Parental smoking cessation and adolescent smoking

OBJECTIVE: To examine the relation of parent smoking cessation to adolescent smoking and test its potential mediators. METHOD: Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes. RESULTS: Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. In general, ex-smoking parents showed more antismoking socialization than did smoking parents. However, in children's reports, these effects were negated if the other parent (particularly the mother) smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking. CONCLUSIONS: Parental smoking cessation may help lower risk for adolescent smoking. However, this benefit may be realized only if the other parent does not currently smoke. Antismoking parenting might be a useful focus in cessation interventions.     

Predictors of adolescent smoking cessation and smoking reduction

Objective

To investigate the processes of change, demographic, health- and smoking-related predictors of both smoking cessation and smoking reduction in adolescents.

Methods

Data were drawn from a sample of 755 adolescent smokers who participated in a study testing the efficacy of a text messaging-based intervention for smoking cessation. Demographic, health- and smoking-related variables were assessed at baseline. Five processes of smoking cessation, derived from the Transtheoretical Model and the Social Cognitive Theory, as well as outcome measures were assessed at 6-month follow up. Univariate and multivariate regression analyses were conducted to identify baseline and process variables to predict smoking abstinence and smoking reduction.

Results

Male gender (OR = 0.43, p < .01), lower alcohol consumption (OR = 0.90, p = .05) and a lower number of cigarettes smoked per day at baseline (OR = 0.87, p < .01) predicted smoking abstinence. Baseline physical activity predicted smoking reduction (OR = 1.04, p = .03). None of the examined process variables significantly predicted smoking abstinence. The process variable “counter-conditioning” predicted smoking reduction (OR = 1.46, p = .03).

Conclusions

Baseline predictors of smoking cessation differ from predictors of smoking reduction. Dynamic or modifiable variables play an important role in predicting adolescent smoking cessation.

Practice implications

Counter-conditioning might be an important element in adolescent smoking cessation interventions.     

A situational analysis of adolescent smoking

Forty-four adolescent smokers self-monitored their smoking for 1 week. For 4 hr each day subjects recorded the person, place, and activity associated with each cigarette smoked. Seventy-one percent of all cigarettes were smoked in the presence of another person. Roughly half of those cigarettes were smoked with peers. A surprising amount of smoking occurred in the subject's own home, suggesting that the smoking of the subjects is accepted, if not condoned, by their parents. The data generally confirm the social nature of adolescent smoking.     

The impact of self-control indices on peer smoking and adolescent smoking progression

OBJECTIVE: To determine the direct impact of self-control variables on baseline smoking and smoking progression and determine whether self-control had indirect effects on smoking practices through effects on peer smoking. METHODS: Study participants were 918 adolescents who were followed from 9th through the 12th grade and completed self-report measures of peer smoking, self-control, and cigarette smoking. An exploratory factor analysis (EFA) was conducted to assess the factor structure of a 41-item self-control measure. The EFA indicated a six-factor structure comprising of impulsive control, planning, hostile blaming, attentional disregulation, conscientiousness, and physical aggression. RESULTS: The results of a latent growth model indicated that conscientiousness (OR = 0.81, CI = 0.73-0.90), hostile blaming (OR = 0.89, CI = 0.81-0.99), and physical aggression (OR = 1.16, CI = 1.06-1.27) had direct effects on baseline smoking, whereas planning (OR = 0.90, CI = 0.82-0.99) and impulse control (OR = 1.15, CI = 1.02-1.28) had indirect effects on adolescent smoking at baseline through baseline peer smoking. There were no significant direct or indirect effects of the self-control indices on smoking progression. There was a direct effect of peer smoking progression (number of peers who smoked) on adolescent smoking progression, such that increases in the number of peers who smoked across time increased the odds that an adolescent would progress to a higher level of smoking. CONCLUSIONS: Youth smoking prevention and intervention program outcomes may potentially improve by addressing self-control behaviors as they appear to have direct effects on smoking and indirect effects through peers who smoke.     

Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation

OBJECTIVE: Evaluation of novel treatment delivery methods, such as the Internet are notably absent from the adolescent smoking treatment literature. METHODS: Adolescent smokers ages 11-18 years were randomized to a clinic-based, brief office intervention (BOI; N=69) consisting of four individual counseling sessions; or to Stomp Out Smokes (SOS), an Internet, home-based intervention (N=70). Adolescents in SOS had access to the SOS site for 24 weeks. RESULTS: The 30-day, point-prevalence smoking abstinence rates for BOI and SOS were 12% versus 6% at week 24 and 13% versus 6% at week 36, with no significant treatment differences. Among participants who continued to smoke, SOS was associated with a significantly greater reduction in average number of days smoked than BOI (P=0.006). The BOI was found to be feasible with high session attendance rates. SOS participants accessed the site a mean+/-S.D. of 6.8+/-7.1 days. SOS use dropped to less than one-third of participants by week 3. CONCLUSION: Additional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components. PRACTICE IMPLICATIONS: Augmenting the SOS type of intervention with more structured, personal and proactive patient-education components delivered in-person or by telephone or electronic mail is recommended.     

Randomized clinical trial of an Internet-based versus brief office intervention for adolescent smoking cessation

ObjectiveEvaluation of novel treatment delivery methods, such as the Internet are notably absent from the adolescent smoking treatment literature.MethodsAdolescent smokers ages 11–18 years were randomized to a clinic-based, brief office intervention (BOI; N = 69) consisting of four individual counseling sessions; or to Stomp Out Smokes (SOS), an Internet, home-based intervention (N = 70). Adolescents in SOS had access to the SOS site for 24 weeks.ResultsThe 30-day, point-prevalence smoking abstinence rates for BOI and SOS were 12% versus 6% at week 24 and 13% versus 6% at week 36, with no significant treatment differences. Among participants who continued to smoke, SOS was associated with a significantly greater reduction in average number of days smoked than BOI (P = 0.006). The BOI was found to be feasible with high session attendance rates. SOS participants accessed the site a mean ± S.D. of 6.8 ± 7.1 days. SOS use dropped to less than one-third of participants by week 3.ConclusionAdditional research is needed to tap the potential capabilities of the Internet for adolescent smoking cessation using proactive, personalized, patient-education components.Practice implicationsAugmenting the SOS type of intervention with more structured, personal and proactive patient-education components delivered in-person or by telephone or electronic mail is recommended.     

Measurement of adolescent smoking behavior: Rationale and methods

The initiation of cigarette smoking among adolescents is a health problem which has been the subject of discussion and study for many years. The evaluation of strategies to deter the adoption of smoking has long been hampered by the problems of measuring adolescent smoking behavior. Recently, interest has increased in biochemical measures of smoking under the assumption that they are more objective measures. The validity of this assumption is addressed for several ages of adolescents. This paper presents saliva thiocyanate levels, expired air carbon monoxide levels, and smoking self-reports from a sample of 2200 junior and senior high-school students. Interrelationships among the biochemical and behavioral measures are strong among the total population, ranging from 0.48 to 0.95 (Pearson r) but are much weaker at the younger age levels. Normative levels of carbon monoxide and saliva thiocyanate are presented by age (11-13, 14-15, and 16-17 years old). These data indicate that habitual smoking appears to develop in a gradual fashion and that several years may pass between initial experimentation and adult levels of smoking. Younger students consistently display lower levels of thiocyanate and carbon monoxide than older students of the same self-reported levels of smoking, suggesting that inhalation patterns may vary as a function of age or years smoking.     

Images of smokers and willingness to smoke among African American pre-adolescents: an application of the prototype/willingness model of adolescent health risk behavior to smoking initiation

OBJECTIVE: This study used the prototype/willingness model of adolescent health risk behavior to examine factors related to onset of smoking. METHODS: Two waves of data were collected from a panel of 742 African American children (mean age=10.5 at Wave 1) and their primary caregivers. Measures included cognitions outlined by the prototype model as well as self-reports of smoking by the parent and child. RESULTS: Structural equation modeling revealed a pattern consistent with expectations generated by the prototype model. The relation between contextual, familial, and dispositional factors-including neighborhood risk, parental smoking, and children's academic orientation-and the initiation of smoking at Wave 2, two years later, was mediated by the children's cognitions. Primary among these cognitions were the children's images of smokers and children's willingness to smoke. CONCLUSIONS: Smoking cognitions mediate the impact of important distal factors (such as context, family environment, and disposition) on the onset of smoking in children. Perhaps more important, it is possible to predict onset of smoking in African American children as young as age 10 by assessing the cognitive factors suggested by the prototype model.     

