. METHODS: Secondary analyses of data in a subsample from the Youth Risk Behavior Survey of 3,704 (27.2%) adolescents who identified as Hispanic/Latino only, multiracial Hispanic, or multiracial non-Hispanic were conducted. Regression analyses were conducted using SUDAAN for the complex sampling to test for differences in health behaviors (i.e., smoking, exercise, substance abuse, and suicide risk) among the three ethnicity/race groups. RESULTS: Each health behavior scale yielded significant between-group differences according to ethnic/racial identity: Hispanic/Latino adolescents scored significantly lower than both multiracial groups on the measure of cigarette smoking, lower than multiracial Hispanic adolescents on the substance abuse scale, and lower than multiracial non-Hispanic adolescents on the measure of exercise. The multiracial Hispanic group was also at marginally increased risk for suicide compared to the Hispanic/Latino group. CONCLUSIONS: The results support the hypothesis that multiracial Hispanic adolescents have more behavioral health problems than monoracial Hispanic adolescents. The second hypothesis--that multiracial Hispanic adolescents are more similar to multiracial non-Hispanic adolescents--was also supported. The implications of these findings for the classification of Hispanic adolescents in terms of ethnicity and race in relation to health behaviors are discussed.     

Racial/ethnic differences in cigarette smoking initiation and progression to daily smoking: a multilevel analysis

OBJECTIVES: We sought to identify individual and contextual predictors of adolescent smoking initiation and progression to daily smoking by race/ethnicity. METHODS: We used data from the National Longitudinal Study of Adolescent Health to estimate the effects of individual (adolescent, family, peer) and contextual (school and state) factors on smoking onset among nonsmokers (n = 5374) and progression to daily smoking among smokers (n = 4474) with multilevel regression models. RESULTS: Individual factors were more important predictors of smoking behaviors than were contextual factors. Predictors of smoking behaviors were mostly common across racial/ethnic groups. CONCLUSIONS: The few identified racial/ethnic differences in predictors of smoking behavior suggest that universal prevention and intervention efforts could reach most adolescents regardless of race/ethnicity. With 2 exceptions, important contextual factors remain to be identified.     

Peer Reviewed: Risk and Protective Factors for Tobacco Use Among 8th- and 10th-Grade African American Students in Virginia

Introduction

Few studies have simultaneously examined the influence of multiple domains of risk and protective factors for smoking among African Americans. This study identified individual-peer, family, school, and community risk and protective factors that predict early cigarette use among African American adolescents.

Methods

Data from 1,056 African American 8th and 10th graders who completed the 2005 Community Youth Survey in Virginia were analyzed by using logistic regression.

Results

The prevalence of smoking among the weighted sample population was 11.2%. In univariate analyses, the strongest predictors of smoking were low academic achievement, peer drug use, and early substance use (individual domain). In multivariate analyses, these factors and being in the 10th grade were significant predictors. The single protective factor in multivariate analyses was in the school domain (rewards for prosocial behavior in the school setting). When family and community variables were entered into a model in which individual-peer and school factors were controlled for, these variables were not significantly associated with smoking, and they failed to improve model fit.

Conclusion

These findings suggest that tobacco prevention programs that aim to increase school connectedness while decreasing youth risk behaviors might be useful in preventing cigarette use among African American adolescents. Given the relative importance of peer drug use in predicting smoking among African American youth, more work is needed that explores the accuracy of youths'' perceptions of their friends'' cigarette use and how family factors may moderate this risk.     

Cigarette Initiation Among Chinese Male Teenagers in Early Smoking Interactions

To collect in-depth information regarding cigarette initiation interactions in the early smoking experimentation among male youth in China, twenty focus groups with male teenagers (N = 165) were conducted. Focus group discussions indicated a high prevalence of cigarette initiation among peers, and such initiation often translated into immediate smoking. Of the identified cigarette initiation appeals, “face” and normative pressure appeals were the most difficult to reject. Upon first initiation attempts, more teenagers accepted cigarettes than rejected them. The reasons behind both cigarette initiation and acceptance primarily related to facilitating social interaction. Upon being rejected, initiating teenagers (agents) who insisted on offering cigarettes often gained compliance. Profiles of peer agents were constructed in this study. Key practical implications suggest simultaneously prioritizing efforts to reduce cigarette initiation and encouraging cigarette refusal.     

Long-term secular trends in initiation of cigarette smoking among Hispanics in the United States

Preventing the initiation of cigarette smoking plays a vital role in reducing rates of cigarette smoking. The authors investigated trends in cigarette smoking initiation among Mexican Americans, Cuban Americans, Puerto Rican Americans, compared with whites, by examining the cigarette smoking histories of adults from the 1982-83 Hispanic Health and Nutrition Examination Survey and the 1987 National Health Interview Survey. To evaluate these trends, they calculated the prevalence of cigarette smoking among 20-24-year-olds, an indicator of the rate of smoking initiation, in successive 5-year birth cohorts from 1908-12 to 1958-62 among Hispanics and from 1908-12 to 1963-67 among whites. Recently, rates of smoking initiation among Mexican American and Cuban American men have declined and converged with rates of initiation among white men. However, rates of initiation among Puerto Rican American men appeared to have remained unchanged since the 1950s. During the 1970s rates of smoking initiation among Cuban American and Puerto Rican American women surpassed those of white women. In the early 1980s, however, rates of initiation among these groups of Hispanic women have declined to levels comparable to or perhaps lower than the rates among white women. Although recently the rates among Mexican American women have been the lowest of all groups of women, they have not experienced appreciable declines. In general, rates of smoking initiation either declined or leveled off later for Hispanics than for whites. These results suggest that Hispanics tended to follow the smoking trends observed among whites and that special efforts are needed to prevent cigarette smoking among Hispanics.     

Translation of health programs for American Indians in the United States

American Indian and Alaska Native (AI/AN) cultures in the United States include a diverse group of indigenous cultures that have been affected by their contact with European Americans and have suffered adverse psychological, physical, and economic consequences. AI/AN adolescents have the highest prevalence of cigarette smoking of all U.S. ethnic groups. Culturally competent health promotion programs are needed to enhance their resiliency and help them avoid recreational, addictive use of commercial tobacco. The authors describe the diverse AI/AN populations and their unique health and social issues, including adolescent smoking. They present examples of smoking prevention programs tailored or adapted for AI/AN adolescents and make recommendations for implementation and evaluation of prototype programs. Recommendations include involving the community, respecting tribes' wishes for confidentiality, being aware of IRB issues, beginning with formative and qualitative research, using culturally appropriate measures, understanding the diversity of AI/AN cultures, and involving multiple generations of the family.     

The validity of self-reports of smoking: analyses by race/ethnicity in a school sample of urban adolescents.

OBJECTIVES: This research compared the validity of self-reports of cigarette smoking for African-American, Hispanic, and White respondents. Previous research has raised a question about the validity of self-report for African Americans. METHODS: A self-report of cigarette smoking was obtained together with a measure of carbon monoxide from expired air. Convergence between self-reported smoking and the biochemical measure was analyzed separately for three ethnic groups at 7th grade, 8th grade, 9th grade, and 10th grade. RESULTS: Analyses indicated that the validity of self-reports of smoking was generally comparable across ethnic groups. Sensitivity and specificity were comparable with data reported in recent meta-analyses. Though sensitivity was slightly lower for minority adolescents than for White adolescents, prevalence rates corrected for group differences in sensitivity showed significantly lower smoking rates for African-American and Hispanic adolescents than for White adolescents. CONCLUSIONS: The lower smoking rates reported for African-American adolescents are real and are not substantially a consequence of reporting artifacts.     

A school-based smoking prevention program for adolescent girls in New York City

Teenaged girls comprise the largest percentage of new cigarette smokers in the United States today. Factors contributing to smoking initiation include peer pressure, family and social influences, cigarette availability, and cigarette advertising. Because three-quarters of smokers become dependent on cigarettes by age 20, smoking prevention programs aimed at the adolescent population have great potential. The proposed program outlined is directed at girls 12 to 18 years of age in New York City. Among the objectives are increasing students' knowledge of the short- and long-term health effects of smoking and awareness of the social factors which lead to smoking. Participants would be taught social skills and behaviors which could help them to resist initiating smoking, by such activities as assertiveness training through role playing. Endurance sports activities would be emphasized while learning of the effects of smoking on physical conditioning. The costs of such a program are estimated, and classroom activities are outlined.     

The North Norwegian Youth Study: cigarette smoking among ethnically diverse adolescents