Interacting effects of depression and tobacco advertising receptivity on adolescent smoking

OBJECTIVE: To evaluate the independent effects of exposure to others who smoke and receptivity to tobacco advertising on adolescent smoking practices and the moderating influence of depression on these relationships. METHODS: Participants were 1,123 high school freshmen who completed a self-report survey as part of a longitudinal investigation of the biobehavioral predictors of adolescent smoking adoption. Sixty percent of freshmen reported that they were never smokers (i.e., never tried or experimented with smoking, even a few puffs), and 40% reported being ever smokers (i.e., ever smoked at least a partial or whole cigarette). RESULTS: In logistic regression models, the adjusted likelihood of ever smoking was greater for students reporting exposure to peer smoking. Further, a significant interaction was detected between receptivity to tobacco advertising and depression; specifically, adolescents with a high receptivity to tobacco advertising and clinically significant depressive symptoms were more likely to smoke than adolescents without these symptoms. CONCLUSIONS: Our data support the hypothesis that adolescents with both high advertising receptivity and depressed moods are most vulnerable to experiment with smoking. Tailoring prevention and intervention efforts to encompass tobacco advertising's effects and the role of depression could lead to a reduction in youth smoking.     

A model of psychosocial and cultural antecedents of blood pressure control

Hypertension is a major modifiable risk factor for stroke, congestive heart failure, and end-stage renal disease. Hypertension is particularly prevalent and deadly among African Americans. Effective treatment for hypertension has been available for decades, yet only one fourth of all individuals have their blood pressure under control. Despite the potential impact of hypertension, interventions to improve control have had limited success. We present a model of how to understand antecedents of blood pressure control according to three interrelated categories: patient characteristics, social and cultural environment, and medical environment. This theoretical paper was conducted using a literature review and a model to explain psychosocial antecedents of blood pressure control is presented. We conclude that improved understanding of important antecedents of blood pressure control coupled with technological advances, such as tailored interventions, provide clinicians with a tool that may lead to improved blood pressure control. These interventions will require the involvement of clinicians and consideration of sociocultural factors to be successful.     

Sex, ADHD symptoms, and smoking outcomes: an integrative model

Both females and individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have been found to be at increased risk for a range of smoking outcomes, and recent empirical findings have suggested that women with ADHD may be particularly vulnerable to nicotine dependence. On a neurobiological level, the dopamine reward processing system may be implicated in the potentially unique interaction of nicotine with sex and with ADHD status. Specifically, nicotine appears to mitigate core ADHD symptoms through interaction with the dopamine reward processing system, and ovarian hormones have been found to interact with nicotine within the dopamine reward processing system to affect neurotransmitter release and functioning. This article synthesizes data from research examining smoking in women and in individuals with ADHD to build an integrative model through which unique risk for cigarette smoking in women with ADHD can be systematically explored. Based upon this model, the following hypotheses are proposed at the intersection of each of the three variables of sex, ADHD, and smoking: (1) individuals with ADHD have altered functioning of the dopamine reward system, which diminishes their ability to efficiently form conditioned associations based on environmental contingencies; these deficits are partially ameliorated by nicotine; (2) nicotine interacts with estrogen and the dopamine reward system to increase the positive and negative reinforcement value of smoking in female smokers; (3) in adult females with ADHD, ovarian hormones interact with the dopamine reward system to exacerbate ADHD-related deficits in the capacity to form conditioned associations; and (4) during different phases of the menstrual cycle, nicotine and ovarian hormones may interact differentially with the dopamine reward processing system to affect the type and value of reinforcement smoking provides for women with ADHD. Understanding the bio-behavioral mechanisms underlying cigarette addiction in specific populations will be critical to developing effectively tailored smoking prevention and cessation programs for these groups. Overall, the goal of this paper is to examine the interaction of sex, smoking, and ADHD status within the context of the dopamine reward processing system not only to elucidate potential mechanisms specific to female smokers with ADHD, but also to stimulate consideration of how the examination of such individual differences can inform our understanding of smoking more broadly.     

实验性大鼠肺气肿模型的建立

目的:建立可行并可靠的大鼠肺气肿模型,为药物的筛选提供有效的方法。方法:20只SD大鼠随机分为对照组和模型组,每组各10只。模型组采用LPS致敏加烟熏诱导复制实验性肺气肿模型,30 d后观察各组大鼠的血气与肺组织的病理学变化情况。结果:血气分析发现模型组和对照组有显著性差异(P0.05);模型组病理结果显示出明显的肺气肿特征,经图像分析发现对照组平均肺泡面积明显低于模型组(P0.05)。结论:采用LPS加上烟熏诱导可以在较短时间内诱发大鼠肺气肿模型。     

Longitudinal changes in adolescent cigarette smoking behavior: Onset and cessation

Employing a 1-year longitudinal design, this study examined factors related to change in adolescent smoking. Predictors of smoking onset differed from predictors of continued smoking, underscoring the importance of studying factors related to adolescent smoking onset separately from mechanisms associated with changes in smoking among current smokers. Peer smoking predicted continuation of smoking after smoking initiation. Smokers received over 26 times more offers to smoke than did nonsmokers, suggesting that smokers attempting to quit need effective refusal skills to be successful. Habitual smoking was found to develop slowly, providing a substantial time window for refusal skill training and other prevention efforts. Predictors of smoking onset differed by developmental level. Peer smoking and marijuana use were stronger predictors of smoking onset for high-school students, and number of cigarette offers predicted better among middle-school students. Parent variables were not significant predictors of later smoking. Intention to smoke was unrelated to onset and was redundant with pretest smoking behavior in predicting cessation.This research was supported in part by Grants: HD13409 and HD15825 from the National Institute of Child Health and Human Development, CA38273 from the National Cancer Institute, and DA037706 from the National Institute on Drug Abuse.     

A model for disclosing the first trimester part of an integrated Down's syndrome screening test

This study was designed to evaluate a model for disclosing the first part of an integrated Down's syndrome (DS) test without affecting its low false-positive results. Parturient women underwent sequential DS-screening tests. They included nuchal translucency (NT) and biochemistry assessments in the first trimester and a mid-gestation triple test. Although screening tests results were given following each test, fetal karyotyping was performed by means of mid-gestation amniocentesis. The proposed approach for disclosure refers to either (a) cases picked by a statistical model (this is based on a logistic regression analysis and a receiver-operated curve that was set to a specificity of 100% of first-trimester markers pointing on at very high probability of aneuploidy) or (b) cases demonstrating a first trimester DS risk > or = 1 : 40 (a threshold level at which the integrated test results will always be screen positive). The results of the sequential screening and pregnancy outcome were available for 372 normal and 22 chromosomal affected singletons. NT and pregnancy-associated placental protein A emerged as the most sensitive marker combination. The statistical model picked up seven of 22 abnormal cases (32%), and a first-trimester DS risk > or = 1 : 40 was detected in 11 (50%) (there was an overlap of five cases). The combined strategy yields a 60% detection rate (13/22) of the affected pregnancies and without any increase in the false-positive results. This can be achieved immediately following the first part of the integrated DS test. This model obviates the ethical, clinical, and financial implications of further assessing about 60% of the affected pregnancies.     