Objectives: To examine ethnic and gender differences in the prevalence of cigarette smoking among indigenous Sami, ethnocultural Kven and majority Norwegian adolescents, and ethnic-specific gender differences in smoking. Design: 'The North Norwegian Youth Study' was a longitudinal epidemiological study. It collected data at two time points at a three-year interval (1994/95 and 1997/98). It was based on student self-reports (10-12th grade) from 21 state schools in North Norway. The initial analysis included 2997 students aged 15-19 years (response rate (RR): 85%) and 1533 responders at follow-up (RR: 55%). The sample consisted of 12% Kvens, 23% Sami and 65% Norwegians. Results: Baseline (follow-up) smoking rates were; 38% (35%) never smokers, 29% (29%) current regular smokers, 11% (12%) current irregular smokers and 23% (24%) former smokers. Ethnic differences in cigarette smoking were minor and found at baseline only. Sami students reported a lower proportion of current irregular smokers (8%) and a higher rate of former smokers (26%). Gender differences were most pronounced at baseline with females more involved in cigarette smoking than their male peers. However, males were more likely to be heavy smokers at both time points. Conclusions: Cigarette smoking among adolescents and young people in North Norway was generally independent of the ethnicity of the respondents. There were no ethnic differences in smoking rates at follow-up. Sami youth were not at higher risk of cigarette smoking than their non-indigenous peers. This finding contrasts with findings among other Arctic indigenous youth.     

Inter-ethnic differences in youth tobacco language and cigarette brand preferences

Objective. To describe and understand variations in cigarette brand preferences between adolescents from varying ethnic and gender groups around the US. Design. A qualitative study where adolescents, both smokers and nonsmokers, were interviewed individually in depth. Setting. Schools and recreation centers in four sites: urban Maryland (Baltimore), urban Texas (Houston), rural Alabama and rural New Mexico. Participants. 121 adolescent volunteers 13-19 years of age, representing African American, white, American Indian and Hispanic ethnic groups, from both genders. Results. Considerable geographic and ethnic variation exists in terminology used by youth to refer to cigarettes and to their use. Clear patterns in brand preference by ethnic group were found that follow patterns of targeted marketing by ethnicity. White teens preferred Marlboro brand cigarettes, while African-American teens who smoke preferred Newports. Hispanic and American Indian teens were more likely to smoke Marlboro or Camel cigarettes. Hispanic teens were most likely to mention low price as a reason for choosing a particular brand or to state that the brand does not matter. Tobacco advertisements targeting ethnic groups and the use of promotional items to encourage teen smoking were also recognized as factors influencing brand preferences. Conclusions. These findings have implications for the design of intervention programs aimed at curbing teen smoking. When working with teens who already smoke, using youth language to target messages at perceived characteristics of commonly used brands may be more effective and meaningful than talking about cigarette use in general. Another implication of this work is to shed light on what impact an advertising ban would have on teen brand preferences, brand loyalty, and prevalence of smoking.     

Being a Young Migrant in Italy: The Effect of Perceived Social Support in Adolescence

Parental and peer support seems to be a favourable determining factor in the acculturation process among young immigrants. We aimed to assess the level of perceived support among first- and second-generation adolescent immigrants and compare it to that perceived by the adolescents from the host population. Using Italian HBSC survey data collected in 2013–2014, first- and second-generation immigrants aged 11, 13 and 15 years were classified according to their ethnic background as being from Western countries, Eastern European countries, or from non-Western/non-European countries. The domains of teacher, classmate, family, and peer support was measured through multidimensional, standardised, validated scales. Analyses were run on a 47,399 valid responses (2195 from Western countries, 2424 from Eastern European countries, and 2556 from non-Western/non-European countries). Adolescent immigrants from Eastern European countries and non-Western/non-European countries reported significantly lower support than their peers from the host population in all explored domains. Girls perceived a lower level of classmate and family support compared to boys across all ethnic backgrounds. We observed two different immigration patterns: the Western pattern, from more affluent countries, and the Eastern pattern. Among the latter, second-generation immigrants showed the lowest level of support in all domains. Increasing family connections and developing peer networks should favour the acculturation process among adolescent immigrants.     

Characteristics of social networks in adolescents with end-stage renal disease treated with renal transplantation

In adolescents, the establishment of same- and opposite-sex nonfamily peer relations facilitates the normal development of independence and separation from family. Adolescents with end-stage renal disease (ESRD) may be particularly vulnerable to delayed social development and isolation from their peers because of the unique physical and psychosocial aspects of their illness. The characteristics of the social networks of 16 adolescents with ESRD treated with renal transplantation were studied using the Social Networks of Youth Questionnaire. Compared with a matched group of healthy adolescents, these teenagers named fewer significant others in their total social networks, as well as fewer unrelated and opposite-sex peers. Family members comprised a greater proportion of the transplant patients' networks compared to controls. Self-esteem, measured by the Coopersmith Self-Esteem Scale, was similar for transplant and control groups, with the exception of home self-esteem, which was higher in the chronically ill adolescents. Body image was somewhat lower, but not significantly, in adolescents with ESRD. The characteristics of the chronically ill adolescents' social networks suggest that these patients may experience a degree of social isolation. Interventions that promote increased peer contacts and enhance interpersonal skills should be included in the psychosocial management of adolescents with ESRD after renal transplantation.