Parenting style and smoking-specific parenting practices as predictors of adolescent smoking onset

OBJECTIVE: To test whether parenting style and smoking-specific parenting practices prospectively predicted adolescent smoking. METHODS: Three hundred eighty-two adolescents (age 10-17 years, initial nonsmokers, 98% non-Hispanic whites) and their parents were interviewed, with smoking also assessed 1-2 years later. RESULTS: Adolescents from disengaged families (low acceptance and low behavioral control) were most likely to initiate smoking. Adolescents' reports of parents' smoking-related discussion was related to lowered smoking risk for adolescents with nonsmoking parents, but unrelated to smoking onset for adolescents with smoking parents. Smoking-specific parenting practices did not account for the effects of general parenting styles. CONCLUSIONS: Both parenting style and smoking-specific parenting practices have unique effects on adolescent smoking, although effects were largely confined to adolescents' reports; and for smoking-specific parenting practices, effects were confined to families with nonsmoking parents. Interventions that focus only on smoking-specific parenting practices may be insufficient to deter adolescent smoking.     

Cultural diversity in the predictors of adolescent cigarette smoking: The relative influence of peers

A culturally diverse sample of 4375 adolescents completed a self-report inventory assessing their current amount of smoking, and several psychosocial predictors of smoking (e.g., depression, anger, stress, smoking among peers, etc). Results revealed that Whites smoke more than Blacks, Asians, and less acculturated Latinos but not more than highly acculturated Latinos. Stepwise regression analyses of the predictors of smoking found significant ethnic and acculturation differences in the relative predictive power of 18 well-known risk factors. Smoking among peers was the best predictor of smoking for White adolescents (accounting for 23.5% of the variance) but accounted for only 15% of the variance for Latino youth, 9.6% of the variance for Asian youth, and none of the variance for Black youth. Results are discussed in terms of their implications for smoking prevention programs that focus on resisting peer influences.This research was supported by NIDA Grant R01DA6307 to Brian Flay.     

Electronic health record acceptance by physicians: Testing an integrated theoretical model

ObjectiveSeveral countries are in the process of implementing an Electronic Health Record (EHR), but limited physicians’ acceptance of this technology presents a serious threat to its successful implementation. The aim of this study was to identify the main determinants of physician acceptance of EHR in a sample of general practitioners and specialists of the Province of Quebec (Canada).MethodsWe sent an electronic questionnaire to physician members of the Quebec Medical Association. We tested four theoretical models (Technology acceptance model (TAM), Extended TAM, Psychosocial Model, and Integrated Model) using path analysis and multiple linear regression analysis in order to identify the main determinants of physicians’ intention to use the EHR. We evaluated the modifying effect of sociodemographic characteristics using multi-group analysis of structural weights invariance.ResultsA total of 157 questionnaires were returned. The four models performed well and explained between 44% and 55% of the variance in physicians’ intention to use the EHR. The Integrated model performed the best and showed that perceived ease of use, professional norm, social norm, and demonstrability of the results are the strongest predictors of physicians’ intention to use the EHR. Age, gender, previous experience and specialty modified the association between those determinants and intention.ConclusionsThe proposed integrated theoretical model is useful in identifying which factors could motivate physicians from different backgrounds to use the EHR. Physicians who perceive the EHR to be easy to use, coherent with their professional norms, supported by their peers and patients, and able to demonstrate tangible results are more likely to accept this technology. Age, gender, specialty and experience should also be taken into account when developing EHR implementation strategies targeting physicians.     

Determinants of functioning and well-being among individuals with schizophrenia: an integrated model

Outcomes for health conditions are typically the result of multiple factors; however, studies tend to focus on a narrow class of variables. Functioning and well-being outcomes for schizophrenia are diverse and have resisted simple explanation; however, prior research has not offered an integrated understanding of the relative contributions of enduring and episodic environmental factors, personal resources and psychiatric factors, and cognitive appraisal and coping, on functioning and well-being outcomes in schizophrenia. The present article sets out an integrated model of the determinants of functioning and well-being among individuals with schizophrenia. To examine evidence that bears on the model, literature on hypothesized relationships is reviewed to identify areas for which there is strong evidence and areas where more research is needed. The article suggests areas for further research, and directs researchers and practitioners toward areas of intervention that can enhance functioning and well-being for persons diagnosed with schizophrenia.